Version May 2024
Alkalinizer, bicarbonate precursor: Oral:
Mild to moderate hypocitraturia (>150 mg/day urinary citrate): Initial: 15 mEq 2 times daily or 10 mEq 3 times daily; maximum dose: 100 mEq/day.
Severe hypocitraturia (<150 mg/day urinary citrate): Initial: 30 mEq 2 times daily or 20 mEq 3 times daily; maximum dose: 100 mEq/day.
Hypokalemia (mild to moderate), treatment (alternative agent) (off-label use):
Note: All doses in this monograph are expressed as mEq of potassium (1 mEq = 1 mmol potassium). Typically, potassium chloride is preferred because it corrects serum potassium more quickly than other salts and hypochloremia may develop with potassium citrate use (Asmar 2012; Cohn 2000). Consider use in patients with hypokalemia accompanied by metabolic acidosis (eg, due to diarrhea or renal tubular acidosis). Individualize dosing based on serum potassium levels and clinical factors (eg, underlying cause, presence of symptoms, concomitant medications, ongoing potassium losses). Concurrent hypomagnesemia requires correction to facilitate potassium repletion (Clase 2020; Kraft 2005). General guidance is provided below; refer to institutional protocols.
Mild to moderate (serum potassium 3 to 3.4 mEq/L): Oral: Initial: 10 to 20 mEq 2 to 4 times daily; base subsequent dosing on electrolyte monitoring (eg, serum potassium, sodium, chloride, carbon dioxide concentrations [manufacturer’s labeling]) and clinical factors (Asmar 2012; Cohn 2000; Kraft 2005; Mount 2022).
Use is contraindicated in patients with renal insufficiency (GFR <0.7 mL/kg/minute) or chronic renal failure.
No dosage adjustment provided in manufacturer's labeling.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Endocrine & metabolic: Hyperkalemia
Gastrointestinal: Abdominal distress, diarrhea, nausea, vomiting
Renal insufficiency (GFR <0.7 mL/kg/minute); patients with hyperkalemia or with conditions predisposing to hyperkalemia (eg, chronic renal failure, acute dehydration, adrenal insufficiency, uncontrolled diabetes mellitus, tissue breakdown, strenuous physical exercise in unconditioned individuals); patients with delayed gastric emptying, esophageal compression, or intestinal obstruction or stricture; patients with active urinary tract infection; peptic ulcer disease
Concerns related to adverse effects:
• GI effects: May cause GI upset (eg, nausea, vomiting, diarrhea, abdominal pain, discomfort) and lead to GI ulceration, bleeding, perforation and/or obstruction; discontinue use and evaluate for possible bowel perforation or obstruction if severe GI effects occur.
• Hyperkalemia: Close monitoring of serum potassium concentrations is needed to avoid hyperkalemia; severe hyperkalemia may lead to muscle weakness/paralysis and cardiac conduction abnormalities (eg, heart block, ventricular arrhythmias, asystole).
Disease-related concerns:
• Acid/base disorders: Use with caution in patients with acid/base alterations; changes in serum potassium concentrations can occur during acid/base correction, monitor closely.
• Cardiovascular disease: Use with caution in patients with cardiovascular disease (eg, heart failure, cardiac arrhythmias); patients may be more susceptible to life-threatening cardiac effects associated with hyper/hypokalemia.
• Hepatic impairment: Citrate is converted to bicarbonate in the liver; this conversion may be blocked in patients in hepatic failure.
• Potassium-altering conditions/disorders: Use with caution in patients with disorders or conditions likely to contribute to altered serum potassium and hyperkalemia (eg, untreated Addison's disease, heat cramps, severe tissue breakdown from trauma or burns).
• Renal impairment: Use with caution in patients with renal impairment; monitor serum potassium concentrations closely. Contraindicated with severe impairment.
• Severely ill: Citrate is converted to bicarbonate in the liver; this conversion may be blocked in patients who are severely ill or in shock.
Concurrent drug therapy issues:
• Digitalis: Use with caution in digitalized patients; may be more susceptible to potentially life-threatening cardiac effects with rapid changes in serum potassium concentrations.
