Di Sodium Hydrogen Citrate
Synonym :
Citric acid
Mechanism :
Sodium citrate is metabolized to bicarbonates, which increase urinary pH by increasing the excretion of free bicarbonate ions, without producing systemic alkalosis when administered in recommended doses. A rise in urinary pH increases the solubility of cystine in the urine and the ionization of uric acid to more soluble urate ion. By maintaining an alkaline urine, the actual dissolution of uric acid stones may be accomplished.
Indication :
- (Each tablet: 1000 mg citric acid, or Syrup 1.35 gm/5 ml) Alkalinize urine
Contraindications :
Where Na salt is contraindicated like HTN & oedema, hyperosmolar states.
Dosing :
>12 years:
2 tab PO every 6 hours or 5 ml dissolved in water 2-3 times/day.
Adverse Effect :
Stomach cramps & flatulence, anxiety, GI ulceration, diarrhea, hypokalemia, metabolic alkalosis, dyspnea, tiredness, mood swings.
Interaction :
Quinidine, Amphetamines, Ephedrine & Pseudoephedrine: May increase T ½ of basic drugs like quinidine, amphetamines, ephedrine & pseudoephedrine.
Methotrexate: Reduces nephrotoxicity caused by methotrexate.
Salicylates & Barbiturates: Enhances elimination of salicylates & barbiturates.
Corticosteroids: Additive effect with Na retention caused by corticosteroids.
Tetracyclines: Potentiates renal excretion of tetracyclines.
Potassium-Depleting Diuretics: Hypochloraemia alkalosis may occur if used in conjunction with potassium- depleting diuretics.
Hepatic Dose :
Use with caution in patients with liver disease. There are no specific dosage adjustments provided in patients with hepatic impairment in the manufacturer’s label.