Disodium Hydrogen Citrate

Therapeutic Indications

Disodium Hydrogen Citrate is an acidic salt that is used in making urine more alkaline. It is an alkalizing agent. It is a salt of citric acid. It is used in the treatment, control, and management of the following conditions, diseases, and symptoms:

• Gout
• Urate kidney stones
• Acidosis due to kidney disease
• Burning micturition
• Urinary tract infections
• Acidosis due to diarrhea
• An antioxidant
• With sulphonamides in adjuvant therapy
• Constipation
• Abdominal complications
• Gastric problems
• Uterine tract infections
• To improve the effects of other antioxidants

Do I Need a Prescription?

Disodium hydrogen citrate can be bought from pharmacies close to you and online drug stores. But a doctor’s prescription is mandatory.

Dosage

The dosage and duration of use for disodium hydrogen citrate depend on the medical condition, response to therapy and age. The recommended dosage is:

• Adults: 15 to 30 ml two or three times a day when dissolved in water
• Children 7 to 12 years: 5 ml two to three times a day when dissolved in water
• Children below the age of 7 years: 2 ml three times a day dissolved in water

Chemical composition

The active ingredient in disodium hydrogen citrate syrup is disodium hydrogen citrate. It is a salt of citric acid.

Mechanism of Action (MOA)

Disodium hydrogen citrate works by removing excess uric acid from the blood through urine.  The active ingredient once administered is metabolized and forms bicarbonate ions that neutralize acids in blood and urine, this makes urine to be more alkaline, and the pH is increased, lowering acidosis symptoms.

When the pH of urine is alkaline, micro-organism growth is hindered thus being able to relieve the symptoms of urinary tract infections and curing it.  Disodium hydrogen citrate makes cysteine to be more soluble in urine and also makes ions of uric acid, urate ions, this prevents formations of kidney stones.

Contraindications

The use of disodium hydrogen citrate is contraindicated in some conditions. When used it could lead to the occurrence of an adverse reaction or make the medical condition severe that it is. Before taking disodium hydrogen citrate, inform your doctor of all medical conditions you have or have had before and those your family has a history of as they may affect the prescription. Disodium hydrogen citrate is not to be used if you have the following conditions:

• Allergic reactions to the active ingredient disodium hydrogen citrate
• Kidney dysfunction
• Heart problems such as irregular heartbeat, heart failure, congestive heart failure, heart enlargement
• Fluid retention in the body in the ankles. Legs or feet ( peripheral edema)
• High blood pressure
• On a diet with sodium restriction
• High levels of sodium
• A breathing problem such as pulmonary edema
• Low levels of calcium
• Diabetes as the product might contain sugar
• Dehydration
• A bacterial infection that is severe
• Disodium hydrogen citrate is not advised to be used during pregnancy as it could harm the fetus.
• Lactation, Disodium hydrogen citrate is not advised as it could harm the nursing baby.
• Neonates
• Addison’s disease
• Toxemia of pregnancy
• Crohn’s disease

Facts on Disodium Hydrogen Citrate

• The effect of Disodium hydrogen citrate begins within a minute of administration.
• The duration of effect of disodium hydrogen citrate lasts for 4 to 6 hours.
• Disodium hydrogen citrate is also used as a food additive and as an anticoagulant.
• It is manufactured by reacting sodium hydroxide and citric acid
• It has not been shown to have any effects on fetus and nursing babies.
• It is an antioxidant.

Side effects

Medications cause side effects apart from the intended results. Disodium hydrogen citrate causes side effects, but they do not occur in everybody. They depend on the duration of use, the dosage and individual reaction to the medication. The side effects can occur at the beginning of the treatment but go away on their own. The side effects can be common and less serious while others can be rare and very serious. Inform your doctor of any side effects you experience to get medical advice on how to cope with them and for medical attention for those that are serious. The following are the less serious and common side effects of disodium hydrogen citrate:

• Stomach ache
• Nausea
• Vomiting
• Weakness
• Gastrointestinal discomfort
• Bloating
• A headache

Rare and serious side effects include:

• Diarrhea that is severe and ongoing
• Irritable
• Nervous
• Stomach ulceration
• Mood swings
• Seizures
• Slow or fast heartbeat
• Confusion
• Increased urination
• Reduced blood levels of potassium
• Metabolic alkalosis
• Dizziness
• Shallow and rapid breathing
• Bloody stool
• Muscle twitching or pain
• Cramps or leg pain
• Peripheral edema
• Numbness or tingling in the hands and legs
• Irregular heartbeat

Nausea, vomiting, diarrhea, and pain in the stomach can be reduced by taking the medication after a meal, taking a lot of water and taking the drug with juice or plenty of water.

In case you have an allergic reaction to disodium hydrogen citrate, stop taking the medication and inform your doctor or seek medical attention urgently. Symptoms of an allergic reaction include difficulty breathing, severe dizziness, swelling of throat, lips, face and tongue and hives.

If you accidentally take an overdose of disodium hydrogen citrate, inform your doctor or rush into the emergency center of the nearest hospital carrying the medication package with you. Taking an overdose can result in adverse reactions that can be fatal. An overdose can cause loss of consciousness, muscle spasms, seizures, and metabolic alkalosis.