Each tablet contains 5, 10, or 15 mEq potassium and delivers approximately 5, 10, or 15 mEq bicarbonate.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet Extended Release, Oral:
Urocit-K 5: 5 mEq (540 mg)
Urocit-K 10: 10 mEq (1080 mg)
Urocit-K 15: 15 mEq (1620 mg)
Generic: 5 mEq (540 mg), 10 mEq (1080 mg), 15 mEq (1620 mg)
Yes
Tablet, controlled release (Potassium Citrate ER Oral)
5 MEQ (540 MG) (per each): $0.31 - $1.97
10 MEQ (1080 MG) (per each): $0.69 - $2.76
15 MEQ (1620 mg) (per each): $1.43 - $4.15
Tablet, controlled release (Urocit-K 10 Oral)
10 MEQ (1080 MG) (per each): $2.57
Tablet, controlled release (Urocit-K 15 Oral)
15 MEQ (1620 mg) (per each): $4.37
Tablet, controlled release (Urocit-K 5 Oral)
5 MEQ (540 MG) (per each): $1.83
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet, Oral:
Urocit-K: 540 mg
Tablet Extended Release, Oral:
Urocit-K: 10 mEq (1080 mg)
Oral:
Administer with meals or bedtime snack (or within 30 minutes after). Swallow tablets whole with a full glass of water.
Bariatric surgery: Tablet, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. ER tablet should be swallowed whole. Do not crush, chew, or suck on tablet. Take when upright or in sitting position. No alternative formulations are available for citrate formulation. Potassium is a known GI irritant. Minimum necessary dose and duration of potassium therapy is recommended to minimize risk of GI irritation or ulceration. Proton pump inhibitor therapy is recommended if therapy is to continue chronically.
Kidney stones: For the management of renal tubular acidosis with calcium stones, hypocitraturic calcium oxalate nephrolithiasis of any etiology, and uric acid lithiasis with or without calcium stones.
Hypokalemia (mild to moderate), treatment (alternative agent)
Urocit-K may be confused with Urised
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Risk C: Monitor therapy
Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Risk C: Monitor therapy
Aluminum Hydroxide: Citric Acid Derivatives may increase the absorption of Aluminum Hydroxide. Risk C: Monitor therapy
Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Risk C: Monitor therapy
AMILoride: Potassium Salts may enhance the hyperkalemic effect of AMILoride. Management: Amiloride and potassium supplements should not be used except in severe or refractory cases of hypokalemia. If coadministered, monitor serum potassium closely as rapid increases in potassium are possible. Risk D: Consider therapy modification
Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Risk D: Consider therapy modification
Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Risk C: Monitor therapy
Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Risk C: Monitor therapy
Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Citrate. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium citrate. Risk X: Avoid combination
Drospirenone-Containing Products: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Potassium supplements may be needed to treat/prevent hypokalemia in select patients with heart failure receiving eplerenone and high dose loop diuretics. Risk D: Consider therapy modification
Finerenone: Potassium Salts may enhance the hyperkalemic effect of Finerenone. Risk C: Monitor therapy
Flecainide: Alkalinizing Agents may decrease the excretion of Flecainide. Risk C: Monitor therapy
Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Risk C: Monitor therapy
Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Risk C: Monitor therapy
Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents: May enhance the hyperkalemic effect of Potassium Salts. Risk C: Monitor therapy
QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Risk C: Monitor therapy
Spironolactone: Potassium Salts may enhance the hyperkalemic effect of Spironolactone. Risk X: Avoid combination
Triamterene: Potassium Salts may enhance the hyperkalemic effect of Triamterene. Risk X: Avoid combination
Animal reproduction studies have not been conducted.
Potassium is excreted into breast milk. The normal potassium ion content of human milk is ~13 mEq/L. It is not known if this product may affect normal concentrations.
Ensure adequate fluid intake; limit salt intake. Take with meals or snack.
Serum electrolytes (potassium, chloride, sodium), bicarbonate, serum creatinine, and CBC every 4 months (more frequently with cardiac/renal disease or acidosis); urinary citrate and/or urinary pH at initiation or dose change and every 4 months; ECG (periodically)
Note: Reference ranges may vary depending on the laboratory
Urinary pH: 4.6-8.0
Metabolism: Hepatic to bicarbonate
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