rewarding [2:<5% of an oral dose is excreted in the urine unchanged. 104 105 108 109 a Stability Storage Oral Solution Potassium citrate and citric acid oral solutions (e.g., Cytra-K): Tight, light-resistant containers at 20 25 C; protect from excessive heat or freezing. 107 111 Potassium citrate and citric acid for oral solution (Cytra-K Crystals): Protect from excessive heat or freezing. 108 Sodium citrate and citric acid oral solution (Oracit ): Well-closed containers at 15 30 C. 104 Sodium citrate and citric acid oral solution (Cytra-2): Tight, light-resistant containers at 20 25 C; protect from freezing. 105 Sodium citrate and citric acid oral solution (Bicitra ): Tight containers; protect from freezing or excessive heat. 109 Tricitrates oral solution (e.g., Cytra-3): Tight, light-resistant containers at 20 25 C; protect from excessive heat or freezing. 106 112 Compatibility For information on systemic interactions resulting from concomitant use, see Interactions. Oral Solution May use sodium citrate and citric acid as a buffer to maintain an approximate pH in various extemporaneous formulations. a In general, the addition of the following concentration of the drugs should produce a solution buffered to the approximate pH listed: Adapted from Schumacher GE. Buffer formulations. Am J Hosp Pharm . 1966; 23:628-9. Citrate Buffer pH Citric Acid Monohydrate g/L Sodium Citrate Dihydrate g/L 2.5 64.4 7.8 3.0 57.4 17.6 3.5 47.6 31.4 4.0 40.6 41.2 4.5 30.8 54.9 5.0 19.6 70.6 5.5 9.8 84.3 6.0 4.2 92.1 6.5 1.8 95.6 Actions Potassium citrate is absorbed and then appears to be metabolized to potassium bicarbonate, resulting in systemic alkalinization. 108 111 Sodium citrate is absorbed and then appears to be metabolized to sodium bicarbonate, resulting in systemic alkalinization. 105 109 Sodium citrate has anticoagulant activity; a prevents the clotting of blood by forming an undissociated calcium citrate complex, making calcium unavailable to the clotting mechanism. a Anticoagulant sodium citrate solution, when added to blood, prevents the clotting of blood and the crenation or swelling of cells. a Sterile solution is used as an anticoagulant for banked blood for transfusion and to prepare citrated human plasma and blood for fractionation. a Sodium citrate prevents the curdling of milk by rennin; has been used to alter cow s milk so that large hard curds are not formed in the stomach of feeding infants. a Advice to Patients Importance of following instructions for dosage preparation, including reconstitution and/or dilution recommendations. 104 105 106 107 108 109 (See Oral Administration under Dosage and Administration.) Importance of taking drugs only as prescribed, unless otherwise instructed by a clinician. 105 106 107 109 111 Importance of taking doses after meals to avoid saline laxative effect. 104 105 106 107 108 109 111 112 Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed. 104 105 106 107 108 109 Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. 105 106 107 108 109 Importance of informing patients of other important precautionary information. 104 105 106 107 108 109 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Potassium Citrate and Citric Acid Routes Dosage Forms Strengths Brand Names Manufacturer Oral For solution Potassium Citrate Monohydrate 3300 mg and Citric Acid Monohydrate 1002 mg per packet Cytra-K Crystals Cypress Solution Potassium Citrate Monohydrate 1100 mg/5 mL and Citric Acid Monohydrate 334 mg/5 mL* Cytra-K Cypress Potassium Citrate Monohydrate and Citric Acid Monohydrate Solution Sodium Citrate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder Sodium Citrate and Citric Acid Routes Dosage Forms Strengths Brand Names Manufacturer Oral Solution (Shohl s Solution) Hydrous Sodium Citrate 490 mg/5 mL and Citric Acid 640 mg/5 mL Oracit Carolina Medical Sodium Citrate Dihydrate 500 mg/5 mL and Citric Acid Monohydrate 334 mg/5 mL Bicitra Ortho-McNeil Cytra-2 Cypress * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Tricitrates Routes Dosage Forms Strengths Brand Names Manufacturer Oral Solution Citric Acid Monohydrate 334 mg/5 mL, Potassium Citrate Monohydrate 550 mg/5 mL, and Sodium Citrate Dihydrate 500 mg/5 mL* Cytra-3 Syrup Cypress Citric Acid Monohydrate, Potassium Citrate Monohydrate, and Sodium Citrate Dihydrate Solution AHFS DI Essentials. Copyright 2017, Selected Revisions April 1, 2009. