sodium citrate

Sodium citrate is the sodium salt of citric acid used to neutralize excessive acidity (metabolic acidosis) in the body, and prevent the formation of kidney stones (nephrolithiasis). Sodium citrate increases systemic and urinary pH levels and also increases the excretion of urinary calcium, inhibiting the formation of calcium stones in the kidneys.

Citrate reacts with hydrochloric acid in the stomach and is metabolized to sodium bicarbonate which raises systemic pH levels. Kidney stones tend to form in an acidic environment, and reduction in urinary acidity prevents the crystallization of salts including calcium oxalate, calcium phosphate, and uric acid. Citrate inhibits the spontaneous nucleation of calcium oxalate and calcium phosphate, binds with urinary calcium, and increases its excretion in the urine. The higher alkalinity of urine increases the ionization of uric acid to the more soluble urate ion.

The uses of sodium citrate include:

• Metabolic acidosis and acidosis caused by certain kidney tubular disorders
• Buffer agent to neutralize gastric acidity
• Systemic alkalinizing agent
• Prevention of aspiration in patients undergoing anesthesia (off-label)

• Do not use in patients with hypersensitivity to sodium citrate, citric acid, or any component of the formulation.
• Do not use sodium citrate in the following conditions:
  • Sodium-restricted diet
  • Acute dehydration and heat cramps
  • Severe kidney impairment with low urine output (oliguria) or lack of urine production (anuria), and azotemia, a condition of elevated blood urea nitrogen (BUN) and creatinine 
  • Untreated Addison’s disease
  • Adynamia episodica hereditaria, an inherited disorder that causes periodic paralysis and an increase in blood potassium levels
  • High blood potassium levels (hyperkalemia)
  • Severe damage to the heart muscles (myocardial damage)
• Because of the sodium content in sodium citrate, use with caution in patients who have:
  • Peripheral or pulmonary edema
  • Kidney impairment
  • High blood pressure (hypertension)
  • Heart failure
• Conversion of sodium citrate to sodium bicarbonate may be impaired in patients who are severely ill, in shock, or have impaired liver function, use with caution.
• Do not use formulations that contain sodium benzoate/benzoic acid, a metabolite of benzyl alcohol in newborn babies. Large amounts of benzyl alcohol have been associated with potentially fatal toxicity (gasping syndrome) in neonates.
• Some formulations may contain propylene glycol which can be toxic in large amounts, use with caution.

Common side effects of sodium citrate/citric acid include:

• Nausea
• Vomiting
• Diarrhea
• Stomach pain
• Fluid retention
• Excessive alkalinity of body fluids (metabolic alkalosis)
• Involuntary muscle contractions (tetany)

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.

Sodium Citrate/Citric Acid (1 mEq sodium equivalent to 1 mEq bicarbonate)

Oral Solution

• (500 mg/334 mg)/5 mL
• (500 mg/300 mg)/5 mL
• (490 mg/640 mg)/5 mL

Urine Alkalinization, Prevention of Nephrolithiasis

Adult:

• 10-30 mL diluted in up to 6 oz water/juice orally after meals and at bedtime as needed
• Follow with additional water if desired

Pediatric:

• Children below 2 years: Based on physician's discretion
• Children 2 years and above: 5-15 mL diluted in 30-90 mL of water/juice orally after meals and at bedtime as needed
• Follow with additional water if desired

• Sodium citrate/citric acid overdose can increase the pH and the alkalinity of body fluids excessively and lead to alkalosis. The drug increases the excretion of urinary calcium and an overdose can cause a severe drop in calcium levels which can cause involuntary muscle contractions (tetany) and depressed heart function.
• Overdose of sodium citrate/citric acid may be treated with calcium chloride infusion and supportive care as appropriate.

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.

• Sodium citrate/citric acid has no listed severe interactions with other drugs.
• Serious interactions of sodium citrate/citric acid include:
  • atazanavir
  • dapsone
  • dasatinib
  • demeclocycline
  • digoxin
  • doxycycline
  • eltrombopag
  • fleroxacin
  • gemifloxacin
  • indinavir
  • itraconazole
  • ketoconazole
  • levofloxacin
  • levoketoconazole
  • minocycline
  • moxifloxacin
  • nimodipine
  • nisoldipine
  • nitrendipine
  • ofloxacin
  • oxytetracycline
  • tetracycline
• Sodium citrate/citric acid has moderate interactions with at least 85 different drugs.
• Mild interactions of sodium citrate/citric acid include:
  • aspirin
  • aspirin rectal
  • aspirin/citric acid/sodium bicarbonate
  • balsalazide
  • blessed thistle
  • choline magnesium trisalicylate
  • chromium
  • devil's claw
  • diflunisal
  • mesalamine
  • salicylates (non-asa)
  • salsalate
  • strontium ranelate
  • sulfasalazine
  • willow bark

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.

• Sodium citrate/citric acid should be used during pregnancy only if clearly needed and maternal benefits outweigh potential fetal risks.
• Sodium citrate/citric acid may worsen high blood pressure that can occur during pregnancy (toxemia of pregnancy), use with caution.
• It is not known if sodium citrate/citric acid is present in breast milk. Check with your healthcare provider before taking sodium citrate if you are breastfeeding.

• Take sodium citrate/citric acid exactly as prescribed.
• Dilute sodium citrate with water to minimize gastrointestinal injury and administer after meals to minimize saline laxative effect. Do not dilute in tomato juice.
• Do not take sodium citrate if you are on a sodium-restricted or no-sodium diet.
• Store safely away from the reach of children.
• In case of overdose, seek medical help or contact Poison Control.