PRICE OF POTASSIUM CITRATE

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WHAT IS POTASSIUM CITRATE

We have reached the point in the evolution of this site where the main stone risk factors are introduced and detailed, and the importance of citrate established. I have written about the price of potassium citrate because many patients and physicians have told me that it has risen steeply in recent months, and I would like to be of help.

A LOUD DISCLAIMER

In this post I will mention beverages and medications by name. Let me be clear: I have no financial relationships with the companies that produce or sell the products I write about here. Likewise neither I nor my colleagues at University of Chicago receive any support, financial or otherwise from these companies.

WHAT DOES CITRATE DO FOR PATIENTS?

It Can Reduce Formation of Uric Acid Stones

Some patients produce too acidic a urine which raises risk of uric acid stones, and they need supplemental alkali to make their urine less acidic. The use of potassium citrate to make urine less acidic will prevent uric acid stones in most patients who form them.

It Can Reduce Calcium Stone Formation in Patients with Low Urine Citrate

Some patients form calcium stones because they produce urine that is low in citrate, a valuable inhibitor of crystal formation. Most of the naturally occurring inhibitors in urine are complex molecules about which we can presently do nothing. But citrate is a small and easily measured molecule which we can prescribe and which will increase the urine citrate in at least some patients. Potassium citrate lowers urine calcium excretion. In so doing it reverses a key kidney stone risk factor. In trials potassium citrate reduced stone formation. 

Potassium Citrate is Preferable to Sodium Citrate

I have a long list of sodium’s undesirable effects. It can raise blood pressure in large numbers of people, especially with age. It raises the amount of calcium lost in the urine, and that increase of calcium can raise supersaturation and promote calcium kidney stones. High sodium intake can reduce bone mineral retention. But, it may be that the sodium in sodium bicarbonate causes less of these problems than the sodium in sodium chloride – table salt. So I offer sodium bicarbonate as an alternative – with reservations.

Because sodium produces problems of its own, we tend to use potassium citrate as the preferred medication, and generations of stone patients have taken it. In several trials it has reduced new stone formation when given to patients whose urine is citrate deficient.

IS THERE A COST ISSUE?

I am not at all sure why the pricing of potassium citrate has become a topic I often hear about from patients, doctors, and just about everybody in the kidney stone world. Certainly the price must have increased, but I cannot find data on the web to prove the point. I also believe Medicare and perhaps other insurers have altered the status of this drug in their payment schedules. Perhaps some of you know more about the problem than I do and are willing to share what you know by way of a comment.

I did find on inspection of the Medicare lists of drug prices by insurance plan that some plans appear to include potassium citrate pills in their formularies at a preferred level and charge as little as $10 for what appears to be 90 pills. Others do not do this and publish higher prices, often as percentages of the retail cash price. Once again, I hope those of you with experiences in purchasing the drug will share what you know.

CAREFUL SHOPPING LOWERS PRICES

Listening to agitated, and worrisome stories about inflated prices for potassium citrate, I decided to try to be helpful. A Google search for prices of potassium citrate yielded a few promising shopping sites, and on study of the prices I found some much better than others. Note that in the following sections I present a lot of prices and arithmetic. Sometimes, when the message is very clear the results are rounded for simplicity. I give the basis for every calculation if you want absolute exact answers to the nearest penny. Likewise, because we are comparing prices, I have chosen 4 pills daily as my cost basis. The actual range can be from 2 to 6 pills or even more daily, so you will have to adjust costs to your own prescription.

SAM’S CLUB

GoodRx gives what I believe is the clearest list of prices. On their site, Sam’s Club was least expensive at $145 for 180 pills or $0.805 per pill. A typical 4 pills per day treatment option would therefore come to $290/quarter, which is still very pricey. The site gives a long list of other stores whose prices are even higher. Everyday health offers an approximate price for Cytra-K and Polycitra K of $50 – $99, but I could not be sure if this was for a month and likewise how much medication was in a dose.

CANADA

So far as I can tell, importing from Canada will not save you much money. I found Urocit K at $1.10 per tablet, which is higher than Sam’s Club. Another generic, K-Citra 10 was $0.79, which is about the same as Sam’s Club. Another less desirable canadian price was $0.52 per pill if you buy 90 pills, but it was for the 5 mEq size, 1/2 of the usual and therefore the corresponding price for 10 mEq would be $1.04/pill. Given that some costs must accrue for mailing, and there are issues with importing, I cannot see an advantage right now.

WHAT TO DO

Shop Well

Certainly web shopping is a good thing because in my modest and amateurish shopping efforts I found a tremendous range of prices. I am sure that many of you who read this post are far more skilled than I am at shopping for best prices. It is time for you to step forward and share your knowledge with all of us by posting a comment. Everyone will benefit and appreciate your contributions.

But even if you shop better than I did, retail pricing for this medication seems too high for most to afford. At even 4 pills a day, and at the best price I found ($290.00/quarter) we are over $1000.00 yearly for this one product. It seems to me that if your plan does not subsidize this medication, cost could be a serious issue.

Use Beverages

A useful publication reports the alkali content of commercial beverages. The ‘lemonade formula’ referred to on the graph is given as 1/2 cup ReaLemon© mixed with 7-1/2 cups of citrate in beverageswater and sweetened to taste with sugar or artificial sweetener. Diet 7-up was the winner with 10 mEq of citrate in a liter. A single Urocit K tablet contains 10 mEq of potassium citrate, as a comparison, so you would need 4 liters of the beverage daily to match 4 pills.

You Can Do Better

My colleague Dr. John Asplin has measured an additional group of products: Minute Maid Lemonade contains 10.3 mEq/liter of alkali, like Diet 7-up. Gatorade contains only 8.3 mEq/liter. But Crystal Light Lemonade contains 21.7 mEq of alkali, so it is the winner. Each liter substitutes for 2 potassium citrate pills, $1.60 a day, or $144 every 3 months.

