Potassium citrate with potassium bicarbonate

How it works

Citrate and bicarbonate are metabolised or excreted to raise urinary pH, while both salts supply potassium; alkalinisation can ease dysuria and discourages the formation of certain urinary crystals.

Prescribing in practice

• Avoid or use with great caution in renal impairment and alongside potassium-sparing diuretics or RAS inhibitors, since the potassium load can cause serious hyperkalaemia.
• It is not appropriate where the urine is already alkaline or in conditions worsened by an alkali load.
• Dilute the preparation well with water and take after food to reduce gastric irritation.

Monitoring

Monitor serum potassium and renal function, particularly with repeated use or in at-risk patients.

Counselling the patient

• Dilute the dose well with water and take it after meals.
• Seek review if urinary symptoms persist beyond a couple of days.
• Report muscle weakness or an irregular heartbeat.

Evidence & guidelines

Long-standing symptomatic use for cystitis and urinary alkalinisation is reflected in current prescribing references and the SPC, which stress caution over the potassium content.