Potassium citrate 1620 mg

Contents

Potassium Citrate

Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

Potassium citrate is used to treat a kidney stone condition called renal tubular acidosis.

Potassium citrate may also be used for other purposes other than those listed in this medication guide.

You should not use this medication if you have kidney failure, a urinary tract infection, uncontrolled diabetes, a peptic ulcer in your stomach, Addison’s disease, severe burns or other tissue injury, if you are dehydrated, if you take certain diuretics (water pills), or if you have high levels of potassium in your blood (hyperkalemia).

You should not take potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Do not crush, chew, break, or suck on an extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Sucking on a potassium tablet can irritate your mouth or throat.

Avoid lying down for at least 30 minutes after you take this medication.

Take this medication with a meal or bedtime snack, or within 30 minutes after a meal.

To be sure this medication is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Serious side effects of potassium citrate include uneven heartbeat, muscle weakness or limp feeling, severe stomach pain, and numbness or tingling in your hands, feet, or mouth.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse.

You should not use this medication if you are allergic to it, or if you have certain conditions. Be sure your doctor knows if you have:

  • high levels of potassium in your blood (hyperkalemia);
  • kidney failure;
  • a urinary tract infection;
  • untreated or uncontrolled diabetes;
  • Addison’s disease (an adrenal gland disorder);
  • a large tissue injury such as a severe burn;
  • a peptic ulcer in your stomach;
  • if you are severely dehydrated; or
  • if you are taking a “potassium-sparing” diuretic (water pill) such as amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide), triamterene (Dyrenium, Dyazide, Maxzide).

You should not take potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Before using potassium citrate, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;
  • congestive heart failure, enlarged heart, or history of heart attack;
  • other heart disease or high blood pressure;
  • diabetes;
  • a blockage in your stomach or intestines; or
  • chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

If you have any of these conditions, you may need a dose adjustment or special tests to safely take potassium citrate.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether potassium passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

This information from Lexicomp® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Urocit-K 10; Urocit-K 15; Urocit-K 5

Brand Names: Canada

Urocit-K

What is this drug used for?

  • It is used to treat kidney stones.
  • It is used to treat acid problems in the blood.

What do I need to tell my doctor BEFORE I take this drug?

  • If you are allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell your doctor about the allergy and what signs you had.
  • If you have any of these health problems: Fluid loss (dehydration), high blood sugar (diabetes), high potassium levels, kidney disease, stomach ulcers, urinary tract infection, or adrenal gland disease.
  • If you have any of these health problems: A bowel block, slow-moving GI (gastrointestinal) tract, or slow stomach clearing.
  • If you will be doing a lot of exercise and are not in shape.
  • If you are taking any of these drugs: Amiloride, eplerenone, spironolactone, or triamterene.

This is not a list of all drugs or health problems that interact with this drug.

Tell your doctor and pharmacist about all of your drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe for you to take this drug with all of your drugs and health problems. Do not start, stop, or change the dose of any drug without checking with your doctor.

What are some things I need to know or do while I take this drug?

  • Tell all of your health care providers that you take this drug. This includes your doctors, nurses, pharmacists, and dentists.
  • Have blood work checked as you have been told by the doctor. Talk with the doctor.
  • You may need to have an ECG checked before starting this drug and while taking it. Talk with your doctor.
  • Follow the diet plan that your doctor told you about.
  • You may need to lower how much salt is in your diet. If you have questions, talk with your doctor.
  • You may need to check the acid content (pH) of your urine using a dipstick test.
  • If you are taking a salt substitute that has potassium in it, a potassium-sparing diuretic, or a potassium product, talk with your doctor.
  • If the tablet gets stuck after you swallow it, you may notice chest pain or pressure. If this happens, call your doctor right away. Do not take another tablet unless told to do so by your doctor.
  • Tell your doctor if you are pregnant, plan on getting pregnant, or are breast-feeding. You will need to talk about the benefits and risks to you and the baby.

What are some side effects that I need to call my doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

  • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
  • Signs of a high potassium level like a heartbeat that does not feel normal; change in thinking clearly and with logic; feeling weak, lightheaded, or dizzy; feel like passing out; numbness or tingling; or shortness of breath.
  • Feeling very tired or weak.
  • Swelling of belly.
  • Black, tarry, or bloody stools.
  • Throwing up blood or throw up that looks like coffee grounds.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

  • Upset stomach or throwing up.
  • Stomach pain or diarrhea.
  • You may see the tablet shell in your stool. This is normal and not a cause for concern.

These are not all of the side effects that may occur. If you have questions about side effects, call your doctor. Call your doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best taken?

Use this drug as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • Take this drug with food.
  • Take with a full glass of water.
  • Swallow whole. Do not chew, break, or crush.
  • Do not suck on this product.
  • Drink lots of noncaffeine liquids unless told to drink less liquid by your doctor.
  • If you have trouble swallowing, talk with your doctor.