We know About Classic Crystal Light

Crystal Light beverages include teas and other drinks. Our measurements refer to the classic or standard lemonade beverage. In what follows all of my remarks at bounded by that limitation. For example, I do not know if liters of the Crystal Light tea might contain excessive amounts of oxalate.

The Prices of Crystal Light

I did not research the price of Crystal Light Lemonade extensively, but Crystal Light Lemonade Pitcher Packs – 3-Pack – are $27.95 at Amazon. Each 3 pack provides 96 quarts of beverage. Each quart is about one liter (0.946 liters to be exact). The cost is therefore $27.95/96 or about $0.29 per 20 mEq (2 pills). This comes to $0.58 daily or $52 every three months. The Amazon site points out that prices might be lower at other stores. Please comment on the best prices you have found so everyone can benefit.

It is Not Just How Much Citrate is in the Beverage

You may have read, on a label or in a scientific paper, that some of the beverages I have listed contain quite a lot of citrate, yet we show them as inferior as an alkali. The reason has to do with the form of the citrate. If the drink is made up in a very acidic manner, much of the citrate is citric acid and will not produce alkali in the body when metabolized. It is only when the molecule is citrate itself, not the citric acid, that it can benefit you as an alkali. The graph and the additions by Dr. Asplin present the true alkali content.

Be Wary of Sugar

The beverages are mainly diet so they do not add to your caloric burden. If you sweeten them, or lace them with fruit juice, or add fruit juice or other flavorings to baking soda – see below, you will be adding calories to your diet and that may not be ideal.

But apart from weight gain, sugar has undesirable effects specific to kidney stone formers: It raises urine calcium losses. Even worse, as the article points out, urine flow rate falls as urine calcium increases, so supersaturation rises for two reasons.

What About Sodium Bicarbonate

It Has a Lot of Alkali for the Money

Baking Soda

According to Google, a teaspoon contains 4,500 mg of baking soda (sodium bicarbonate). Given the molecular weight of 84 mg/mEq (each molecule is one mEq of alkali) the teaspoon contains 53 mEq of sodium alkali. In principle, therefore, one can get alkali for nearly nothing by way of price. According to Dr. Asplin, who has – unbelievably – determined such matters, a teaspoon can contain up to 6,100 mg of baking soda depending on packing and whether the teaspoon is level or heaping.

To get 20 mEq of alkali from baking soda would require about 1/3 teaspoon. Given the variability of what a teaspoon holds, and the sheer problems of fractions of a teaspoon for every dose, I strongly recommend we abandon the remarkable cost savings from baking soda and use sodium bicarbonate tablets, which are very inexpensive and measure out the dose for you.

Sodium Bicarbonate Tablets 

You can buy sodium bicarbonate tablets OTC and they are cheap. Concord, via Amazon, sells one hundred 650 mg tablets for $14.95 ($0.14 each). Rugby sells 1000 tablets of the same size for $25.77 ($0.026 each). Because each tablet contains only 7.7 mEq of alkali, it takes about 3 to match 2 K citrate pills (I realize 7.7 times 3 is 23.1 mEq but it approximates 20 mEq and the difference is not important). But that is only $0.075 for the three. So the price can come way down with this form of alkali.

It has a lot of Sodium, Too

But, alas, the 1/3 teaspoon, or the three 650 mg pills, deliver 20 mEq of sodium for each 20 mEq of alkali. The extra 20 mEq of sodium is 460 mg, about 20% of a full day’s sodium intake. For the 40 mEq (4 potassium citrate pills) we have used as a benchmark thus far, it is 40% of a full day’s sodium intake.

Whereas I am unconcerned to recommend beverages as replacements for potassium citrate pills, I have considerable reservation about sodium loads for reasons I have already mentioned and repeat here for emphasis. Excess sodium intake can raise blood pressure in those who are sensitive to salt. Although we have not as yet discussed urine calcium losses as a risk factor for stones, sodium loads will raise urine calcium, and are therefore not beneficial in that respect. If you are taking a diuretic to reduce urine calcium for stone prevention, sodium loads will reduce the efficacy of the treatment and promote losses of potassium. People with heart disease may develop worsening heart failure. Always ask your physician before using sodium bicarbonate as an alkali.

Even so, sodium bicarbonate is not sodium chloride – table salt. For physicians I have reviewed a few papers on the subject. If I sound ambivalent, I am. We may need a few more trials on this subject. In the mean time, all of my reservations hold sway. Use sodium bicarbonate sparingly. 

How To Put It All Together

Compromise is the best policy, and I offer a general scheme which patients and physicians can use, if they wish, with their personal alterations. Be sure and check that your combinations provide the dosages your physician wants you to have.

Make a List of Equivalent Dosages

Each potassium citrate pill is 10 mEq; 2 are 20 mEq of alkali. Each liter of Crystal Light is just over 20 mEq of alkali. Each OTC 10 grain (650 mg) sodium bicarbonate tablet is 7.7 mEq of alkali so 3 make 23 mEq.

Make A Day’s Menu

Consider dividing the day’s alkali into 3 parts: Beverages; sodium bicarbonate; potassium citrate pills.

To Replace 2 Potassium Citrate Pills

If we only need 2 10 mEq potassium citrate pills (20 mEq), substitute 1 liter of Crystal Light (20 mEq). It is part of the day’s fluids, but also like a medication, so spread its use out over the day and, if possible, night.

To Replace 4 Potassium Citrate Pills

If we need 4 pills (40 mEq) consider 1 liter of Crystal Light and three sodium bicarbonate pills (20 mEq). The beverage and individual pills can be spread out through the day.

To Replace 6 Potassium Citrate Pills

If we need 6 pills (60 mEq), consider 2 liters of Crystal light (40 mEq) and three sodium bicarbonate pills (20 mEq) likewise spread out through the day. Reserve the potassium citrate pills for when you tire of the beverage or if the extra sodium is raising blood pressure or urine calcium.