Drug Interactions

When you take more than one medication at the same time, it can result in the drugs interacting. Drug interactions can change the way your medication is working making it less effective or affects the working of the other medications you are taking. Drug interactions can also cause accumulation of drugs in the body that can cause adverse reactions to occur. Inform your doctor of all medications you are using or have been using both over the counter medications and prescription drugs, dietary supplements and herbal products. The following drugs and products interact with disodium hydrogen citrate:

• Tetracycline, when used together increases their renal excretion.
• Amphetamine
• Quinidine
• Ephedrine
• Antacids containing aluminum and sodium, and baking powder (sodium bicarbonate) when used can cause a severe imbalance of electrolyte in the body or toxicity due to aluminum.
• Lithium
• Methenamine
• Allergy medications and cold medications or decongestants
• Diet Pills
• ADHD medications
• Mineral and vitamin supplements containing calcium
• Medications that contain calcium
• Salicylates like aspirin effects are lowered as their excretion is enhanced given that they are acidic drugs
• Corticosteroids, it causes retention of sodium
• Alcohol
• Barbiturates, their excretion is enhanced when used together with disodium hydrogen citrate
• Diuretics that deplete potassium, when used concurrently can cause hypochloraemia alkalosis

What to Do If You Skip a Dose?

If you skip a dose, take it as soon as you realize it. If it is time close to your next treatment, you can skip the dose and take your next dose then continue with the normal drug schedule. However, do not double the dose to compensate for the skipped dose as it will be an overdose that can result in adverse effects. Frequent missing does make your medication less effective in treating your condition. To avoid frequent dose missing set the alarm to remind you or have a family member remind you when it is time for your next dose.

Precautions

A number of precautions should be considered before you use and when using disodium hydrogen citrate. The precautions include:

• Hypersensitive reactions: Do not use disodium hydrogen citrate if you are allergic to the active ingredient.
• Inform your doctor of all medications and products you are using to avoid drug interactions that may be fatal.
• Notify your doctor of all medical conditions you have or have had before to prevent them worsening or adverse reactions from occurring.
• Pregnant or planning to be pregnant and lactating mothers should use disodium hydrogen citrate with cautions as there is no conclusive evidence of its effects on the growing fetus and nursing baby.
• Renal impairment. If you have kidney disease, disodium hydrogen citrate should be used with caution. In very severe cases, the dose should be adjusted.
• If you experience dizziness and drowsiness while using disodium hydrogen citrate, then you are advised not to engage in activities that require mental alertness such as driving and operation of heavy machinery.
• Disodium hydrogen citrate should be taken after a meal with plenty of water to avoid stomach upset.
• Avoid foods that contain a lot of salt and the use of extra table salt while using disodium hydrogen citrate as it already contains sodium.
• While taking disodium hydrogen citrate, you should carry out frequent urine and blood test to ensure that the medication is working.
• Disodium hydrogen citrate should be stored in a closed container, at room temperature away from moisture, sunlight, children and pets.
• Do not increase or lower the dosage prescribed by your doctor. Taking large doses of disodium hydrogen citrate can affect the working of your kidney.
• Avoid or reduce alcohol consumption while sing disodium hydrogen citrate, as alcohol, might lower its effects.
• The syrup form of disodium hydrogen citrate contains sugar in it, thus use it with caution if you have diabetes.
• The bottle of disodium hydrogen citrate should be well shook before measuring the dose using a measuring cup and not a tablespoon.
• Do not take disodium hydrogen citrate that is expired. Its potency may have reduced making it less effective in treating your condition. Always check the medication package while purchasing the drug.

Different Brands and Manufacturing Companies of the Drug

Disodium hydrogen citrate is manufactured mainly as a syrup or a suspension. It is manufactured by different pharmaceutical companies and sold under different brand names. The different brands can be used as alternatives and substitutes. The different brand includes:

• Cital – 1.37 mg/5 ml – Indoco Remedies Ltd
• Siocitrate – 1.375g/5 ml – Albert David Limited
• Oricitral – 1.38g/5 ml – TTK Healthcare Ltd
• Alkaryl – 1.4 g/5 ml – Cadila Pharmaceuticals Ltd
• Alkasol – 1.4 g/5 ml – Stadmed Private Limited
• Citralka – 1.53 g/5 ml – Parke – Davis (India) Ltd
• Biocetral – 1.53 gm – Bioguard Organics
• Citra Sip Syrup – 1.20 gm – Kwality Pharmaceuticals (P) Ltd
• Alkanil –Inga Pharmaceuticals Pvt Ltd
• Alkarate – 1.37 g/5 ml – Macleods Pharmaceuticals Ltd(Pharma)
• Citralka – 1.53 g/5 ml – Pfizer Limited
• Systal – 1.38 g/ 5ml – Commonwealth Laboratories (India) Pvt Ltd.

References
https://www.niddk.nih.gov/health-information/kidney-disease
https://www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/financial-help-treatment
https://medlineplus.gov/chronickidneydisease.html
https://healthfinder.gov/FindServices/SearchContext.aspx?topic=1148
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/kidneys-age-related-problems

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