What do I do if I miss a dose?

  • Take a missed dose as soon as you think about it.
  • If it is close to the time for your next dose, skip the missed dose and go back to your normal time.
  • Do not take 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

  • Store at room temperature in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

General drug facts

  • If your symptoms or health problems do not get better or if they become worse, call your doctor.
  • Do not share your drugs with others and do not take anyone else’s drugs.
  • Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your doctor, nurse, pharmacist, or other health care provider.
  • If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine.

Last Reviewed Date

Copyright

WHAT IS POTASSIUM CITRATE

We have reached the point in the evolution of this site where the main stone risk factors are introduced and detailed, and the importance of citrate established. I have written about the price of potassium citrate because many patients and physicians have told me that it has risen steeply in recent months, and I would like to be of help.

A LOUD DISCLAIMER

In this post I will mention beverages and medications by name. Let me be clear: I have no financial relationships with the companies that produce or sell the products I write about here. Likewise neither I nor my colleagues at University of Chicago receive any support, financial or otherwise from these companies.

WHAT DOES CITRATE DO FOR PATIENTS?

It Can Reduce Formation of Uric Acid Stones

Some patients produce too acidic a urine which raises risk of uric acid stones, and they need supplemental alkali to make their urine less acidic. The use of potassium citrate to make urine less acidic will prevent uric acid stones in most patients who form them.

It Can Reduce Calcium Stone Formation in Patients with Low Urine Citrate

Some patients form calcium stones because they produce urine that is low in citrate, a valuable inhibitor of crystal formation. Most of the naturally occurring inhibitors in urine are complex molecules about which we can presently do nothing. But citrate is a small and easily measured molecule which we can prescribe and which will increase the urine citrate in at least some patients. Potassium citrate lowers urine calcium excretion. In so doing it reverses a key kidney stone risk factor. In trials potassium citrate reduced stone formation.

Potassium Citrate is Preferable to Sodium Citrate

I have a long list of sodium’s undesirable effects. It can raise blood pressure in large numbers of people, especially with age. It raises the amount of calcium lost in the urine, and that increase of calcium can raise supersaturation and promote calcium kidney stones. High sodium intake can reduce bone mineral retention. But, it may be that the sodium in sodium bicarbonate causes less of these problems than the sodium in sodium chloride – table salt. So I offer sodium bicarbonate as an alternative – with reservations.

Because sodium produces problems of its own, we tend to use potassium citrate as the preferred medication, and generations of stone patients have taken it. In several trials it has reduced new stone formation when given to patients whose urine is citrate deficient.

IS THERE A COST ISSUE?

I am not at all sure why the pricing of potassium citrate has become a topic I often hear about from patients, doctors, and just about everybody in the kidney stone world. Certainly the price must have increased, but I cannot find data on the web to prove the point. I also believe Medicare and perhaps other insurers have altered the status of this drug in their payment schedules. Perhaps some of you know more about the problem than I do and are willing to share what you know by way of a comment.

I did find on inspection of the Medicare lists of drug prices by insurance plan that some plans appear to include potassium citrate pills in their formularies at a preferred level and charge as little as $10 for what appears to be 90 pills. Others do not do this and publish higher prices, often as percentages of the retail cash price. Once again, I hope those of you with experiences in purchasing the drug will share what you know.

CAREFUL SHOPPING LOWERS PRICES

Listening to agitated, and worrisome stories about inflated prices for potassium citrate, I decided to try to be helpful. A Google search for prices of potassium citrate yielded a few promising shopping sites, and on study of the prices I found some much better than others. Note that in the following sections I present a lot of prices and arithmetic. Sometimes, when the message is very clear the results are rounded for simplicity. I give the basis for every calculation if you want absolute exact answers to the nearest penny. Likewise, because we are comparing prices, I have chosen 4 pills daily as my cost basis. The actual range can be from 2 to 6 pills or even more daily, so you will have to adjust costs to your own prescription.

SAM’S CLUB

GoodRx gives what I believe is the clearest list of prices. On their site, Sam’s Club was least expensive at $145 for 180 pills or $0.805 per pill. A typical 4 pills per day treatment option would therefore come to $290/quarter, which is still very pricey. The site gives a long list of other stores whose prices are even higher. Everyday health offers an approximate price for Cytra-K and Polycitra K of $50 – $99, but I could not be sure if this was for a month and likewise how much medication was in a dose.

CANADA

So far as I can tell, importing from Canada will not save you much money. I found Urocit K at $1.10 per tablet, which is higher than Sam’s Club. Another generic, K-Citra 10 was $0.79, which is about the same as Sam’s Club. Another less desirable canadian price was $0.52 per pill if you buy 90 pills, but it was for the 5 mEq size, 1/2 of the usual and therefore the corresponding price for 10 mEq would be $1.04/pill. Given that some costs must accrue for mailing, and there are issues with importing, I cannot see an advantage right now.