Use Many Beverage Types But Keep the Dose of Alkali The Same

Crystal Light is convenient because of how much citrate it contains. But the chart shows many alternatives which can be used instead in larger volumes. Just remember to multiply so the total amount of alkali remains about the same. For example, you need 2 liters of Diet 7-Up to equal one liter of Crystal Light.

Be Inventive: Not All Days Need Be The Same

Mixing and matching is perfectly acceptable. Each day need not look like the one before so long as the correct amount of total alkali is used. The only drawback of a mix and match approach is confusion, so make lists and keep track. As a general rule, try to make the sodium component smaller than the beverage component. Keep the expensive potassium citrate pills as a convenience and source of variety. Obviously if sodium is contraindicated medically, and beverages are too tiresome as a source for all the alkali that is needed, potassium citrate pills can be used to replace sodium bicarbonate pills.

Not All Patients Need Potassium Citrate Or Any Other Alkali

This post is for those who have been told by their physicians to use alkali. Nothing I have written here should induce anyone to begin alkali unless their physician has prescribed or recommended it. Stone formation is complicated. Sometimes alkali can worsen stones, or even become a danger. Potassium can itself be dangerous if kidney function is below normal. Sodium loads are a problem for people with high blood pressure, heart disease, and other illnesses. Do not use sodium or potassium alkali or even high volumes of Crystal Light unless the physician who is treating your stones recommends you do so.

Stay Hopeful

Whatever caused the price rise, the changes in how insurers pay for this medication, or both, may be transitory. Millions of people have kidney stones in the US. Prices for 90 days of a standard treatment are so high that few can afford them without serious budgetary concerns. When so many people are affected, hopefully market or even political forces will countervail. In the meantime, between a few potassium citrate pills, a few liters of Crystal Light, and maybe some sodium bicarbonate, physicians can piece together an adequate regime of alkali for those patients who need it. Not every stone former does need alkali, of course.

ANOTHER AND FINAL DISCLAIMER

I have brought Crystal Light to your attention as an inexpensive substitute for some of the medicinal alkali your physicians may have prescribed. As in my initial ‘Loud Disclaimer’ I say here that I receive no financial or other benefits of any kind from the makers of this beverage, have not, in fact, ever tasted it, and do not currently plan to do so. My evidence for the value of Crystal Light comes from the work of Dr. John Asplin, and comparisons to the published work of Dr. Eisner and his colleagues.

345 Responses to “PRICE OF POTASSIUM CITRATE”

  1. Kim Lott

    I have taken a supplement of Magnesium Citrate in the form of Natural Calm http://naturalvitality.com/natural-calm/ in the past for the magnesium. I have sent them an inquiry to see how much citrate is in each dose. Can you speak to the efficacy of taking citrate in this form for kidney stones?

    Reply
  2. Bill Wilson

    I am on potassium citrate for my stones and would rather drink crystal light but am deterred by the aspartame. A beverage called Tru Lemon is sweetened by Stevia which seems to be healthier than aspartame. Would you happen to know if this Tru Lemon contains the same ability to help with stones as Crystal Light? Thank you

    Reply
    • Fredric Coe, MD

      Hi Bill, No evidence supports a danger from aspartame. The sugar lobby has spread unfounded fears. I do not know what is in the lemon beverage as we did not test it. Regards, Fred Coe

      Reply
      • Sheldon Haversham

        I have a similar question to Bill that may interest Bill as well. Crystal Light Pure is another product sold in the exact manner as its original except made with Stevia instead of Aspartame. I too came here to ask if Crystal Light Pure had been tested as I do prefer Stevia over Aspartame. Aspartame & Sucralose has been shown to change gut flora which in turn is related to the onset of diabetes. Here’s an article about it in the NY Times: https://well.blogs.nytimes.com/2014/09/17/artificial-sweeteners-may-disrupt-bodys-blood-sugar-controls/?action=click&contentCollection=Europe&module=MostEmailed&version=Full&region=Marginalia&src=me&pgtype=article&_r=0

        Would you or anyone out there be willing to test Crystal Light Pure for Alkali content? If anyone out there must ingest Aspartame or Sucralose I recommend taking something to rectify your gut flora daily such as the probiotic “Kefir”. There are many brands of Kefir in the milk refrigerator at your local grocers.

        Reply
        • Sheldon Haversham

          Ps. Crystal Light Pure does not taste as acidic & its ingredients differ in many ways other than just its sweetener.

          Reply
        • Fredric Coe, MD

          Hi Sheldon, The person who did the work is Dr John Asplin at Litholink. I do not know if he is willing to do this kind of testing again. I read the NYT review of the work, in rats with inadequate human work – too small. I am unimpressed because the sugar institute has long financed research designed to cast doubt on the safety of sugar substitutes and found willing scientists to find this or that problem. Sans a real human study – large enough and convincing – I am totally not convinced. But, if you are concerned, I understand. Beverages with sugar in them are a known health problem because sugar is 1/2 fructose and fructose is established as a serious health hazard – that is why the sugar industry keeps trying. Regards, Fred Coe

          Reply
        • David B

          Here’s a quote from another part of this site, regarding sweeteners: “Please note that Stevia is very high at 42 mg for one tsp so be careful.” It’s on the page entitled How to Eat a Low Oxalate Diet.

          Reply
  3. C chan

    You can also buy bulk potassium citrate powder on amazon. $14 for 250gm or $30 for one kg.

    Reply
    • Joseph Ventresca

      Be careful taking potassium citrate powder, because that is a huge quick dose, compared to the pop and lemonade that are drank a little at a time thru out the day, or the prescription potassium citrate that is in a wax base to allow it to be released much more gradually than plain pot cit powder. Also, the prescription pot cit has cautions for it, like it can burn a hole in your intestine, so I suppose the powder is much more dangerous. So you’ll have to dilute it and take it like the lemonade in a dilute concentration thru out the day. I suggest reading -googling potassium citrate FDA insert to see the side effects /dangers of it to help you be careful with using a concentrated powder.

