For patients taking the tablet form of this medicine:

• Swallow the tablets whole. Do not crush, chew, or suck the tablet.
• Take with a full glass (8 ounces) of water.
• If you have trouble swallowing the tablets or they seem to stick in your throat, check with your doctor at once. If this medicine is not completely swallowed and not properly dissolved, it can cause severe irritation.

For patients taking the liquid form of this medicine :

• Dilute with a full glass (6 ounces) of water or juice and drink; follow with additional water, if desired.
• Chill, but do not freeze, this medicine before taking it, for a better taste.

For patients taking the crystals form of this medicine :

• Add the contents of one packet to at least 6 ounces of cool water or juice.
• Stir well to make sure the crystals are completely dissolved.
• Drink all the mixture to be sure you are taking the correct dose. Follow with additional water or juice, if desired.

Take each dose immediately after a meal or within 30 minutes after a meal or bedtime snack. This helps prevent the medicine from causing stomach pain or a laxative effect.

Drink at least a full glass (8 ounces) of water or other liquid (except milk) every hour during the day (about 3 quarts a day), unless otherwise directed by your doctor. This will increase the flow of urine and help prevent kidney stones.

Take this medicine only as directed by your doctor . Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important if you are also taking a diuretic (water pill) or digitalis medicine for your heart.

Dosing

The dose of these single or combination medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take or of teaspoonfuls or ounces of solution that you drink depends on the strength of the single or combination medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking this single or combination medicine.

For potassium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 1.08 to 2.16 grams three times a day with meals. Some people may take 1.62 grams four times a day with meals or within thirty minutes after a meal or bedtime snack. Your doctor may change your dose if needed. However, most people usually will not take more than 10.8 grams a day.
    • Children Dose must be determined by your doctor.

For potassium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 2 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the urine more alkaline (less acidic):
    • Children At first, 1 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day after meals and at bedtime. Your doctor may change the dose if needed.
• For oral dosage form (crystals for solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 3.3 grams of potassium citrate, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children Use is not recommended.

For potassium citrate and sodium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 1 to 4 tablets after meals and at bedtime.
    • Children Dose must be determined by your doctor.

For sodium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 2 to 6 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed. However, most people will usually not take more than five ounces a day.
  • To make the contents of the stomach less acidic before surgery:
    • Adults 1 to 2 tablespoonfuls as a single dose. You may mix it in one to two tablespoonfuls of water.
  • To make the blood more alkaline (less acidic):
    • Children At first, 1 to 3 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed.

For tricitrates
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults At first, 1 to 2 tablespoonfuls of solution four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the contents of the stomach less acidic before surgery:
    • Adults 1 tablespoonful as a single dose. You should mix the solution in one tablespoonful of water.
  • To make the urine or blood more alkaline (less acidic):
    • Children At first, 5 to 10 mL four times a day after meals and at bedtime. Your doctor may change the dose if needed.

Missed dose

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

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For citrates, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to potassium citrate or potassium. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Studies on effects in pregnancy have not been done in either humans or animals.

Breast-feeding Although it is not known whether citrates pass into the breast milk, this medicine has not been reported to cause problems in nursing babies.

Children Although there is no specific information comparing use of citrates in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Older adults Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of citrates in the elderly with use in other age groups.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking citrates, it is especially important that your health care professional know if you are taking any of the following:

• Amiloride (e.g., Midamor) or
• Benazepril (e.g., Lotensin) or
• Captopril (e.g., Capoten) or
• Digitalis glycosides (heart medicine) or
• Enalapril (e.g., Vasotec) or
• Fosinopril (e.g., Monotril) or
• Heparin (e.g., Panheprin) or
• Lisinopril (e.g., Prinivil; Zestril) or
• Medicines for inflammation or pain (except narcotics) or
• Potassium-containing medicines (other) or
• Quinapril (e.g., Accuprol) or
• Ramipril (e.g., Altase) or
• Salt substitutes, low-salt foods or milk or
• Spironolactone (e.g., Aldactone) or
• Triamterene (e.g., Dyrenium) Use with potassium-containing citrates may further increase potassium blood levels, possibly leading to serious side effects

• Antacids, especially those containing aluminum or sodium bicarbonate Use with citrates may increase the risk of kidney stones; also, citrates may increase the amount of aluminum in the blood and cause serious side effects, especially in patients with kidney problems

• Methenamine (e.g., Mandelamine) Use with citrates may make the methenamine less effective

• Quinidine (e.g., Quinidex) Use with citrates may cause quinidine to build up in the bloodstream, possibly leading to serious side effects

• Addison's disease (underactive adrenal glands) or
• Diabetes mellitus (sugar diabetes) or
• Kidney disease The potassium in potassium-containing citrates may worsen or cause heart problems in patients with these conditions

• Diarrhea (chronic) Treatment with citrates may not be effective; a change in dose of citrate may be needed

• Edema (swelling of the feet or lower legs) or
• High blood pressure or
• Toxemia of pregnancy The sodium in sodium-containing citrates may cause the body to retain (keep) water

• Heart disease The sodium in sodium-containing citrates may cause the body to retain (keep) water; the potassium in potassium-containing citrates may make heart disease worse

• Intestinal or esophageal blockage Potassium citrate tablets may cause irritation of the stomach or intestines

• Stomach ulcer or other stomach problems Potassium citratecontaining products may make these conditions worse

• Urinary tract infection Citrates may make conditions worse