WHAT TO DO

Shop Well

Certainly web shopping is a good thing because in my modest and amateurish shopping efforts I found a tremendous range of prices. I am sure that many of you who read this post are far more skilled than I am at shopping for best prices. It is time for you to step forward and share your knowledge with all of us by posting a comment. Everyone will benefit and appreciate your contributions.

But even if you shop better than I did, retail pricing for this medication seems too high for most to afford. At even 4 pills a day, and at the best price I found ($290.00/quarter) we are over $1000.00 yearly for this one product. It seems to me that if your plan does not subsidize this medication, cost could be a serious issue.

Use Beverages

A useful publication reports the alkali content of commercial beverages. The ‘lemonade formula’ referred to on the graph is given as 1/2 cup ReaLemon© mixed with 7-1/2 cups of water and sweetened to taste with sugar or artificial sweetener. Diet 7-up was the winner with 10 mEq of citrate in a liter. A single Urocit K tablet contains 10 mEq of potassium citrate, as a comparison, so you would need 4 liters of the beverage daily to match 4 pills.

You Can Do Better

My colleague Dr. John Asplin has measured an additional group of products: Minute Maid Lemonade contains 10.3 mEq/liter of alkali, like Diet 7-up. Gatorade contains only 8.3 mEq/liter. But Crystal Light Lemonade contains 21.7 mEq of alkali, so it is the winner. Each liter substitutes for 2 potassium citrate pills, $1.60 a day, or $144 every 3 months.

We know About Classic Crystal Light

Crystal Light beverages include teas and other drinks. Our measurements refer to the classic or standard lemonade beverage. In what follows all of my remarks at bounded by that limitation. For example, I do not know if liters of the Crystal Light tea might contain excessive amounts of oxalate.

The Prices of Crystal Light

I did not research the price of Crystal Light Lemonade extensively, but Crystal Light Lemonade Pitcher Packs – 3-Pack – are $27.95 at Amazon. Each 3 pack provides 96 quarts of beverage. Each quart is about one liter (0.946 liters to be exact). The cost is therefore $27.95/96 or about $0.29 per 20 mEq (2 pills). This comes to $0.58 daily or $52 every three months. The Amazon site points out that prices might be lower at other stores. Please comment on the best prices you have found so everyone can benefit.

It is Not Just How Much Citrate is in the Beverage

You may have read, on a label or in a scientific paper, that some of the beverages I have listed contain quite a lot of citrate, yet we show them as inferior as an alkali. The reason has to do with the form of the citrate. If the drink is made up in a very acidic manner, much of the citrate is citric acid and will not produce alkali in the body when metabolized. It is only when the molecule is citrate itself, not the citric acid, that it can benefit you as an alkali. The graph and the additions by Dr. Asplin present the true alkali content.

Be Wary of Sugar

The beverages are mainly diet so they do not add to your caloric burden. If you sweeten them, or lace them with fruit juice, or add fruit juice or other flavorings to baking soda – see below, you will be adding calories to your diet and that may not be ideal.

But apart from weight gain, sugar has undesirable effects specific to kidney stone formers: It raises urine calcium losses. Even worse, as the article points out, urine flow rate falls as urine calcium increases, so supersaturation rises for two reasons.

What About Sodium Bicarbonate

It Has a Lot of Alkali for the Money

Baking Soda

According to Google, a teaspoon contains 4,500 mg of baking soda (sodium bicarbonate). Given the molecular weight of 84 mg/mEq (each molecule is one mEq of alkali) the teaspoon contains 53 mEq of sodium alkali. In principle, therefore, one can get alkali for nearly nothing by way of price. According to Dr. Asplin, who has – unbelievably – determined such matters, a teaspoon can contain up to 6,100 mg of baking soda depending on packing and whether the teaspoon is level or heaping.

To get 20 mEq of alkali from baking soda would require about 1/3 teaspoon. Given the variability of what a teaspoon holds, and the sheer problems of fractions of a teaspoon for every dose, I strongly recommend we abandon the remarkable cost savings from baking soda and use sodium bicarbonate tablets, which are very inexpensive and measure out the dose for you.

Sodium Bicarbonate Tablets

You can buy sodium bicarbonate tablets OTC and they are cheap. Concord, via Amazon, sells one hundred 650 mg tablets for $14.95 ($0.14 each). Rugby sells 1000 tablets of the same size for $25.77 ($0.026 each). Because each tablet contains only 7.7 mEq of alkali, it takes about 3 to match 2 K citrate pills (I realize 7.7 times 3 is 23.1 mEq but it approximates 20 mEq and the difference is not important). But that is only $0.075 for the three. So the price can come way down with this form of alkali.

