Disodium Hydrogen Citrate is an oral systemic alkalinizing agent and urinary alkalizer. It is a sodium salt of citric acid that, upon metabolism, increases the plasma bicarbonate concentration, buffers excess hydrogen ion concentration, raises blood pH, and increases the excretion of urine pH. It is primarily used to treat metabolic acidosis and to alkalinize urine in conditions like uric acid and cystine stone prophylaxis. In the Indian context, it is widely used as an adjunct in the management of gout and urinary tract infections, and to reduce the nephrotoxicity of certain drugs.
Adult: 10-20 ml (2.5gm - 5gm of Disodium Hydrogen Citrate) diluted in a glass of water, 3-4 times daily. For urinary alkalinization, dose is titrated to maintain urine pH between 6.5-7.5.
Note: Must be diluted in a full glass (at least 120-240 ml) of water before ingestion. Take after meals to minimize GI upset. Do not take with antacids containing aluminum or magnesium concurrently, as it may increase aluminum absorption. The solution should be sipped slowly over 5-10 minutes. Regular monitoring of urine pH (using pH paper) is recommended for titration.
Disodium Hydrogen Citrate acts as a systemic and urinary alkalinizer. After oral administration, the citrate anion is absorbed and metabolized in the liver (via the Krebs cycle) to yield bicarbonate (HCO3-). This bicarbonate enters the systemic circulation, where it acts as a buffer, neutralizing excess hydrogen ions (H+) and raising the blood pH, thereby correcting metabolic acidosis. In the kidneys, the increased filtered load of bicarbonate alkalinizes the urine, increasing the solubility of uric acid, cystine, and certain drugs (like sulfonamides and methotrexate), preventing their crystallization and deposition.
Pregnancy: Category C: Animal reproduction studies have not been conducted. Use only if clearly needed and potential benefit justifies potential risk to the fetus. Monitor for fluid retention and electrolyte imbalance.
Driving: Unlikely to affect driving ability. However, if alkalosis occurs, symptoms like dizziness, confusion, or tetany could impair performance.
| Potassium-Sparing Diuretics (e.g., Spironolactone, Amiloride) | Increased risk of severe hyperkalemia due to reduced renal potassium excretion in an alkaline environment. | Major |
| Lithium | Increased urinary alkalinity reduces lithium reabsorption, leading to decreased serum lithium levels and potential loss of efficacy. | Major |
| Quinidine | Alkalinization of urine decreases quinidine excretion, increasing its plasma levels and risk of toxicity (cinchonism, arrhythmias). | Major |
| Amphetamines | Urinary alkalinization reduces excretion, increasing plasma levels and CNS effects/toxicity. | Major |
| Methenamine (e.g., Hiprex) | Alkalinized urine inactivates methenamine, rendering it ineffective as a urinary antiseptic. | Moderate |
| Salicylates (Aspirin) | Alkalinization increases renal excretion of salicylates, reducing their plasma levels. Used therapeutically in overdose. | Moderate |
| Tetracycline antibiotics | Reduced absorption of tetracyclines if taken simultaneously due to chelation with divalent cations in an alkaline milieu. | Moderate |
| Anticholinergics | May enhance GI absorption of disodium hydrogen citrate by delaying gastric emptying. | Minor |
| Corticosteroids | May potentiate the sodium-retaining effects, increasing risk of edema and hypertension. | Moderate |
Same composition (Disodium Hydrogen Citrate (1.25gm/5ml)), different brands: