Usage
Potassium Magnesium Citrate + Vitamin B6 is primarily prescribed for the prevention and treatment of kidney stones, particularly calcium oxalate and calcium phosphate stones. It may also be used to treat renal tubular acidosis, a condition where the kidneys cannot effectively remove acids from the blood, leading to an overly acidic blood pH. This combination is sometimes used for the symptomatic relief of dysuria associated with mild urinary tract infections.
It is classified as a urinary alkalinizer and dietary supplement.
The mechanism of action involves alkalizing the urine, increasing urinary citrate levels, and reducing urinary oxalate levels. This less acidic environment inhibits the crystallization and growth of kidney stones.
Alternate Names
This combination medication doesn’t have a universally recognized international nonproprietary name (INN). It is often referred to as Potassium Magnesium Citrate and Vitamin B6, or Magnesium Citrate + Potassium Citrate + Vitamin B6. It is also known as KMB6. Some brand names include Urikind-KM6.
How It Works
Pharmacodynamics: Potassium Magnesium Citrate alkalinizes the urine by increasing the excretion of citrate, which binds to calcium, reducing the amount of free calcium available to form stones. Magnesium inhibits calcium oxalate crystal growth and aggregation. Vitamin B6 (pyridoxine) reduces oxalate production in the body.
Pharmacokinetics: Potassium and magnesium citrate are absorbed from the gastrointestinal tract. Citrate is metabolized to bicarbonate, which contributes to urine alkalinization. Vitamin B6 is absorbed in the small intestine and metabolized in the liver. The primary route of elimination for potassium and magnesium is renal excretion. Vitamin B6 and its metabolites are also primarily excreted in the urine.
Mode of Action: Potassium and magnesium citrate increase urinary pH and citrate levels, creating an environment unfavorable for stone formation. Magnesium also directly inhibits calcium oxalate crystal growth and aggregation. Vitamin B6 decreases endogenous oxalate production, further reducing the risk of stone formation.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: The primary mechanism of action doesn’t involve direct receptor binding, enzyme inhibition, or neurotransmitter modulation. However, Vitamin B6 plays a role as a cofactor in various enzymatic reactions, including those involved in oxalate metabolism.
Elimination Pathways: Potassium and magnesium are primarily excreted renally. Vitamin B6 and its metabolites are also primarily excreted in the urine.
Dosage
Standard Dosage
Adults:
The typical adult dose is 10-20 mL of oral solution one to three times daily, diluted in a glass of water. Alternatively, one to two teaspoons (5-10 mL) of syrup once or twice daily, or one tablet daily may be prescribed. These dosages might vary based on the particular formulation of the drug. The dose is typically taken after meals.
Children:
Dosing in children should be determined by a healthcare provider based on the child’s age, weight, and specific health needs.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary based on renal function.
- Patients with Renal Impairment: Use with caution. Dose reduction or avoidance may be necessary depending on the degree of impairment, as it can lead to hyperkalemia and hypermagnesemia. Close monitoring of electrolyte levels is crucial.
- Patients with Hepatic Dysfunction: Caution is advised. Dose adjustment might be needed.
- Patients with Comorbid Conditions: Patients with heart conditions, gastrointestinal disorders (such as peptic ulcer disease, intestinal obstruction, or achlorhydria), hyperkalemia, hypercalcemia, or those taking certain medications (potassium-sparing diuretics, ACE inhibitors, angiotensin receptor blockers, some antibiotics) require careful monitoring and potential dose adjustments.
Clinical Use Cases
The use of Potassium Magnesium Citrate + Vitamin B6 in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not standard practice. Its primary indication is the prevention and treatment of kidney stones and renal tubular acidosis.
Dosage Adjustments
Dose adjustments may be necessary based on renal function, hepatic function, electrolyte levels, and concomitant medications.
Side Effects
Common Side Effects
Diarrhea, nausea, vomiting, stomach upset, abdominal discomfort, and gas.
Rare but Serious Side Effects
Hyperkalemia (high potassium levels) with symptoms like muscle weakness, fatigue, and irregular heartbeat. Hypermagnesemia (high magnesium levels) with symptoms like low blood pressure, nausea, and slowed breathing. Severe allergic reactions (skin rash, swelling, breathing difficulties).
Long-Term Effects
Long-term effects are generally minimal when used as directed and monitored appropriately. However, chronic use in patients with renal impairment can exacerbate kidney problems and electrolyte imbalances.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include severe hyperkalemia, hypermagnesemia, and allergic reactions, which require immediate medical intervention.