It has a lot of Sodium, Too

But, alas, the 1/3 teaspoon, or the three 650 mg pills, deliver 20 mEq of sodium for each 20 mEq of alkali. The extra 20 mEq of sodium is 460 mg, about 20% of a full day’s sodium intake. For the 40 mEq (4 potassium citrate pills) we have used as a benchmark thus far, it is 40% of a full day’s sodium intake.

Whereas I am unconcerned to recommend beverages as replacements for potassium citrate pills, I have considerable reservation about sodium loads for reasons I have already mentioned and repeat here for emphasis. Excess sodium intake can raise blood pressure in those who are sensitive to salt. Although we have not as yet discussed urine calcium losses as a risk factor for stones, sodium loads will raise urine calcium, and are therefore not beneficial in that respect. If you are taking a diuretic to reduce urine calcium for stone prevention, sodium loads will reduce the efficacy of the treatment and promote losses of potassium. People with heart disease may develop worsening heart failure. Always ask your physician before using sodium bicarbonate as an alkali.

Even so, sodium bicarbonate is not sodium chloride – table salt. For physicians I have reviewed a few papers on the subject. If I sound ambivalent, I am. We may need a few more trials on this subject. In the mean time, all of my reservations hold sway. Use sodium bicarbonate sparingly.

How To Put It All Together

Compromise is the best policy, and I offer a general scheme which patients and physicians can use, if they wish, with their personal alterations. Be sure and check that your combinations provide the dosages your physician wants you to have.

Make a List of Equivalent Dosages

Each potassium citrate pill is 10 mEq; 2 are 20 mEq of alkali. Each liter of Crystal Light is just over 20 mEq of alkali. Each OTC 10 grain (650 mg) sodium bicarbonate tablet is 7.7 mEq of alkali so 3 make 23 mEq.

Make A Day’s Menu

Consider dividing the day’s alkali into 3 parts: Beverages; sodium bicarbonate; potassium citrate pills.

To Replace 2 Potassium Citrate Pills

If we only need 2 10 mEq potassium citrate pills (20 mEq), substitute 1 liter of Crystal Light (20 mEq). It is part of the day’s fluids, but also like a medication, so spread its use out over the day and, if possible, night.

To Replace 4 Potassium Citrate Pills

If we need 4 pills (40 mEq) consider 1 liter of Crystal Light and three sodium bicarbonate pills (20 mEq). The beverage and individual pills can be spread out through the day.

To Replace 6 Potassium Citrate Pills

If we need 6 pills (60 mEq), consider 2 liters of Crystal light (40 mEq) and three sodium bicarbonate pills (20 mEq) likewise spread out through the day. Reserve the potassium citrate pills for when you tire of the beverage or if the extra sodium is raising blood pressure or urine calcium.

Use Many Beverage Types But Keep the Dose of Alkali The Same

Crystal Light is convenient because of how much citrate it contains. But the chart shows many alternatives which can be used instead in larger volumes. Just remember to multiply so the total amount of alkali remains about the same. For example, you need 2 liters of Diet 7-Up to equal one liter of Crystal Light.

Be Inventive: Not All Days Need Be The Same

Mixing and matching is perfectly acceptable. Each day need not look like the one before so long as the correct amount of total alkali is used. The only drawback of a mix and match approach is confusion, so make lists and keep track. As a general rule, try to make the sodium component smaller than the beverage component. Keep the expensive potassium citrate pills as a convenience and source of variety. Obviously if sodium is contraindicated medically, and beverages are too tiresome as a source for all the alkali that is needed, potassium citrate pills can be used to replace sodium bicarbonate pills.

Not All Patients Need Potassium Citrate Or Any Other Alkali

This post is for those who have been told by their physicians to use alkali. Nothing I have written here should induce anyone to begin alkali unless their physician has prescribed or recommended it. Stone formation is complicated. Sometimes alkali can worsen stones, or even become a danger. Potassium can itself be dangerous if kidney function is below normal. Sodium loads are a problem for people with high blood pressure, heart disease, and other illnesses. Do not use sodium or potassium alkali or even high volumes of Crystal Light unless the physician who is treating your stones recommends you do so.

Stay Hopeful

Whatever caused the price rise, the changes in how insurers pay for this medication, or both, may be transitory. Millions of people have kidney stones in the US. Prices for 90 days of a standard treatment are so high that few can afford them without serious budgetary concerns. When so many people are affected, hopefully market or even political forces will countervail. In the meantime, between a few potassium citrate pills, a few liters of Crystal Light, and maybe some sodium bicarbonate, physicians can piece together an adequate regime of alkali for those patients who need it. Not every stone former does need alkali, of course.