      Reply
      • Fredric Coe, MD

        Hi Joseph, I like both of your comments, and I agree with them. If anyone is buying the food grade potassium citrate and weighing out doses, diluting the powder in some beverage and drinking it over some hours – that is a good idea.

        I also have to say that I cannot endorse this whole practice unless everyone who practices home measurement of potassium citrate does it in consultation with their physicians who can assure things are being done correctly. Potassium salts are dangerous, some people have diseases that make sudden doses of potassium especially dangerous. I regret the profiteering of the drug maker(s) who have so scandalously inflated the price of this simple supplement but I fear someone will injure himself/herself for lack of skill in measuring, for taking in potassium too rapidly, or by having a condition that affects potassium handling. Please, everyone who reads this, involve your physician if you intend to do your own potassium citrate preparation – your physician has scientific training and medical training and can keep you safe. So I agree with Joseph but also worry. Regards, Fred Coe

        Reply
  4. James Roberts

    Dr. Coe- I was taking 4 Potassium Citrate tablets ER (15MEQ) per day, but going on Medicare has made those steep price rises a factor now. My doctor recommended Klor-con EF (25MEQ) 3X’s a day as a cheaper alternative–but every pharmacist I speak to says Klor-con is not indicated for uric acid in the bladder, which is my particular condition. I feel caught in the middle–do you have any thoughts on this? Thanks in advance. James Roberts

    Reply
    • Fredric Coe, MD

      Hi James, Klor-con is potassium chloride which will not help you. Klor-con/EF is potassium citrate bicarbonate which will raise urine pH and help prevent uric acid stones. THe confusion is about the ‘EF’. Regards, Fred Coe

      Reply
  5. Dennis Rph

    Drug pricing is my specialty, I have worked years for the PBM which is now known as Caremark or CVS/Caremark. I also have owned and ran several pharmacies, this includes independents as well as Walmart’s and Costco’s. I would be glad to go over individual drug pricing trends, but for summary sake here is the issue. Generic (non patent holding) drugs are being pursued as commodities in the free market capitalist system. Companies or even huge investors with drug distribution ties are playing a supply and demand game. They corner the market on the supply and then demand you pay whatever price they determine. The supply takeover is really quite easy as there are usually very limited production sources of cheap raw materials in the global market place. This limitation of producers was market driven due to very low drug prices in the market for these long time off patent drugs. Now some great profit based minds decided hey since these materials are so inexpensive in daily drug price dollars, and couple that with the fact people are Forced to take this product or suffer the consequences, market takeovers are commonplace. As soon as a investor or generic manufacturing company (many of which are big drug company owned!), achieves market control on the supply, they can raise prices with reckless abandon! Who’s gonna stop them! There are no regulations against. The people are often oblivious especially if their insurance is paying the tab so there is minimal outcry if your only paying 10$ copay regardless. And the insurers or the PBMs responsible for paying the Bill! They get paid by the group plan they administer for and are indirectly rewarded for managing higher drug outlay. Not to mention that the pbms like Caremark/cvs are owned by drug wholesalers, manufacturers and insurers even! When prices are high in drug industry everyone wins except consumer who finances this bill. Drug price comparing sources like good Rx are a scam, look logically at why would they give a discount card for FREE and spend millions in ads as a for profit company??? Where does the money come from? I’d be glad to tell you in emails. Frustrated Pharmacist, and drug Managed care and pricing expert. Dennis clark.

    Reply
    • Fredric Coe, MD

      Hi Dennis, I am amazed and appreciative! The latter to have you comment on this site – we have about 68,000 people on the site monthly, all because of kidney stones – I presume – and shocked about this one cheap now expensive mineral supplement. Dr Steinerman was right to post here and try to create a discussion forum. For a physician, there is only one question needed to have a moral compass: Is this the best I can do for my patient? It looks like for the drug industry the moral compass is also exacting: Is this the worst I can do for my patients? You imply there are no regulations because of the anaesthetic effects of insurance companies that themselves are happy to simply pass on costs to the plans who then pass it on the – did I say? – patients. If the plans evaporated and people had to buy the stuff prices would fall like a lead plummet into the ocean and all would be well. Thank you so much for helping us understand our local plight in a larger context. Is it possible you would write a guest article on this site concerning exactly what is in your comment? This site, as you can see, is run by me for my university and free from all commercial content and bias. I would be thrilled to host the article and feature it. Let me know – email is on the site. Obviously, because of our specific issue, it would be ideal to focus on potassium citrate as an example of the much more vast issue in your comment. Warm regards, Fred

      Reply
      • Dennis clark

        Dr Coe,
        Dear sir, sorry I’m just seeing this. Would love to re-write for your audience. Pricing in the drug world has got to change. Individuals make more selling a bottle of pills that you would be paid for an entire surgical procedure.
        Will send this via email as well with my personal contact info.

        Reply
        • Fredric Coe, MD

          Hi Dennis, That would be great. Best for the text would be as a Word or perhaps Google Doc for the text. Likewise, I would like to post a standard head shot if you have one convenient. I do this for all posts when possible. Please feel free to expand on the theme, articles can run to over 8,000 words which means essentially no limit. I think many would love to know more. If there are links to news articles, or other sources, let me have them and I can put them in. If you do it as a Google Doc the links stay in when I import.

          I will feature your article on all the pages and I assure you thousands will read it.

          Fred

          Reply
  6. John

    Fred,

    Would an meq of potassium bicarbonate be just as effective as an meq of potassium citrate for urinary alkalinization and raising urinary citrate levels?

    Thanks!

