Potassium citrate is a potassium salt of citric acid that works by making the urine less acidic. Once absorbed, it is metabolized to bicarbonate, which increases urinary pH and boosts urinary citrate levels. These changes help reduce the risk of stone formation in the urinary tract and correct certain imbalances in the body.
This medicine has been used for many years to prevent kidney stones and to treat conditions that cause the urine to become too acidic. Its effectiveness has been confirmed in several clinical studies, and it is included in international treatment guidelines.
In addition to kidney health, research suggests that potassium citrate may also have benefits for bone health and may reduce the recurrence of stones after certain surgical treatments. However, its main approved uses remain linked to urinary and metabolic conditions.
Indications
Potassium citrate is prescribed for conditions that affect the kidneys and urinary tract, as well as for certain metabolic problems. It works by raising citrate levels in the urine and reducing acidity, which helps prevent the buildup of stones and corrects chemical imbalances in the body.
The main indications include:
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Prevention and treatment of calcium oxalate kidney stones when citrate levels are low
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Management of uric acid stones, with or without calcium stones
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Mixed calcium stones in people with low urinary citrate
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Treatment of distal (type 1) renal tubular acidosis in adults and children over one year old
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Correction of metabolic acidosis and prevention of nephrocalcinosis
Overall, potassium citrate is most often used to prevent stones from forming or coming back in people at risk.
How to take and dosing
The dose of potassium citrate depends on age, health condition, and the level of citrate in the urine. Adults with kidney stones may be prescribed between 30 and 60 mEq per day, usually divided into two or three smaller doses. In some cases, the dose may be increased, but it typically does not go above 100 mEq per day.
For children with renal tubular acidosis, dosing is based on weight and age. Younger children may start with higher amounts per kilogram of body weight, while adolescents require less. The goal is usually between 3 and 4 mEq per kilogram each day.
Potassium citrate is best taken with meals or within 30 minutes after eating, and the tablets should be swallowed with plenty of water. Treatment is usually adjusted over time depending on lab results and how well it is tolerated.
Side effects and contraindications
Like any medicine, potassium citrate can cause unwanted effects. The most common ones are stomach discomfort, nausea, vomiting, or diarrhea. These are usually mild and improve within a few days.
More serious side effects include high levels of potassium in the blood, which can cause weakness, irregular heartbeat, or chest pain. In rare cases, it can also cause stomach or intestinal bleeding. Anyone who develops these symptoms should seek medical care immediately.
Potassium citrate should not be used in people with high blood potassium, severe kidney problems, uncontrolled diabetes, dehydration, adrenal problems, stomach ulcers, or intestinal blockage. It should also be avoided in people taking certain medicines such as potassium-sparing diuretics, ACE inhibitors, or ARBs, since these increase the risk of high potassium.
Extra care is needed in pregnancy and breastfeeding, where use is recommended only if clearly necessary. Older adults and people with kidney impairment should start at lower doses and be monitored closely