ANOTHER AND FINAL DISCLAIMER

I have brought Crystal Light to your attention as an inexpensive substitute for some of the medicinal alkali your physicians may have prescribed. As in my initial ‘Loud Disclaimer’ I say here that I receive no financial or other benefits of any kind from the makers of this beverage, have not, in fact, ever tasted it, and do not currently plan to do so. My evidence for the value of Crystal Light comes from the work of Dr. John Asplin, and comparisons to the published work of Dr. Eisner and his colleagues.

Orange Juice Is Better Than Lemonade At Keeping Kidney Stones Away

The findings indicate that although many people assume that all citrus fruit juices help prevent the formation of kidney stones, not all have the same effect. The study is available online and is scheduled to be published in the Oct. 26 issue of the Clinical Journal of the American Society of Nephrology.

Medically managing recurrent kidney stones requires dietary and lifestyle changes as well as treatment such as the addition of potassium citrate, which has been shown to lower the rate of new stone formation in patients with kidney stones.

But some patients can’t tolerate potassium citrate because of gastrointestinal side effects, said Dr. Clarita Odvina, assistant professor of internal medicine at the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and the study’s lead author. In those cases, dietary sources of citrate — such as orange juice — may be considered as an alternative to pharmacological drugs.

“Orange juice could potentially play an important role in the management of kidney stone disease and may be considered an option for patients who are intolerant of potassium citrate,” Dr. Odvina said.

All citrus juices contain citrate, a negatively charged form of citric acid that gives a sour taste to citrus fruits. Researchers compared orange juice and lemonade — juices with comparable citrate contents — and found that the components that accompany the citrate can alter the effectiveness of the juice in decreasing the risk of developing new kidney stones.

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Kidney stones develop when the urine is too concentrated, causing minerals and other chemicals in the urine to bind together. Over time, these crystals combine and grow into a stone.

In the UT Southwestern study, 13 volunteers — some with a history of kidney stones and some without — underwent three phases, each lasting one week. Chosen in random order, the phases included: a distilled water or control phase; an orange juice phase; and a lemonade phase. There was a three-week interval between phases.

During each phase, volunteers drank 13 ounces of orange juice, lemonade or distilled water three times a day with meals. They also maintained a low-calcium, low-oxalate diet. Urine and blood samples were taken at intervals during each phase. The study was done at UT Southwestern’s General Clinical Research Center.

Orange juice, researchers found, boosted the levels of citrate in the urine and reduced the crystallization of uric acid and calcium oxalate — the most frequently found ingredient in kidney stones.

But lemonade did not increase the levels of citrate, an important acid neutralizer and inhibitor of kidney stone formation.

“One reason might be the different constituents of various beverages,” Dr. Odvina said.

For instance, the citrate in orange and grapefruit juice is accompanied by a potassium ion while the citrate in lemonade and cranberry juice is accompanied by a hydrogen ion. Ions of hydrogen, but not potassium, counteract the beneficial effects of the high citrate content.

“There is an absolute need to consider the accompanying positive charge whenever one assesses the citrate content of a diet,” Dr. Odvina said.

About potassium citrate

Type of medicine An alkalinising agent
Used for Mild urinary tract infections such as cystitis
Also called Cystopurin®; Effercitrate®
Available as Sachets of powder, effervescent tablets, and oral mixture

Cystitis means inflammation of the bladder. It is usually caused by a urine infection. Typical symptoms are pain when you pass urine and passing urine more frequently. Your urine may also become cloudy and smelly. It is particularly common in women. A short course of antibiotics may be prescribed for you, although mild cases often improve on their own without the need for any treatment as your own immune system can often clear the infection.

Potassium citrate is a product that is sometimes recommended for the treatment of mild cystitis. It may help to relieve the discomfort, although there is no strong evidence of its benefit. It works by making the urine less acidic. It can be bought without a prescription at pharmacies and other retail outlets.

Note: if you are pregnant, male or have a medical condition, you should always see a doctor if you think you have cystitis because you may need to be treated with antibiotics. Men are advised to drink at least one litre of water and seek medical attention if your symptoms last longer than three hours

Before taking potassium citrate

To make sure that this is the right treatment for you, before you start taking potassium citrate it is important that you speak with a doctor or pharmacist:

  • If you are pregnant.
  • If your kidneys do not work well.
  • If you have a heart condition, or any other serious medical condition.
  • If you are taking or using any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.

How to take potassium citrate

  • Before you start the treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about the specific product you have been given and how to take it.
  • Please follow the dosage instructions on the label of the pack. Take your doses after meals. The following guidelines are adult doses:
    • Effervescent tablets (brand Effercitrate®) – take two tablets, up to three times a day. Take the tablets dissolved into a whole glassful of water.
    • Liquid medicine (brand Cymaclear®) – take two 5 ml spoonfuls, stirred into a whole glassful of water. You can take up to three doses a day.
    • Sachets (brand Cystopurin®) – empty the contents of one sachet into a whole glassful of water. Stir it well before drinking. Take one sachet, three times daily.