    Reply
    • Fredric Coe, MD

      Hi John, In a way yes: alkali is alkali. Possibly no in that citrate has to be metabolized to bicarbonate and that spreads the effect out. Said better, it has to be absorbed and metabolized as citric acid, taking up a proton in the process which proton, being consumed, is replaced by loss of a proton from carbonic acid in blood thereby producing bicarbonate. The longer time span – it real – is an advantage. I have happily used both for years and cannot tell them apart. I know of no trials even in relation to urine pH although perhaps I have not looked well enough. Thanks for the great comment – Fred

      Reply
      • John

        Fred,

        Thank you for the follow up. I asked because:

        1. If the alkali effect of 1 meq of both substances is equal, would the potassium bicarb be useful/not as useful because the bicarb version would have less potassium?

        2. I am not a chemist but wondered if the citrate version had more alkali effect due to having three proton binding sites rather than one.

        Once again thank you for all that you do.

        John

        Reply
        • Fredric Coe, MD

          Hi John, In mEq units of the potassium salt, the two are equal if equal. The mass of material for 10 mEq of the one is not the same as for the other. mEq is the product of gm moles of the material times the available binding sites. Regards, Fred

          Reply
  7. Joshua R Steinerman MD

    As a stone former and physician drug developer sensitive to pricing and public health, I was shocked to learn my 3 month supply of potassium citrate would cost me over $1000 at a retail pharmacy, whereas I paid much less than this last year under a different pharmacy benefits manager. On the other hand, I was so grateful for Dr. Coe’s writing on this issue and for the community of stone formers who are struggling to secure their necessary preventative treatments.

    Given all of the above, I am endeavoring to understand the extent and basis for the apparent price increase, perhaps somehow to improve this unfortunate trend. I would be pleased if this would be an appropriate forum to exchange more specific facts regarding recent prices trends of prescription potassium citrate, and possible recent changes in market dynamics, such as with the various manufacturers, pharmacies, or pharmacy benefits managers.

    Thanks to all who may have constructive input or who may be interested in joining me in additional due diligence.

    Joshua

    Reply
    • Fredric Coe, MD

      Hi Joshua, this is an open forum for all interested and good intentioned people, and certainly for an expert like yourself. COnsider it your forum. The price increase is indeed shocking and seems like mere greed. But perhaps you have a more nuanced view which I would want to understand. Warm regards, Fred

      Reply
      • Joshua R Steinerman MD

        I’m so glad we will be able to bring our collective influence to bear on the problem of PC pricing. Although Dr. Coe indicated he is not particularly political, he rightly noted that the solution will involve activism. I’m hoping to play some part in this, and will rely on support of those on this blog and others. I am fortunate to be under treatment by a nephrolithiasis expert at the University of Pennsylvania, who mentioned on my last visit that if he learns about increasingly concerning price issues, he would himself take this to Washington!

        While I’m not yet able to conclude the price driver is “pure greed” I will not be surprised to learn something similar is at play. What will be helpful now are more detailed facts about actual prices paid/charged in the past 1-2 years for prescription PC, including the manufacturer of the dispensed product, the pharmacy, and the pharmacy benefits manager or insurance plan.

        To facilitate, I have created a dedicated email account: potassiumcitratepricing@gmail.com

        Please send all specific facts of interest to that account and I will update the forum as I learn more.

        This won’t be easy, and I don’t know the probability of success, but I hope to find out! At a minimum, armed with facts and the testimonies on this forum alone, I expect we can attract media interest and additional expert input.

        It is very clear to me that the PC pricing case is a specific and clear example of unjustified price hikes on a simple, off-patent, molecule which addresses a medical need of a relatively small, but captive clinical population.

        Reply
    • Linda Canestraro

      I am not a doctor. I’ve been on this computer hoping to find out why my potassium citrate 1080mg prescription went from a tier 2 to a tier 4 drug this year! I don’t have a kidney stone issue. I take a “cocktail” of drugs to stave off osteoporosis (also OTC calcium, Vitamin D and hydrochlorothiazide). I screamed when the pharmacy aide told me I would have to fork out over $160 for a one-month supply of this medication! But now I see you have found much higher pricing, depending, I guess, on the prescription plan. Who manufacturers this medication? What did they pay for R&D? Is there a patent on it? It’s potassium, for God’s sake, not an invention! I would like to see an investigation and new media coverage, but, alas, this is not a life-saving drug, for the most part. It’s not an EpiPen. President Trump wants to replace the ACA with something more affordable. I hope that drug pricing is on his list. I hope you will put me on your email list.

      Reply
    • Dace Pellettiere

      We are lucky that we have AARP Supplement OptumRX, we pay a premium for both my husband and myself. This medication costs $65.00 for us as a co-payment, but actual price would be $160.00. So we’re saving $95.00, but if you take into account the premiums we have to pay the savings are lower. I don’t know why the cost of this medication is so high, but I have noticed that many medications have gone into higher tiers of drugs. So then the prices go up.

      Reply
  8. Stanley Gage

    BTW
    Blood tests done at the same time as the urine test showed potassium levels were right in the middle of the desired range. Can’t get to the actual data right now because med center servers are down for maintenance.

    Reply
    • Fredric Coe, MD

      Hi Stanley, I would expect the blood potassium to be normal as it is regulated powerfully by the kidneys and the body cell mass. Regards, Fred Coe

      Reply
  9. Stanley Gage

    I’ve made my own 1000 milligram postassium citrate gel caps w/o any real challenges. Problem is that after 1 month of taking these in place of the 1080mEq tablets the urine Ph had dropped from about 6 to about 5. This urine test was from a sample taken about 8 hours after taking 2 of the prescribed 4 – 1000 milligram doses. Question is how quickly does the Ph respond to the ingested dose and how quickly is most of the dose excreted through urine or other body functions? ie. has anyone done studies on Ph vs time after dosing? Urologist has suggested spreading the 4 gel-caps more evenly over the day. I did experiment with the dissolution time of the gel-caps versus the tablets. Gel caps were fully dissolved in 100 F water in ~ 8 minutes. Tablets were unchanged in form but easily penetrated by a fork after 1 hour. After 5 hours I gave up and could easily crush the tablet between 2 fingers which released some granular material which quickly dissolved and left behind a small amount of what I presume was a binder material. I suspect the granular postassium citrate was slowly dissolving out of a platform of the binder material.

