citric acid/sodium citrate (Bicitra, Cytra-2, Oracit, Shohl's)

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GENERIC NAME: Sodium citrate dihydrate and citric acid monohydrate

BRAND NAME: Cytra-2

DRUG CLASS AND MECHANISM: Sodium citrate/citric acid is used to make urine less acidic and therefore prevent formation of kidney stones. Sodium citrate/citric acid also is useful as a buffer and neutralizing agent for gastric acid. Sodium citrate is broken down to sodium bicarbonate which decreases the acidity of urine, increasing the excretion of substances that cause kidney stones.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS: Sodium citrate/citric acid oral solution contains 500 mg of sodium citrate dihydrate and 334 mg of citric acid monohydrate per 5 ml, available in 16 fluid ounce bottles. Sodium citrate/citric acid is grape flavored and sugar free liquid.

STORAGE: Store sodium citrate/citric acid solution at room temperature between 20 C and 25 C (68 F and 77 F). Keep container tightly closed. Keep from excessive heat or freezing.

PRESCRIBED FOR: Sodium citrate/citric acid is used for reducing the acidity of urine in patients with poor kidney function, prevention of kidney stones, and to neutralize gastric acid in stomach.

DOSING:

Systemic alkalization:

  • Adult: Take 2 to 6 teaspoons (10 to 30 ml) of liquid diluted in 1 to 3 ounces (30 to 90 ml) of water after meals and at bedtime, or as directed by doctor.
  • Pediatric: Take 1 to 3 teaspoons (5 to 15 ml) of liquid diluted in 1 to 3 ounces (30 to 90 ml) of water after meals and at bedtime, or as directed by doctor.

Neutralizing buffer: Take 3 teaspoons (15 ml), diluted in 15 ml of water, taken as single dose or as directed by doctor.

Safe and effective use of sodium citrate/citric acid is not established for children under two years of age.

DRUG INTERACTIONS: Sodium citrate/citric reduces stomach acidity, which reduces the absorption and may decrease the effectiveness atazanavir (Reyataz), ritonavir (Norvir), and indinavir (Crixivan), antibiotics like ciprofloxacin (Cipro), moxifloxacin (Avelox), doxycycline (Vibramycin), tetracycline (Tetracon), and antifungals like ketoconazole (Nizoral) and itraconazole (Sporanox).

Sodium citrate/citric acid reduces stomach acidity, which can lead to increased digoxin (Lanoxin) absorption and possible digoxin side effects like dizziness, headache, nausea, diarrhea, irregular heart rate and rhythm, and visual disturbances.

PREGNANCY: There are no adequate studies done on sodium citrate/citric acid to determine safe and effective use in pregnant women.

NURSING MOTHERS: It is not known whether sodium citrate/citric acid enters breast milk; therefore, it is best to be cautious before using it in nursing mothers.

SIDE EFFECTS: Common side effects of sodium citrate/citric acid are nausea, vomiting, diarrhea, stomach pain, and water retention.

It should not be used in patients with kidney failure.

REFERENCE: FDA Prescribing Information.


Medically Reviewed by a Doctor on 8/14/2014



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