Uses

This medication is used to make the urine less acidic. This effect helps the kidneys get rid of uric acid, thereby helping to prevent gout and kidney stones. This medication can also prevent and treat certain metabolic problems (acidosis) caused by kidney disease.

Citric acid and citrate salts (which contain potassium and sodium) belong to a class of drugs known as urinary alkalinizers. If you have a condition that requires you to limit your intake of potassium and sodium, your doctor may direct you to take a product that is lower in potassium and sodium.

How To Use

Take this medication by mouth as directed by your doctor. Follow your doctor's directions carefully. This medication should be taken with meals or a bedtime snack.

Swallow this medication with a full glass of water or other liquid (8 ounces or 240 milliliters) unless your doctor directs you otherwise. Swallow the tablets whole. Do not crush or chew the tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Do not lie down for at least 10 minutes after taking this medication. Do not take this medication on an empty stomach.

Your doctor may direct you to eat a low-salt (low-sodium) diet and drink lots of fluids. Follow your doctor's directions closely. Do not use salt substitutes that contain potassium.

Dosage is based on your medical condition and response to treatment.

Take this medication exactly as prescribed. Do not increase your dose or take this more often without your doctor's approval. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

While taking this medication, you may need to test the pH (acidity) of your urine using special paper. The pH will help determine the proper dose. Consult your doctor or pharmacist for more information.

Side Effects

Nausea, vomiting, diarrhea, and stomach pain may occur. Taking it after meals will help prevent these side effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

An empty tablet shell may appear in your stool. This is harmless because your body has already absorbed the medication.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This drug may cause serious stomach or intestinal problems (such as bleeding, blockage, puncture). Tell your doctor right away if any of these serious side effects occur:

• abdominal swelling
• black/bloody stools
• constipation
• dizziness
• fast heartbeat
• severe stomach/abdominal pain
• difficult/painful swallowing
• severe vomiting
• vomit that looks like coffee grounds

This medication may cause high potassium levels in the blood (hyperkalemia). Tell your doctor right away if any of these serious side effects occur:

• muscle cramps/weakness
• severe dizziness
• slow/irregular heartbeat
• mental/mood changes (such as confusion, restlessness)
• tingling of the hands/feet
• unusually cold skin

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• a certain adrenal gland problem (Addison's disease)
• bladder infection
• diabetes
• low calcium levels
• severe diarrhea
• heart problems (such as irregular heartbeat, heart attack)
• kidney problems
• potassium-restricted diet
• high potassium levels
• stomach/intestinal problems (such as blockage, constipation, ulcers)
• dehydration

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• antacids that contain aluminum
• aspirin and other salicylates (such as salsalate)
• certain blood pressure medications (including ACE inhibitors such as lisinopril, angiotensin blockers such as losartan)
• drospirenone
• drugs that slow the movement of food/drugs through the esophagus/stomach (including anticholinergics such as belladonna/scopolamine/benztropine, antispasmodics such as glycopyrrolate/oxybutynin, strong opioid pain medicines such as morphine)
• eplerenone
• certain heart medications (such as quinidine, digoxin)
• lithium
• potassium supplements (including salt substitutes)
• pramlintide
• certain "water pills" (potassium-sparing diuretics such as amiloride, spironolactone, triamterene)

If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Alberta residents can call PADIS (Poison and Drug Information Service) 24 hours a day at 1-800-332-1414. Canada residents can call a provincial poison control center. Symptoms of overdose may include: slow heartbeat, heart attack, inability to move.

Notes

Do not share this medication with others.

Lab and/or medical tests (such as complete blood count, potassium/sodium/chloride levels, kidney function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

If you have questions about missing a dose or you don't have more medication, contact your healthcare provider or pharmacist.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.