    Reply
    • Fredric Coe, MD

      Hi Stanley, the fall in pH makes one wonder if the material is being absorbed. The eight hours should be enough. If the tablets you make are a proper substitute the correct approach is to substitute them for the Rx version at the same presumed dose and timing, and get the pH of a 24 hour urine collection for comparison. All else is subject to timing issues that confuse matters. Regards, Fred Coe

      Reply
    • Fredric Coe, MD

      Hi Stanley, the fall in pH makes one wonder if the material is being absorbed. The eight hours should be enough. If the tablets you make are a proper substitute the correct approach is to substitute them for the Rx version at the same presumed dose and timing, and get the pH of a 24 hour urine collection for comparison. All else is subject to timing issues that confuse matters. Regards, Fred Coe

      Reply
  10. Lisa

    Hi Dr. Coe,
    I’ve heard that instead of Potassium Citrate, a small amount of sodium bicarb in water can be an effective way of neutralizing the acidity of urine to help decrease the risk of calcium oxalate stone formation. If your blood pressure is under control, is this an alternative method to citrate? Thanks!

    Reply
    • Fredric Coe, MD

      Hi Lisa, No. Sodium alkali will raise urine calcium – because of the sodium, and that will offset the benefits of the alkali which lower urine calcium and perhaps raise urine citrate. In your case, be sure you are acting with informed intent. Have you been fully evaluated? Do you know your stone composition is calcium oxalate? Here is a good plan, check it out. The pH of normal urine is about 6 and one does not want to raise it because higher pH can convert calcium oxalate stones into calcium phosphate stones – in principle. Calcium oxalate stones themselves are independent of pH altogether. Warm regards, Fred Coe

      Reply
  11. Amy Farmer

    I would like to let you know about my results using OTC Potassium Citrate. I am unable to afford the Urocit-K prescription and I had asked for advice prior. My PC level was a 60–yes SIXTY–after my lithrotripsy procedures and I was still making stones. I did the Crystal Light for many months and was able to get my PC up to the low 200’s–still way under normal for my age. I began taking (4) 99mg (just over 3.5 pills equals 10 meq) OTC Potassium Citrate pills from Swanson (mail order, recommended to me by a Health Food store locally) 3 times a day–yes, that is a lot of pills, but the capsules are small and easy to swallow. I am happy to report that, after a follow up with my Nephrologist and a full 24 hour urine test and blood panel, that my reports show that my Pot. Cit. levels are now at 700! This is only after 2 months of the OTC pills. The better news that each 120 capsule bottle is about $2.49–I just bought a bunch on sale at $1.86 during Swanson’s Black Friday sale. With free shipping, that is less than $8.00 a month compared to $350.00 for 3 months via prescription. I am pleased and so is my Nephrologist..he told me to “keep on keeping on” and we will run tests again in 6 months.

    Reply
    • Kathleen Stokes here.

      Kathleen Stokes here. Thank you so much for posting this about the Swanson Potassium Citrate. I’m chronic stone former and should be on PC, but it’s been too blooming expensive. This news may make a huge difference for me.

      Reply
    • Luke

      Hello.

      I am curious, how much lemonade did you drink before? Also, did you switch to PC tabs or added to lemonade drinking? I am asking because the lemonade has about 20,5 mEq of potassium citrate per quart, so 1,5 quarts should make the same dose as 3 daily X 4pcs of OTC potassium citrate pills).

      I’d like to add (assuming dr Coe won’t mind) a small correction: I’d say that “a little less than 4 pills” is more exact than “just over 3,5”. 99mg of potassium = 2,53 mEq, so 4 pills = 10,12 mEq. Also, there is no “potassium citrate” in urine, just “citrate” (in solution, citrate anion won’t bind to potassium).

      PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.

      Regards
      Luke

      Reply
      • Amy Farmer

        Luke–I was drinking approx 2 liters of the Crystal Light. That alone brought my Potassium level to only the low 200’s. I did not get the results from just the drink alone. I continue to drink it–along with another liter of water/lemon water or other beverages throughout the day. The addition of the PC capsules over the last couple of months has brought me up to 700. I assure you, I am in no way affiliated with Swanson’s..just trying to share “real life” results after clinical testing from before and after. We are all looking for a more reasonable alternative to the highway robbery of Urocit-K and the likes. My Dr. actually puffed himself up claiming the “miracle” that his prescribing UK to me and how it worked. I shut him down real quick with the bottle of the capsules I have been taking. I am sure he is disappointed that his kick back won’t be coming. I hope other can have the same success

        Reply
      • Amy Farmer

        “PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.”
        IF I promoted a product and that is not allowed, I apologize, I just thought I would give the name of the product that worked FOR ME. Since we are correcting details, I think that you using the term “lemonade” is deceiving to the general reader. Lemonade is NOT Crystal Light and that is the product that is being touted for it’s PC usefulness.

        Reply
        • Luke

          Well, I didn’t want to offend you in any way, or suggest that you’re affiliated with any company. Also, mentioning a product is allowed and encouraged, as far as I know – and if it is not, only Dr Harris and Dr Coe can decide. I just wanted to point that posts like yours can be received as advertisements for some products (double mentioning the brand, emphasising on the price, saying ‘I am so happy now’ etc.).
          I did not meant *you* are doing it and I apologize if you did take it this way.

          So I understand you have added PC pills and still are drinking the Crystal Light? That explains my doubts – the dose of alkali increased nearly twice; could you post full results of 24h urine test before and after?…
          By the way is it urinary *potassium* or *citrate* in your results?

