Tricitrates

You should not use this medication if you are allergic to it, or if you have:

• severe kidney disease;

• severe heart damage (such as from a prior heart attack);

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

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

• high levels of sodium in your blood (hypernatremia); or

• if you are severely dehydrated.

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

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take citric acid, potassium citrate, and sodium citrate, tell your doctor if you have:

• kidney disease;

• low levels of calcium in your blood (hypocalcemia);

• congestive heart failure, heart rhythm problems, or history of heart attack;

• other heart disease or high blood pressure;

• diabetes;

• a peptic ulcer in your stomach;

• swelling of your hands or feet, or in your lungs (pulmonary edema);

• toxemia of pregnancy;

• urination problems (or if you are unable to urinate);

• chronic diarrhea (such as irritable bowel disease, ulcerative colitis, Crohn's disease); or

• if you are on a low-salt diet.

It is not known whether this medication is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether this medication 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.

Avoid using antacids without your doctor's advice, including household baking soda (sodium bicarbonate). Antacids that contain aluminum or sodium can interact with citric acid, potassium citrate, and sodium citrate, causing a serious electrolyte imbalance or aluminum toxicity.

Avoid taking potassium supplements or using other foods or 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.

Avoid eating foods that are high in salt, or using extra table salt on your meals.

It is very important to follow any 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.

Tricitrates SF Oral Solution 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 hyperkalemia or alkalosis, especially in the presence of hypocalcemia. Potassium intoxication causes listlessness, weakness, mental confusion, and tingling of extremities.

Tricitrates SF Oral Solution should be taken diluted in water, followed by additional water, if desired. Palatability is enhanced if chilled before taking.

Usual Adult Dose

3 to 6 teaspoonfuls (15 to 30 mL), diluted in water, four times a day, after meals and at bedtime, or as directed by a physician.

Usual Pediatric Dose

1 to 3 teaspoonfuls (5 to 15 mL), diluted in water, four times a day, after meals and at bedtime, or as directed by a physician.

Usual Dosage Range

2 to 3 teaspoonfuls (10 to 15 mL), diluted with water, taken four times a day, will usually maintain a urinary pH of 6.5-7.4. 3 to 4 teaspoonfuls (15 to 20 mL), diluted with water, taken four times a day, will usually maintain a urinary pH of 7.0-7.6 throughout most of the 24 hours without unpleasant side effects. To check urine pH, HYDRION Paper (pH 6.0-8.0) or NITRAZINE Paper (pH 4.5-7.5) are available and easy to use.

Overdosage with sodium salts may cause diarrhea, nausea and vomiting, hypernoia, and convulsions. Overdosage with potassium salts may cause hyperkalemia and alkalosis, especially in the presence of renal disease.

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 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.
• Very upset stomach or throwing up.
• Swelling of belly.
• Very bad belly pain.
• Black, tarry, or bloody stools.
• Throwing up blood or throw up that looks like coffee grounds.