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References Only references cited for selected revisions after 1984 are available electronically. 100. Alza Pharmaceuticals. Polycitra -K (potassium citrate and citric acid for oral solution) crystals prescribing information. Mountain View, CA; Feb 2000. From the Alza website () 101. Alza Pharmaceuticals. Polycitra -K (potassium citrate and citric acid) oral solution prescribing information. Mountain View, CA; Apr 1998. From the Alza website () 102. Alza Pharmaceuticals. Bicitra (potassium citrate and citric acid) oral solution prescribing information. Mountain View, CA; Apr 1998. From the Alza website () 103. Alza Pharmaceuticals. Polycitra -LC and syrup (tricitrates) oral solution prescribing information. Mountain View, CA; Apr 1998. From the Alza website () 104. Carolina Medical Products. ORACIT oral citrate (Shohl s) solution prescribing information. Farmville, NC; 1986 May. 105. Cypress Pharmaceuticals. Cytra-2 (sodium citrate and citric acid) oral solution prescribing information.Madison, MS; 2006 Mar. 106. Cypress Pharmaceuticals. Cytra-3 (potassium citrate, sodium citrate, and citric acid) oral syrup prescribing information.Madison, MS; 1998 Jul. 107. Cypress Pharmaceuticals. Cytra-K Oral Solution (potassium citrate and citric acid) prescribing information. Madison, MS; 1998 Jun. 108. Cypress Pharmaceuticals. Cytra-K Crystals (potassium citrate and citric acid for oral solution) prescribing information. Madison, MS; 1997 Dec. 109. Ortho-McNeil Pharmaceutical. Bicitra (sodium citrate and citric acid) oral solution prescribing information. Raritan, NJ; 2005 Mar. 110. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. Lippincott Williams & Wilkins: Philadelphia, PA; 2008. 111. Pai Pharmaceutical Associates. Potassium citrate and citric acid oral solution prescribing information. Greenville, SC; 2000 Jun. 112. Pai Pharmaceutical Associates. Potassium citrate, sodium citrate, and citric acid oral solution prescribing information. Greenville, SC; 1999 Dec. 113. Rudy D, Sica DA, Comstock T et al. Aluminum-citrate interaction in end-stage renal disease. Int J Artif Organs . 1991; 14:625-9. [PubMed 1748529] 114. KDOQI, National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis . 2005; 46(4 Suppl 1):S1-21. Available at . Accessed 2008 Jun 13. 115. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med . 1990; 150:2037-9. [PubMed 2171446] 116. Tatro DS, ed. Drug interaction facts. St. Louis: Wolters Kluwer Health; 2008 (Apr):202he, 313b, 470, 579, 580, 608, 620b, 672, 684a. a. AHFS Drug Information 2008. McEvoy GK, ed. Citrate Salts. Bethesda, MD: American Society of Health-System Pharmacists; 2008: 2710-11. Print this page> ] FEATURED: CAR-T Cell Therapy Overview Mechanism of Action KTE-C19 Studies KTE-C19 Cancer Targets Adverse Events Manufacturing Recently Approved Lonhala Magnair Lonhala Magnair (glycopyrrolate) is a long-acting muscarinic antagonist (LAMA) bronchodilator for... Ozempic Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) analog administered once-weekly for the... Ogivri Ogivri (trastuzumab-dkst) is a HER2 / neu receptor antagonist biosimilar to Herceptin indicated for... Sublocade Sublocade (buprenorphine) is a once-monthly injectable partial opioid agonist formulation for the... More official
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