          Reply
          • Fredric Coe, MD

            Hi, I do not think anyone is promoting products. I would not permit that. Once we get into alternatives to prescription medications naming of products is inevitable, and sometimes can seem like promotion when it is simply identification. Regards, Fred

            Reply
        • Luke

          Looks like compulsory early posting is my habit… I will write in Notepad from now.

          I guess your doctor is more proud than disappointed – prescribed medicine did work perfectly, you only have used a substitute. Much cheaper to be exact.
          Also, I am not familliar with US regulations; possibly he was playing on the safe side – prescribe a controlled pill instead of advising cheaper but not so controlled alternative. So please don’t blame him for it.

          Regards
          Luke

          Regards
          Luke

          Reply
          • Fredric Coe, MD

            US regulations permit physicians to use OTC materials. Use of bulk food products as an alternative to prescription grade is not common, and I have not been enthusiastic because of possible harm from measurement errors when it comes to potassium. Regards, Fred Coe

            Reply
    • Tom Arnote

      Dr. Cole, Thank you for your kidney stone information site which i came across when i was researching Potassium Citrate, which my Kidney doctor has prescribed in order to raise urine citrate levels, so to resist additional Calcium Oxalate stone formation. I have decreased kidney function due to the functional loss of the left side of my horseshoe shaped kidney because of a (painless, unknown) stone blockage in 2006. He categorizes me as a moderate stage chronic kidney disease.

      My most recent blood analysis showed an abnormal high level of blood potassium, 5.6 and then 5.9. this is considered a problem.

      My question regards your article on the substitution of Crystal Light Lemonade Mix for the 10Meq Potassium Citrate Pills. My research seems to indicate there is minimal or zero potassium in lemons, and in the Crystal Light. Therefore, If I drink the lemoande mix, instead of taking the two daily pills, will i continue to benefit from the increased Citrate, while losing the harmful (for me now) effect of the increased Potassium?

      I have been doing the 24 hour urine collection periodically, and the Litholink reports show good improvement in all areas, except for the citrate category, and increasing the dosage of Potassium Citrate is problematic with my decreased kidney function, and the elevated levels of blood potassium. I wonder if the substitution of lemonade mix for the pills will work as i explained above and would sincerely appreciate any comments you may have.

      Best regards,
      Tom

      Reply
      • Fredric Coe, MD

        Hi Tom, Thanks for your important questions. The measurements do indeed show high potassium levels but not in a dangerous range. There is citrate in lemons and potassium is present in almost all fruits. Lemons are in the reasonable amount per portion category with less than 200 mg (5 mEq) per 1/2 cup serving. Crystal litht contains a lot of citrate, and 62 mg (1.5 mEq) in a 2 gm serving which is one drink equivalent. So it is a potassium source if used in large amounts. Your two pills have 20 mEq.

        The real issue for you is in fact none of these matters. Your urine citrate did not seem to rise with the potassium and is probably low because of your kidney disease. I am not so sure you should be on potassium at all, and I would discuss this with my physician if I were you. If your stones are uric acid and you need alkali, perhaps alternative sources are better. If you have had calcium stones, do you still form them or is it that you did once do so? Do your urine chemistries still show any stone risk – often risk vanishes as kidney function falls. In short I would not take potassium in your situation unless your physicians have very significant reasons for needing to use it. Regards, Fred Coe

        Reply
        • Tom Arnote

          Dr Coe, Thank you so much for your reply. I wonder if you have any idea how much good you are doing through this website.
          I have had the same thoughts regarding the use of potassium citrate and your comments are most helpful. I think the initial idea of the Potassium Citrate and other dietary changes was to guard against another serious calcium oxalate stone blockage that caused the failure of the left side of my horseshoe kidney. There was a similar incident some 20 years before, caused by a very large stone that was surgically removed and a temporary stint placed, and the left side kidney function was restored, until the 2006 incident. Because both of my two known stone incidents were serious enough to cause kidney failure and i now have only one kidney, it was felt that i could not afford even one more stone. My 24 hour urine chemistries through Litholink, several between 2011 and 2015, have shown substantial risk reduction, except for citrate, which remains in the higher risk range. So your comments, including the fact that high urine citrate is less likely in kidney compromised patients, and patients with decreased kidney function are less likely to develop stones, leads me to rethink this plan, and i will review with my Kidney Doctor here in Indianapolis soon.
          Thank you again for your kind and good work.
          Best regards
          Tom

          Reply
          • Fredric Coe, MD

            Hi Tom, I am glad the site is helpful. Take a look at the supersaturations, which usually fall a lot with reduced kidney function. Also your stone analyses. Be sure the SS that corresponds to the crystals in stones are not very high – review with your physician. Citrate dosing raises urine pH and urine citrate – more variably, so CaP SS rises and uric acid SS falls below 1. A risk in chronic kidney disease is uric acid stones so be very careful about urine pH – needs to be about 6. There is a syndrome of high serum potassium, low urine pH and low urine ammonia – called Type 4 renal tubular acidosis to which you may be prone. Regards, Fred Coe

            Reply
    • Don

      Dr. Coe, thank you so much for your site and information concerning potassium citrate. I have been on Urocit-K since 1988 taking 2- 10 Meq tablets at night. Paying for them all these years hasn’t been an issue as insurance paid all except $10 after becoming generic. I will be retiring in a couple of years and cost will be an issue. I have looked into the below reference to Swanson Potassium Citrate 99mg capsules and had a couple of questions concerning any potassium citrate. When I looked at the supplement facts on one 99mg tablet, I saw the following; Supplemental Facts: “% Daily Value 3% Potassium(from potassium citrate) Other ingredients: Rice flour, gelatin, may contain one or both of the following: magnesium stearate, silica.Suggested Use: As a dietary supplement, take one capsule per day with food and water.” It states Daily Value at 3% Potassium Citrate. Is this not stating a single tablet is composed of 3% potassium citrate and the remaining 97% composed of the rest of the ingredients? If this is so then how much does one have to take of this to equal the Urocit-k tablet? I have never seen anything stated on the Urocit-K to indicate how much of it’s composition is Potassium Citrate. I’m assuming it is 100% Potassium Citrate unless someone can provide the composition listing on it. The other question concerns the fact the Swanson is a capsule. The advantage of the tablet is it is slow releasing, but if potassium citrate is also available in liquid then then the capsule may not be an issue in an overnight dosage?
      Best regards, Don