Contraindications
Absolute contraindications include severe renal impairment, hyperkalemia, hypercalcemia, achlorhydria, and hypersensitivity to any component of the medication.
Drug Interactions
This medication can interact with potassium-sparing diuretics (e.g., spironolactone, triamterene, amiloride), ACE inhibitors (e.g., ramipril), angiotensin receptor blockers (e.g., losartan), some antibiotics (e.g., tetracyclines, fluoroquinolones), and anticholinergic drugs. Interactions may also occur with other medications that affect potassium or magnesium levels. Concomitant use of other magnesium or potassium supplements should be avoided unless under the supervision of a physician.
Pregnancy and Breastfeeding
The safety of this medication during pregnancy and breastfeeding is not well established. It should only be used if the potential benefits outweigh the risks and under the guidance of a physician.
Drug Profile Summary
- Mechanism of Action: Alkalinizes urine, increases urinary citrate, and reduces urinary oxalate, inhibiting kidney stone formation.
- Side Effects: Diarrhea, nausea, vomiting, abdominal discomfort, hyperkalemia, hypermagnesemia.
- Contraindications: Severe renal impairment, hyperkalemia, hypercalcemia, achlorhydria, hypersensitivity.
- Drug Interactions: Potassium-sparing diuretics, ACE inhibitors, ARBs, some antibiotics, anticholinergic drugs.
- Pregnancy & Breastfeeding: Use with caution if benefits outweigh risks.
- Dosage: Adults: 10-20 mL one to three times daily; children: as directed by a healthcare provider.
- Monitoring Parameters: Serum potassium, magnesium, calcium, and creatinine levels; urine pH.
Popular Combinations
This medication is typically used alone. Combining it with other medications specifically for kidney stones isn’t commonly practiced, as the combination itself addresses multiple factors contributing to stone formation.
Precautions
Pre-screening for kidney disease, heart conditions, gastrointestinal disorders, and electrolyte imbalances is necessary. Monitor potassium, magnesium, and creatinine levels regularly. Advise patients to maintain adequate hydration (2-3 liters/day) and consider dietary adjustments (e.g., low oxalate diet, limiting sodium intake, avoiding excessive calcium and vitamin D intake). Caution is advised in elderly patients and those with hepatic dysfunction. Safety in children has not been established.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Potassium Magnesium Citrate + Vitamin B6?
A: The typical adult dosage is 10-20 mL of the oral solution one to three times daily, diluted in water. Alternatively, one to two teaspoons (5-10 mL) of syrup, or one tablet once daily may be prescribed, depending on the formulation. The dose is generally taken after meals. Pediatric dosing should be determined by a physician.
Q2: How does this medication help prevent kidney stones?
A: It increases urine pH and citrate levels, making the environment less conducive to stone formation. Magnesium also inhibits the growth of calcium oxalate crystals, and vitamin B6 reduces oxalate production.
Q3: What are the common side effects?
A: Common side effects include diarrhea, nausea, vomiting, stomach upset, abdominal discomfort, and gas.
Q4: Are there any serious side effects?
A: Yes. Serious side effects include hyperkalemia and hypermagnesemia. Patients should be monitored for symptoms like muscle weakness, fatigue, irregular heartbeat (hyperkalemia), and low blood pressure, nausea, and slowed breathing (hypermagnesemia). Allergic reactions can also occur.
Q5: Who should not take this medication?
A: Patients with severe renal impairment, hyperkalemia, hypercalcemia, achlorhydria, or a known hypersensitivity to any of the components should not take this medication.
Q6: What are the important drug interactions to be aware of?
A: Potassium-sparing diuretics, ACE inhibitors, angiotensin receptor blockers, some antibiotics (tetracyclines, fluoroquinolones), and anticholinergic medications can interact with this combination. Other drugs affecting potassium or magnesium levels may also interact.
Q7: Can pregnant or breastfeeding women take this medication?
A: The safety during pregnancy and breastfeeding is not well established. It should only be used if clearly needed and under the guidance of a physician.
Q8: Are there any dietary recommendations while taking this medication?
A: Maintaining high fluid intake (2-3 liters/day) is essential. A low-sodium and low-oxalate diet may be beneficial. Avoid excessive intake of vitamin D and calcium unless directed by a physician.
Q9: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is close to the time for the next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q10: How should this medication be stored?
A: The oral solution should be refrigerated to maintain potency and palatability. Store tablets and granules according to the manufacturer’s instructions.
