Citric Acid + Sodium Bicarbonate + Sodium Citrate + Tartaric Acid

Usage

This combination medication, often marketed under brand names like Citro-Soda or Ural, primarily serves as a urinary alkalinizer and a gastric antacid. It is prescribed for:

• Symptomatic relief of mild urinary tract infections (UTIs): By increasing urine pH, it helps alleviate discomfort associated with UTIs like dysuria (painful urination).
• Gout therapy: It helps prevent the crystallization of urates in the urine, a key factor in gout. It may also help dissolve existing uric acid stones.
• Enhancing the action of certain antibiotics: Specifically, some sulfonamides are more effective in alkaline urine.
• Temporary relief from minor gastric upsets: The antacid properties neutralize excess stomach acid, providing relief from heartburn and indigestion.

Pharmacological Classification: This combination product belongs to two pharmacological classes: urinary alkalinizers and antacids.

Mechanism of Action: The components work synergistically: Sodium bicarbonate directly increases urinary excretion of bicarbonate ions, raising urinary pH. Citric acid and sodium citrate are metabolized to bicarbonates, further contributing to alkalinization. Tartaric acid, combined with sodium bicarbonate, generates carbon dioxide, which can provide relief from gastric discomfort and be useful in diagnostic procedures like double-contrast radiography. Sodium bicarbonate and tartaric acid also function as antacids, neutralizing stomach acid.

Alternate Names

• Citro-Soda
• Ural
• Citrogran
• U-Lite
• Sodium bicarbonate-sodium citrate-citric acid-tartaric acid
• Sodium Citrotartrate Granules

How It Works

Pharmacodynamics: Citric acid, sodium citrate, and sodium bicarbonate increase urinary pH by increasing the excretion of bicarbonate ions. This alkalinization can relieve UTI symptoms and prevent urate crystallization in gout. Sodium bicarbonate and tartaric acid neutralize gastric acid, relieving heartburn and indigestion. Tartaric acid, in combination with sodium bicarbonate, can also generate carbon dioxide, useful for diagnostic imaging.

Pharmacokinetics: Sodium bicarbonate is readily absorbed and primarily excreted renally and through the lungs as carbon dioxide. Citric acid and sodium citrate are metabolized to bicarbonate and excreted in the urine. Tartaric acid is partially absorbed, with the unabsorbed portion excreted in feces. The absorbed portion is primarily excreted unchanged in the urine.

Mode of Action: Sodium bicarbonate directly increases bicarbonate ion concentration in the urine. Citric acid and sodium citrate are converted to bicarbonate in the body, adding to the alkalinizing effect. Sodium bicarbonate and tartaric acid neutralize stomach acid by reacting with it to form water and carbon dioxide. Tartaric acid, when mixed with sodium bicarbonate, produces carbon dioxide gas.

Receptor Binding/Enzyme Inhibition/Neurotransmitter Modulation: This combination product doesn’t have any significant receptor binding, enzyme inhibition, or neurotransmitter modulation effects.

Elimination Pathways: Primarily renal excretion for all components except the unabsorbed portion of tartaric acid, which is excreted in feces. Sodium bicarbonate is also eliminated via the lungs as CO2.

Dosage

Standard Dosage

Adults: 4-8 g (1-2 sachets) dissolved in half a glass of cold water, 3-4 times daily. Administer on an empty stomach, followed by additional water. For long-term therapy, 4 g daily is usually sufficient. Drink after effervescence.

Children (6-12 years): 4 g dissolved in half a glass of cold water, 2-3 times daily. Administer on an empty stomach, followed by additional water. Drink after effervescence.

Special Cases:

• Elderly Patients: Use with caution. Monitor renal function and electrolyte levels.
• Patients with Renal Impairment: Contraindicated in severe renal disease. Use with caution in mild to moderate impairment; monitor electrolyte levels and acid-base balance.
• Patients with Hepatic Dysfunction: Use with caution.
• Patients with Comorbid Conditions: Use with caution in patients with hypertension, congestive heart failure, or on sodium-restricted diets. Monitor electrolyte levels.

Clinical Use Cases

The combination product isn’t typically used in clinical settings like intubation, surgical procedures, mechanical ventilation, or the ICU. Its primary uses are outlined in the “Usage” section.