Getting the most from your treatment

  • If your symptoms do not improve within two days of taking potassium citrate, or if you develop a high temperature, you should see your doctor.
  • You might find it helpful to ask your pharmacist to recommend a suitable painkiller. Paracetamol or ibuprofen can also help to ease the pain and discomfort of cystitis.
  • Although it has been said that drinking lots of water may be helpful, there is little evidence for this. Some doctors feel that it does not help and drinking lots may just cause more painful toilet trips. You should follow the directions on the label for taking your potassium citrate preparation with water; however, other than this, drinking normal amounts of fluid is often sufficient.
  • If your symptoms recur within two weeks, you should make an appointment to see your doctor for further advice.

Can potassium citrate cause problems?

Recommended doses of potassium citrate are unlikely to cause any side-effects other than making you want to pass a little more urine than normal, and maybe a mild stomach upset. If either of these become troublesome, speak with your doctor or pharmacist.

Potassium citrate side-effects What can I do if I experience this?
Stomach upset Take your doses diluted with plenty of water, after meals

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

How to store potassium citrate

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light.

Important information about all medicines

Never take more than the recommended dose. If you suspect that you or someone else might have taken an overdose of the medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.

If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Potassium citrate

Generic Name: potassium citrate (poe TASS see um SIT rate)
Brand Name: Urocit-K, Twin-K

Medically reviewed by Drugs.com on Dec 5, 2019 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Dosage
  • Professional
  • Interactions
  • More

What is potassium citrate?

Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

Potassium citrate is used to treat a kidney stone condition called renal tubular acidosis.

Potassium citrate may also be used for other purposes other than those listed in this medication guide.

Important Information

You should not use this medication if you have kidney failure, a urinary tract infection, uncontrolled diabetes, a peptic ulcer in your stomach, Addison’s disease, severe burns or other tissue injury, if you are dehydrated, if you take certain diuretics (water pills), or if you have high levels of potassium in your blood (hyperkalemia).

You should not take potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Do not crush, chew, break, or suck on an extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Sucking on a potassium tablet can irritate your mouth or throat.

Avoid lying down for at least 30 minutes after you take this medication.

Take this medication with a meal or bedtime snack, or within 30 minutes after a meal.

To be sure this medication is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Serious side effects of potassium citrate include uneven heartbeat, muscle weakness or limp feeling, severe stomach pain, and numbness or tingling in your hands, feet, or mouth.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse.

Before taking this medicine

You should not use this medication if you are allergic to it, or if you have certain conditions. Be sure your doctor knows if you have:

  • high levels of potassium in your blood (hyperkalemia);

  • kidney failure;

  • a urinary tract infection;

  • untreated or uncontrolled diabetes;

  • Addison’s disease (an adrenal gland disorder);

  • a large tissue injury such as a severe burn;

  • a peptic ulcer in your stomach;

  • if you are severely dehydrated; or

  • if you are taking a “potassium-sparing” diuretic (water pill) such as amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide), triamterene (Dyrenium, Dyazide, Maxzide).

You should not take potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Before using potassium citrate, tell your doctor if you are allergic to any drugs, or if you have:

  • kidney disease;

  • congestive heart failure, enlarged heart, or history of heart attack;

  • other heart disease or high blood pressure;

  • diabetes;

  • a blockage in your stomach or intestines; or

  • chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

If you have any of these conditions, you may need a dose adjustment or special tests to safely take potassium citrate.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether potassium passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Do not crush, chew, break, or suck on an extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Sucking on a potassium tablet can irritate your mouth or throat. Call your doctor if it feels like the tablet is getting stuck in your throat when you swallow it.

Measure the liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Liquid potassium should be mixed with at least 4 ounces (one-half cup) of cold water or fruit juice. Drink the mixture slowly, over 5 to 10 minutes in all. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Take this medication with a meal or bedtime snack, or within 30 minutes after a meal.

Your treatment may include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

To be sure this medication is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse.

Store potassium citrate at room temperature away from moisture and heat. Keep the medication in a closed container.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of potassium citrate.

Overdose symptoms may include heavy feeling in your arms or legs, muscle weakness, limp feeling, slow or uneven heartbeat, chest pain, or feeling like you might pass out.

What should I avoid while taking potassium citrate?

Avoid lying down for at least 30 minutes after you take this medication.

Avoid taking potassium supplements or using other products that contain potassium without first asking your doctor. Salt substitutes or low-salt dietary products often contain potassium. If you take certain products together you may accidentally get too much potassium. Read the label of any other medicine you are using to see if it contains potassium.

While taking this medication, avoid strenuous exercise if you are not in proper condition for it.

