Citric Acid; Sodium Citrate
Indications: Urine, alkalinization
DESCRIPTION:
Bicitra is a stable and pleasant-tasting oral systemic alkalizer solution containing sodium citrate and citric acid in a sugar-free base. It is a nonparticulate neutralizing buffer.
Bicitra contains in each teaspoonful (5 ml):
Sodium citrate dihydrate 500 mg (0.34 Molar)
Citric acid monohydrate 334 mg (0.32 Molar)
Each ml contains 1 mEq sodium ion and is equivalent to 1 mEq sodium ion and is equivalent to 1 mEq bicarbonate (HCO3). Bicitra also contains butylparaben, flavoring, maltitol, and sodium saccharin.
CLINICAL PHARMACOLOGY:
Sodium citrate is absorbed and metabolized to sodium bicarbonate, thus acting as a systemic alkalizer. The effects are essentially those of chlorides before absorption and those of bicarbonates subsequently. Oxidation is virtually complete so that less than 5% of sodium citrate is excreted in the urine unchanged.
INDICATIONS AND USAGE:
Sodium citrate; citric acid is an effective alkalizing agent. It is useful in those conditions where long-term maintenance of an alkaline urine is desirable, and is of value in the alleviation of chronic metabolic acidosis, such as results from chronic renal insufficiency or the syndrome of renal tubular acidosis, especially when the administration of potassium salts is undesirable or contraindicated. Sodium citrate; citric acid is also useful for buffering and neutralizing gastric hydrochloric acid quickly and effectively.
Sodium citrate; citric acid is concentrated, and when administered after meals and before bedtime, allows one to maintain an alkaline urinary pH around the clock, usually without the necessity of a 2 a.m. dose. Sodium citrate; citric acid alkalinizes the urine without producing a systemic alkalosis in the recommended dosage. Sodium citrate; citric acid is highly palatable, pleasant tasting, and tolerable, even when administered for long periods. Sodium citrate; citric acid is sugar-free.
CONTRAINDICATIONS:
Patients on sodium-restricted diets or with severe renal impairment. In certain situations, potassium citrate, as contained in polycitra-K, may be preferable.
PRECAUTIONS:
Should be used with caution by patients with low urinary output unless under the supervision of a physician. Sodium citrate; citric acid should not be administered concurrently with aluminum-based antacids. Patients should be directed to dilate adequately with water and, preferably, to take each dose after meals to avoid saline laxative effect. Sodium salts should be used cautiously in patients with cardiac failure, hypertension, impaired renal function, peripheral and pulmonary edema, and toxemia of pregnancy. Periodic examinations and determinations of serum electrolytes, particularly serum bicarbonate level, should be carried out in those patients with renal disease in order to avoid these complications.
ADVERSE REACTIONS:
Sodium citrate; citric acid is generally well tolerated, without any unpleasant side effects, when given in recommended doses to patients with normal renal function and urinary output. However, as with any alkalinizing agent, caution must be used in certain patients with abnormal renal mechanisms to avoid development of alkalosis, especially in the presence of hypocalcemia.
OVERDOSAGE:
Overdosage with sodium salts may cause diarrhea, nausea and vomiting, hypernoia, and convulsions.
DOSAGE AND ADMINISTRATION:
Sodium citrate; citric acid should be taken diluted in water, followed by additional water, if desired. Palatability is enhanced if chilled before taking.
For Systemic Alkalization
Usual Adult Dose: 2 to 6 teaspoonfuls (10 to 30 ml), diluted in 1 to 3 ounces of water, after meals and at bedtime, or as directed by a physician.
Usual Pediatric Dose: 1 to 3 teaspoonfuls (5 to 15 ml), diluted in 1 to 3 ounces of water, after meals and at bedtime, or as directed by a physician. For children under two years of age, use is based on a consultation with a physician.
As A Neutralizing Buffer: 3 teaspoonfuls (15 ml), diluted with 15 ml water, taken as a single dose, or as directed by a physician.
Keep tightly closed and protect from excessive heat or freezing.