citric acid/sodium citrate

Citric acid/sodium bicarbonate is a combination antacid tablet medication used for the temporary relief of upset stomach, including sour stomach, heartburn, and acid indigestion.

Both citric acid and sodium bicarbonate react with the hydrochloric acid in the stomach and neutralize it, increasing the pH level and alkalinity of the stomach. Citric acid/sodium bicarbonate is available over the counter (OTC) as effervescent tablets that can be dissolved in water and swallowed.

Citric acid reacts with hydrochloric acid in the stomach to form sodium citrate which neutralizes the acid. Sodium and bicarbonate separate in the stomach and bicarbonate reacts with hydrogen ions to form water and carbon dioxide, thus also neutralizing the hydrochloric acid. Both citric acid and sodium bicarbonate can neutralize the acid that is already present in the stomach but has no effects on the acid-producing capacity of the stomach.

• Do not use citric acid/sodium bicarbonate in patients with hypersensitivity to any of the components in the formulation.
• Use with caution if you are on a sodium-restricted diet.
• Citric acid/sodium bicarbonate tablet contains phenylalanine, an amino acid. Use with caution if you have phenylketonuria, a disorder with inability to breakdown phenylalanine.
• Citric acid/sodium bicarbonate alters the pH in the stomach which may affect the absorption of other drugs if taken concurrently.

Side effects of citric acid/sodium bicarbonate include:

• Gas (flatulence)
• Abdominal bloating
• Nausea
• Vomiting
• Diarrhea
• Fluid retention
• Excessive alkalinity of body fluids (alkalosis)

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Citric Acid/Sodium Bicarbonate

Effervescent Tablet

1000 mg/1940 mg

Indigestion/Heartburn

Adults:

• Dissolve 2 tablets in water and drink effervescent solution every 4 hours as needed
• Not to exceed 8 tablets/24 hours

Geriatric:

• Dissolve 2 tablets in water and drink the effervescent solution every 4 hours as needed
• Adults over 60 years: Not to exceed 4 tablets/24 hours

Pediatric:

Children below 12 years

• Safety and efficacy not established

Children 12 years and above

• Dissolve 2 tablets in water and drink effervescent solution every 4 hours as needed
• Not to exceed 8 tablets/24 hours

Administration

• Fully dissolve tablets in 4 oz of water before drinking

Overdose

• Citric acid/sodium bicarbonate overdose can increase the pH and alkalinity of body fluids and lead to alkalosis. Overdose may be treated with acidifying agents and symptomatic and supportive care.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Citric acid/sodium bicarbonate has no listed severe interactions with other drugs.
• Serious interactions of citric acid/sodium bicarbonate include:
  • atazanavir
  • baloxavir marboxil
  • infigratinib
  • pazopanib
  • ponatinib
  • sotorasib
• Moderate interactions of citric acid/sodium bicarbonate include:
  • budesonide
  • dabrafenib
  • ledipasvir/sofosbuvir
  • nilotinib
  • omadacycline
  • pexidartinib
  • riociguat
  • sarecycline
  • sofosbuvir/velpatasvir
• Citric acid/sodium bicarbonate has no listed mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Citric acid/sodium bicarbonate should be used during pregnancy only if potential benefits outweigh possible risks to the fetus.
• It is not known if citric acid/sodium bicarbonate is present in breast milk. Consult with your physician before use, if you are breastfeeding.
• Never take any OTC drugs including citric acid/sodium bicarbonate without first checking with your healthcare provider, if you are pregnant or breastfeeding.

• Take citric acid/sodium bicarbonate exactly as prescribed, or as per label directions if self-medication with OTC drug.
• Discontinue use and seek medical help if you find no relief for heartburn after using maximum dosage of citric acid/sodium bicarbonate for 2 weeks.
• Store safely out of reach of children.
• In case of overdose, seek medical help or contact Poison Control.