Veterinary Drug Handbook (VDH) is the reference veterinarians turn to when they want an independent source of information on the drugs that are used in veterinary medicine today.

CITRATE SALTS, POTASSIUM CITRATE, SODIUM CITRATE & CITRIC ACID

Chemistry - Generally used as alkalinizing agents, citric acid and citrate salts are available inseveral commercially available dosage forms. Citric acid occurs as an odorless or practicallyodorless, colorless, translucent crystal with a strong acidic taste. It is very soluble in water.
Potassium citrate occurs as odorless, transparent crystals or a white, granular powder having acooling, saline taste. It is freely soluble in water. Sodium citrate occurs as colorless crystals or awhite, granular powder. The hydrous form is freely soluble in water. Sodium citrate and citric acidsolutions may also be known as Shohl's solution.

Storage, Stability, Compatibility

Store solutions and potassium citrate tablets in tight containers at room temperature unless otherwise recommended by manufacturer.

Pharmacology - CITRATE SALTS, POTASSIUM CITRATE, SODIUM CITRATE & CITRIC ACID

Citrate salts are oxidized in the body to bicarbonate, thereby acting as alkalinizingagents. The citric acid component of multi-component products is converted only to carbon dioxideand water and thus, has only a temporary effect on systemic acid-base status.
Uses, Indications - Citrate salts serve as source of bicarbonate; they are more pleasant tasting thanbicarbonate preparations making them more palatable. They are used as urinary alkalinizers whenan alkaline urine is desirable and in the management of chronic metabolic acidosis accompaniedwith conditions such as renal tubular acidosis or chronic renal insufficiency. Potassium citrate alone(Uracit-K®) has been used for the prevention of calcium oxalate uroliths. The citrate can complexwith calcium thereby decreasing urinary concentrations of calcium oxalate. The urinary alkalinizingeffects of the citrate also increase the solubility of calcium oxalate.

Pharmacokinetics - CITRATE SALTS, POTASSIUM CITRATE, SODIUM CITRATE & CITRIC ACID

Absorption and oxidation are nearly complete after oral administration; lessthan 5% of a dose is excreted unchanged.

Contraindications, Precautions, Reproductive Safety

Contraindications for products containing sodium citrate and/or potassium citrate: aluminum toxicity, heart failure, severe renal impairment(with azotemia or oliguria), UTI associated with calcium or struvite stones. Additionalcontraindications for potassium citrate alone include hyperkalemia (or conditions that predispose tohyperkalemia such as adrenal insufficiency, acute dehydration, renal failure, uncontrolled diabetesmellitus), peptic ulcer (particularly with the tablets). The potassium citrate tablets are alsocontraindicated in patients with delayed gastric emptying conditions, esophageal compression, orintestinal obstruction or stricture. These products should be used with caution (weigh risks vs.benefit) in severe renal tubular acidosis or chronic diarrheal syndromes as they may be ineffective.
Sodium citrate products should be used with caution in patients with congestive heart disease.
In dosages not resulting in hypernatremia, hyperkalemia or metabolic alkalosis, these productsshould not cause fetal harm.

Adverse Effects, Warnings

The primary adverse effects noted with these agents are gastrointestinal in nature, however, most dogs receiving these products tolerate them well. Potassium citrate products have the potential of causing hyperkalemia, especially in susceptible patients. Sodiumcitrate products may lead to increased fluid retention in patients with cardiac disease. Rarely, metabolic alkalosis could occur.
Overdosage, Acute Toxicity - Overdosage and acute toxicity would generally fall into 4 categories: gastrointestinal distress and ulceration, metabolic alkalosis, hypernatremia (sodium citrate)or hyperkalemia (potassium citrate). Should an overdose occur and there are reasonable expectations of preventing absorption (especially with the tablets), gut emptying protocols should beemployed if not contraindicated. Otherwise treat GI effects if necessary with intravenous fluids orother supportive care. Hyperkalemia, hypernatremia and metabolic alkalosis should be treated ifwarranted. It is suggested to refer to a veterinary poison center, an internal medicine text or otherreferences for additional information for specific treatment modalities for these conditions.

Drug Interactions

Concurrent use with methenamine is not recommended as it requires anacidic urine for efficacy. Citrate alkalinizers used with antacids (particularly those containingbicarbonate or aluminum salts) may cause systemic alkalosis, and aluminum toxicity (aluminumantacids only) particularly in patients with renal insufficiency. Sodium citrate combined withsodium bicarbonate may cause hypernatremia, and may cause the development of calcium stones inpatients with preexisting uric acid stones. When urine is alkalinized by citrate solutions, excretionof certain drugs (e.g., quinidine, amphetamines, ephedrine, salicylates, tetracycline) isdecreased, and excretion of weakly acidic drugs (e.g., salicylates) is increased.
The solubility of ciprofloxacin & enrofloxacin is decreased in an alkaline environment. Patientswith alkaline urine should be monitored for signs of crystalluria.
With potassium citrate products, the following agents may lead to increases in serum potassiumlevels (including severe hyperkalemia), particularly in patients with renal insufficiency:
Nonsteroidal antiinflammatory drugs, captopril, enalapril, lisinopril, cyclosporine, digitalis glycosides, potassium-sparing diuretics (e.g., spironolactone), potassium-containing drugs, heparin, and salt substitutes.
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