Potassium citrate side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using this medication and call your doctor at once if you have any of these serious side effects:

  • confusion, anxiety, feeling like you might pass out;

  • uneven heartbeat;

  • extreme thirst, increased urination;

  • leg discomfort;

  • muscle weakness or limp feeling;

  • numbness or tingly feeling in your hands or feet, or around your mouth;

  • severe stomach pain, ongoing diarrhea or vomiting;

  • black, bloody, or tarry stools; or

  • coughing up blood or vomit that looks like coffee grounds.

Less serious side effects may include:

  • mild nausea or upset stomach;

  • mild or occasional diarrhea; or

  • appearance of a potassium citrate tablet in your stool.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect potassium citrate?

The following drugs can interact with potassium citrate. Tell your doctor if you are using any of these:

This list is not complete and there may be other drugs that can interact with potassium citrate. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 2.05.

Medical Disclaimer

More about potassium citrate

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  • Drug class: urinary pH modifiers

Consumer resources

  • Potassium
  • Potassium Citrate
  • Potassium citrate (Advanced Reading)

Other brands: Urocit-K

Professional resources

  • Potassium Citrate (Wolters Kluwer)
  • … +1 more

Related treatment guides

  • Renal Tubular Acidosis
  • Nephrolithiasis

Potassium Citrate Dosage

Medically reviewed by Drugs.com. Last updated on Dec 5, 2019.

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Applies to the following strengths: 20 mEq/15 mL; 5 mEq; 10 mEq; 15 mEq

Usual Adult Dose for:

  • Nephrolithiasis
  • Renal Tubular Acidosis

Additional dosage information:

  • Renal Dose Adjustments
  • Liver Dose Adjustments
  • Dose Adjustments
  • Precautions
  • Dialysis
  • Other Comments

Usual Adult Dose for Nephrolithiasis

Severe hypocitraturia (urinary citrate under 150 mg/day):
Initial dose: 60 mEq orally per day; either as 30 mEq two times a day OR 20 mEq three times a day with meals or within 30 minutes after meals or bedtime snack.
Mild to moderate hypocitraturia (urinary citrate over 150 mg/day):
Initial dose: 30 mEq orally per day; either as 15 mEq two times a day OR 10 mEq three times a day with meals or within 30 minutes after meals or bedtime snack.

-The objective of therapy is to normalize urinary citrate (over 320 mg/day and as close to the normal mean of 640 mg/day as possible), and to increase urinary pH to 6.0 to 7.0.
-Add this therapy to salt limitation (avoidance of high salt foods and salt added at the table) and high fluid intake (for a urine volume of at least 2 liters/day).
-Measure 24-hour urinary citrate and/or urinary pH to determine adequacy of initial dosage and for effectiveness of dose changes.
-Doses of Urocit(R)-K over 100 mEq/day have not been studied and should be avoided.
Uses:
-Management of renal tubular acidosis with calcium stones
-Management of hypocitraturic calcium oxalate nephrolithiasis (any etiology)
-Management of uric acid lithiasis with or without calcium stones

Renal Dose Adjustments

Contraindicated in renal insufficiency (glomerular filtration rate under 0.7 mL/kg/min) and chronic renal failure.
-Patients predisposed to hyperkalemia may have a rise in serum potassium leading to possible cardiac arrest.
-Patients with renal insufficiency are at risk of soft tissue calcification and hyperkalemia.

Liver Dose Adjustments

Data not available

Dose Adjustments

Severe renal tubular acidosis or chronic diarrheal syndrome, where urinary citrate may be very low (under 100 mg/day):
-This drug may be relatively ineffective for these patients; higher doses may be required for a satisfactory response.
-Renal acidosis patients with high urinary pH may see a small rise in urinary pH with this drug.

Precautions

CONTRAINDICATIONS:
-Hyperkalemia or conditions predisposing patients to hyperkalemia (including chronic renal failure, uncontrolled diabetes mellitus, acute dehydration, strenuous physical exercise in unconditioned people, adrenal insufficiency, extensive tissue breakdown, or use of potassium-sparing agents such as triamterene, spironolactone, or amiloride); a further increase in serum potassium may cause cardiac arrest.
-Patients with cause for arrest or delay of tablet passage through the gastrointestinal tract (e.g. delayed gastric emptying, esophageal compression, intestinal obstruction or stricture, anticholinergic medication use)
-Peptic ulcer disease because of the ulcerogenic potential
-Active urinary tract infection (with either urea-splitting or other organisms, with either calcium or struvite stones); bacterial enzymatic degradation of citrate may attenuate this drugs effect, and increased urinary pH from this drug may promote bacterial growth.
-Renal insufficiency (glomerular filtration rate under 0.7 mL/kg/min); because of the risks of soft tissue calcification and hyperkalemia.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Monitoring:
-Measure 24-hour urinary citrate and/or urinary pH to determine adequacy of initial dosage and for effectiveness of dose changes.
-Severe hypocitraturia patients should also have urinary citrate and/or urinary pH monitored every 4 months.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Potassium–Magnesium Citrate to Prevent Nephrolithiasis

