Interacting drugs - summary

Urinary alkalinizers/ Potassioum Citrate/ Sodium Citrate  +

Chlorpropamide / Lithium /Methotrexate/  Salicylates / Tetracycline 
 urinary alkalinizers may increase the excretion and decrease the  serum  levels of these agents, decreasing their pharmacologic   effects
       
Urinary alkalinizers  - Potassium Citrate/ Sodium Citrate +

Anorexiants  /   Flecainide /  Mecamylamine / Quinidine /  Sympathomimetics
 urinary alkalinizers decrease the excretion and increase the serum  levels of these agents,possibly increasing their pharmacologic effects

Urinary alkalinisers +

Sulfonylureas
 the hypoglycemic effect of the sulfonylureas  decreased due to   various mechanisms (eg. increased hepatic metabolism, decreased    insulin release, increased renal excretion)

Methenamine 
 alkalinizing agents may decrease the efficacy of methenamine by inhibiting   its conversion to formaldehyde
      
              
 

Hyperacidity 

Hyperlkalemia-listnessess, weakess, mental confusion, tingling of exremities and other sympotoms associated with high serum potassium

.Hyperkalermia may exhibit the following ECG abnormalities.

Disappearnace of P wave, widening or slurring of te ORS complex, changes in the SG segment, tall peaked T waves.

Sevee renal impairment with oliguria,azotemia, or anuria, untreated Addisions disease,adynamic episodica hereditaria, acute dehydration, heat cramps, sevee myocardial damage, hyperkalemia.

Special precautions:

Urolithiasis- citrate metabolozes calcium from bones and increases its renal excretion, this along with elevated urine pH, may predispose tourolithiasis.

Hyperkalemia/alkolosis- patientswith low urinary output and abnormal renal mechanism may develop hyperkalemia or alkalosis,especially in the presence of hypocalcemia.

Sodium salts- use cautiously inpatients with cardiac failure ,hypertension, impaired renal function, peripheral and pulmonary edeam and preeclampsia.

Monitor serum electrolytes, particularly the serum biacrabonate level, in patients with renal, disease.

GI effects- dilute with water to minimise GI injury associated with the oral,ingestion of concentrated potassium salts Take after meals to avoid saline effect.

Warnings-

Pregnancy- Polycitra- K- is not expected to cause fetal harm when admnistered in dosages recommended

Lactation- excercise caution when administered to a nursing woman.

Dosage- Dilute in water before taking.

Adults- 15 to 30 ml diluted in water, after mealsand before bedtime

Children- 5 to 10ml diluted with water after meals and before bedtime.

Overdosage

        Symptoms

Diarrhea, nausea, vomiting,hypertonia( excessive mentalactivity) and convulsion. Overdoage with Potassium salts may cause hyprerkalemia and alkalosis especially in presence of renal diseases. Treat hyperkalemia immediately because lethal levels can be reached in a few hours.

        Treatment - Potassium salts

1. Terminate Potassoium administration

2. Monitor ECG

3. Infuse combined dextrose in ratio of 3g dextrose to 1 unit regular insulin

4. Administer sodium bicarbonate 50 to 100mEq IV to reverse acidosis and to produce intracellular shift

5. Give 10 to 100ml calcium gliconate or calcium chloride 10% to reverse ECG changes

6. To remove potassium from the body use sodium polystrene rersin or hemodialysis or pertional dialysis

       Treament - Sodium salts

1. Discontinue sodium biacrbonate

2. Control symptoms by alkalosis by rebreathing expired air from a paper bag or if more severe by parentral injections of calcium gluconate

         Missed dose-

1. If you miss a dose of this medicine and remember within 2  hours take the missed dose right away with food or liquids.

 2. Then go back to your regular dosing schedule.

 3. However, if do not remember until later skip the missed dose and then go    back to your regular dosing schedule

 4. Do not double doses

Citrates include - Potassium citrate andcitric acid, Sodium citrate and citric acid Tricitrates 

1. Dilute with water, follow with additional water, if desired

2. Take after meals

3. Notify physician, if diarrhea, nausea, stomach pain, vomiting or convulsion occur

4. Allergy- Tell your doctor if you have ever had any unusual or allergic recation to potassium citrate or potassium. Tell your doctor if you are allergic to any other

5. Pregnancy- studies on effects in pregnancy have not been studied.

6. Breast-feeding- this medicine has not been reported to cause problems in nursing babies

7. Children- these medicines are not expected to cause different side effects or problems in children than they do in adults

8. Elderly- no specific information avilalable comparing use of citrates in elderly with use in other age groups

9. Other medicines- tell your doctor if you are taking any of the medicines- Amiloride or Benazapril or Captopril or Digitalis glycosides or Enalapril or Fosinopril or Heparin or Lisonopril or Medicines for inflamation or pain or Potassium contining medicines or Quinalapril or Ramipril or Salt substitutes, low salt foods or milk or Spironolactone or Triamterene - use with potassium containg citrates may further increase potassium blood levels, possibly leading to serious side effects.

10. Other medical problems- tell your doctor if you have any other medical problems- Addisons disease or Diabetes mellitus or Kidney disease - potassium containg citrates may worsen or cause heart problems in patients with these conditions Diarrhea- treatment with citrates may not be effective in dose of citrate may be needed

11. Missed dose- if you miss a dose of this medicine take it as soon as possible, if remembered in 2 hours. However if it is time for the next dose dose, skip the missed dose and go back to your regular dose schedule Do not double doses.

12 Storage- Keep out of reach of children Store away from direct heat and direct light Do not keep outdated medicines or medicines no longer in use. Make sure to keep any discarded medicine from reach of children

Pharmacology-

Citrate and citric acid solutions are systemic and urinary alkalinizers. Preparations containing potassium citrate are prefered in patients requiring potassium or in those who require sodium restriction.

Pharmacokinetics-

Potassium citrate and sodium citrate are absorbed and metabolized to potassium carbonate and sodium bicarbonate thus acting as systemic alkalinizers. The citric acid is metabolized to carbon di oxide and water, therefore it has only a transicent effect on ssytemic acid-base status. It function has a temporary buffer.

Pregnancy-

Polycitra- K- is not expected to cause fetal harm when admnistered in dosages that will not result in hyperkalemia

Lactation-

Excercise caution when administered to a nursing woman.