Dosage Adjustments

Adjust dosage based on renal function, electrolyte levels, and clinical response.

Side Effects

Common Side Effects:

• Stomach cramps
• Laxative effect (diarrhea or loose bowel movements)
• Flatulence
• Belching
• Nausea

Rare but Serious Side Effects:

• Metabolic alkalosis (muscle weakness, mental disturbances, restlessness)
• Hypernatremia (confusion, increased thirst, muscle twitching)
• Hypocalcemia (muscle hypertonicity, twitching, tetany)
• Allergic reactions (hives, difficulty breathing, swelling)

Long-Term Effects: Prolonged use can potentially lead to metabolic alkalosis or hypernatremia.

Adverse Drug Reactions (ADR): Severe allergic reactions require immediate medical attention.

Contraindications

• Hypersensitivity to any component of the drug.
• Severe renal disease.
• Metabolic alkalosis.
• Hypocalcemia.
• Hypochlorhydria.
• Concurrent use with urinary antiseptics requiring acidic urine (e.g., methenamine mandelate, methenamine hippurate).
• Hypernatremia.

Drug Interactions

• Urinary Antiseptics: Avoid concurrent use with methenamine salts.
• Quinolone Antibiotics: Concomitant use may reduce the solubility of quinolones in the urine and increase the risk of crystalluria.
• Antacids: Concurrent use with aluminum-containing antacids can increase aluminum absorption. Concurrent use with other antacids can increase the risk of alkalosis and hypernatremia.
• Medications affected by urinary pH: Alkalinization of urine may affect the efficacy of certain medications like tetracyclines, salicylates, lithium, chlorpropamide, amphetamines, and ephedrine.

Pregnancy and Breastfeeding

The safety of this drug combination during pregnancy and breastfeeding hasn’t been established. Use with caution and only if clearly needed.

Drug Profile Summary

• Mechanism of Action: Urinary alkalinization and gastric antacid.
• Side Effects: Stomach cramps, diarrhea, nausea, metabolic alkalosis, hypernatremia.
• Contraindications: Severe renal disease, metabolic alkalosis, hypocalcemia, concurrent use with methenamine salts.
• Drug Interactions: Quinolones, antacids, drugs affected by urinary pH.
• Pregnancy & Breastfeeding: Safety not established, use with caution.
• Dosage: Adults: 4-8g, 3-4 times daily; Children (6-12 yrs): 4g, 2-3 times daily.
• Monitoring Parameters: Urine pH, serum electrolytes, acid-base balance, renal function.

Popular Combinations

This product is not typically used in combination with other drugs aside from its use to potentiate the effect of sulfonamides.

Precautions

• General Precautions: Evaluate patient history and monitor electrolytes, especially for renal impairment.
• Specific Populations: Use with caution in pregnancy, breastfeeding, children, and the elderly. Monitor closely.
• Lifestyle Considerations: Advise patients on a sodium-restricted diet about sodium content.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Citric Acid + Sodium Bicarbonate + Sodium Citrate + Tartaric Acid?

A: Adults: 4-8g, 3-4 times/day; Children (6-12yrs): 4g, 2-3 times/day.

Q2: What are the primary uses of this drug combination?

A: Relief of UTI symptoms, gout therapy, enhancing sulfonamide antibiotics, and treating minor indigestion.

Q3: What is the mechanism of action of each component?

A: Sodium bicarbonate and citric acid/sodium citrate alkalinize urine; sodium bicarbonate and tartaric acid are antacids.

Q4: Are there any contraindications for this medication?

A: Yes. Severe renal disease, metabolic alkalosis, hypocalcemia, and concurrent use with methenamine salts.

Q5: What are the common side effects?

A: Stomach cramps, diarrhea, flatulence, belching, and nausea.

Q6: What are the potential drug interactions?

A: Quinolones, antacids, and drugs affected by urinary pH.

Q7: Can this medicine be used during pregnancy or breastfeeding?

A: Safety hasn’t been established. Use with caution if the benefits outweigh the risks.

Q8: What precautions should be taken when prescribing this drug?

A: Monitor electrolyte levels, especially in patients with renal impairment. Advise patients with sodium restrictions about the sodium content.

Q9: How should patients take this medication?

A: Dissolve the granules in cold water and drink after effervescence. Take on an empty stomach, followed by additional water.