Potassium citrate has been shown to be effective prophylaxis against recurrent calcium oxalate nephrolithiasis, but its use is limited because of gastrointestinal side effects. Studies suggest that recurrent calcium oxalate stones may be related to magnesium deficiency. In response to these two issues, a formulation of potassium–magnesium citrate was developed by clinical investigators. This formulation has a lower concentration of potassium and may reduce the incidence of gastrointestinal side effects. Ettinger and colleagues studied the effectiveness of potassium–magnesium citrate in the prevention of nephrolithiasis in patients with recurrent stone formation.

Patients were included in the placebo-controlled study if they had a history of two or more calcium oxalate calculi in the previous five years and at least one episode within the previous two years with no secondary causes. One group of 31 patients received potassium–magnesium citrate therapy, which provided a daily dosage of 42 mEq of potassium, 21 mEq of magnesium and 63 mEq of citrate. The placebo group included 33 patients. Initial assessment included 24-hour urine studies, blood chemistries, evaluation for the possibility of current stones and assessment of previous nephrolithiasis. The 24-hour urine studies and blood chemistries were repeated five months later and then every four months during the three years of the study. Side effects of treatment were evaluated at each visit.

At the end of three years, only 13 percent of the treatment group had recurrent nephrolithiasis, compared with 64 percent of the placebo group. Approximately one half of the patients in the treatment group dropped out of the study, but only 16 percent did so because of adverse side effects.

The authors conclude that the potassium–magnesium citrate formulation is effective as prophylaxis against recurrent calcium oxalate stones. This formulation did not cause hypocitraturia, so this parameter would not need monitoring. Gastrointestinal side effects were less frequent with potassium–magnesium citrate than with potassium citrate, but the authors note that the incidence of side effects should be studied further.

Potassium Citrate ER 10meq Tablets

Product Summary

This product requires a valid prescription for shipment, please note that HealthWarehouse.com may not accept prescriptions faxed or emailed by patients.
  • PRESCRIPTION REQUIRED

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

POTASSIUM CITRATE TABLET – ORAL

(poh-TASS-ee-um SYE-trate)

COMMON BRAND NAME(S): Urocit-K

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. Do not crush, chew, or suck the tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing. Do not lie down for 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 persist or worsen, 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 your doctor has prescribed this medication because he or she 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 (e.g., bleeding, blockage, puncture). Tell your doctor immediately if any of these unlikely but 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 immediately if any of these unlikely but serious side effects occur: muscle cramps/weakness, severe dizziness, slow/irregular heartbeat, mental/mood changes (e.g., confusion, restlessness), tingling of the hands/feet, unusually cold skin. A very serious allergic reaction to this drug is rare. However, seek immediate medical attention 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. 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. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: underactive adrenal gland (Addison’s disease), current bladder infection, uncontrolled diabetes, severe heart disease (e.g., recent heart attack, heart damage), certain stomach/intestinal problems (diabetic gastroparesis, conditions decreasing gut movement, peptic ulcer, blockage), severe kidney disease (e.g., inability to make urine), potassium-restricted diet, high potassium levels, severe loss of body water (dehydration). Before using this medication, tell your doctor or pharmacist your medical history, especially of: low calcium levels, severe diarrhea, heart problems (e.g., irregular heartbeat, heart failure), kidney disease, stomach/gut problems (e.g., irritable bowel), severe tissue damage (e.g., severe burns). Before having surgery, tell your doctor or dentist that you are taking this medication. During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor. It is not known whether this drug passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring. To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor’s approval. Some products that may interact with this drug include: antacids that contain aluminum, aspirin and other salicylates (e.g., salsalate), certain blood pressure medications (e.g., ACE inhibitors such as lisinopril, angiotensin blockers such as losartan), drospirenone, drugs that slow the movement of food/drugs through the esophagus/stomach (e.g., anticholinergics such as belladonna/scopolamine/benztropine, antispasmodics such as glycopyrrolate/oxybutynin, strong narcotic pain medicines such as morphine), eplerenone, certain heart medications (e.g., quinidine, digoxin), lithium, potassium supplements (including salt substitutes), pramlintide, stimulants/decongestants (e.g., amphetamine, pseudoephedrine), 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 at dosages of 81-325 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details. This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. 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. Laboratory and/or medical tests (e.g., complete blood count, potassium/sodium/chloride levels, kidney tests) should be performed periodically to monitor your progress or check for side effects. 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 and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE: Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines 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 for more details about how to safely discard your product.

Information last revised June 2012. Copyright(c) 2012 First Databank, Inc.

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