      Reply
      • Fredric Coe, MD

        Hi Don, After much study of the label it seems they mean each tablet contains 99 mg of potassium, which is about 2.5 mmol of potassium. Standard potassium citrate capsules contain 10 mmol of potassium as the citrate salt. So 4 of the small pills will match 1 of the prescription pills you have been taking. The 3 percent comes from comparing the 99 mg of potassium to the recommended amount of diet potassium which is a bit above 4000 mg. Regards,m Fred Coe

        Reply
        • Don

          Thank you so much Dr. Coe for your response. I do have another question concerning the following from your site. “I did find on inspection of the Medicare lists of drug prices by insurance plan that some plans appear to include potassium citrate pills in their formularies at a preferred level and charge as little as $10 for what appears to be 90 pills. Others do not do this and publish higher prices, often as percentages of the retail cash price. Once again, I hope those of you with experiences in
          purchasing the drug will share what you know.” I will be leaving the workforce in a couple of years and will be investigating Medicare supplement insurance. Do you by any chance remember what publication that you reviewed the Medicare list of drug prices by insurance plans? I know United Healthcare maybe one such insurance and my company provides for a limited time an opportunity to continue my healthcare plan after retirement but the cost for such a “Cadillac” plan is expensive and the retirement offer only pays a percentage leaving me to pay well over 50% of the plan besides the deductible. Making me think why spend over half of my pension for a supplement plan, still pay a large deductible and then contend with the high cost of medications for me and my wife. The other thing I’ve learned is Veterinarians offer Potassium Citrate pills for cats and dogs for the same reason as for humans and the cost for them is as expensive. Gee you would think after all these years the cost would come down. Is it really that expensive a process or chemically difficult to make such a medication? Doesn’t appear to have any ingredients outside of what you would find in a high school lab.

          Reply
  12. Edmund J. Scott (nickname "Jack")

    Dr. Coe, this is Jack Scott from Greenville, SC who saw you at the University of Chicago in February, 2000. I trust that you’ll recall my visit… one that I’ll never forget, primarily because of the patience you afforded me at a time in my life where my production of kidney stones was such that I was very much concerned about the practicality of life and an overwhelming desire to find a solution to my problem. I bumped into this site tonight while looking for a way to afford the Potassium Citrate pills you prescribed for me (6/day, 180/month, or 2,160 per year). My problem is that I’m on Medicare Part D and the use of this one drug will put me into the famed “donut hole”. Unfortunately Crystal Light is not a possibility for me because I’m allergic to synthetic sweeteners. What I’ve found, however, is a website called GoodRX.com where I can get a year’s supply today (12/6/2016) for $1,190.58 which I will be doing as soon as I can get my Internist to write me a prescription for 2,160 pills for Potassium Citrate (10MEQ). Note that I could’ve purchased the same number of pills on 7/12/2016 for $1,015.60 (that’s an increase of $174.98 in as little as a few days short of 5 months.

    I would like to take this opportunity to ask you a couple of questions. When I originally saw you and you prescribed Chlorthalidone (25mg), 1 tablet daily, I was thinking that you told me that I might have to begin taking Potassium Citrate if taking the diuretic alone caused me to experience dizziness. Was my thinking at that time correct? If so, has Potassium Citrate now become part of the “daily regimen” for kidney stone producers because of other benefits it brings to the table?

    I want you to know, in case you didn’t for some reason, that I worked briefly with Demetrius Bagley in Philadelphia when I was working in the City as a consultant for Wyeth Pharmaceuticals, and I was very fond of him as a physician and friend. We considered using a procedure he used on other patients to clean out my kidneys, but he suggested that I see James Lingeman in Indianapolis instead. So, I had Dr. Lingeman’s surgical procedure, Percutaneous Lithotripsy, and I was told that he had removed 55 stones from my left and right kidneys. It was like being given a new life and a new chance to live again as a normal person. And I owe all of this to you!!!

    I did have a rather large stone several months ago, and it took almost 3 months for me to pass it. I asked Dr. Lingeman to look at a CT Scan of my kidneys, bladder, etc. and he said I was in significantly better shape than when he had operated on me. I assume that this large stone I passed was an aberration in that I was told that there were very small stones in my kidneys, but nothing to come close to the large stone I’d passed.

    Note that I’ve been seeing a physician in Winston-Salem, NC at Bowman-Gray by the name of Jorge Gutierrez-Aceves MD. Would you happen to know of him and would you have any negative feelings about me continuing to see him?

    Thank you for all you have done to help me, Dr. Coe. I can’t tell you how much you’ve improved my life, both for myself and for my family!

    Jack

    Reply
    • Fredric Coe, MD

      Hi Jack, Thank you for the follow up information. I work closely with Jim Lingeman and never knew he operated on you. It was a good choice. Do I take it you had made new stones or were these leftovers? The store you found was found by others as well and is an excellent resource. Being on medications and all you should certainly be tested yearly with 24 hour urines, and things adjusted as needed – we do not want more stones! Please feel free to keep in touch. Warm regards, Fred

      Reply
  13. Stanley Gage

    I have had 2 bouts with stones that required removal. Since the second bout I have been taking Potassium Citrate (PC) 4 pills a day of the 10 mEq strength. No further stones for past 18 months. As with others the cost is a factor particularly as the PC cost combined with the cost of Pradaxa blood thinner drives me quickly into the Part D doughnut hole with a net increase in prescription drugs nearing $1500 per year. It seems as though from reading your material that alternate sources of PC are a viable alternative but I can’t see myself ingesting 2 liters or 4 liters of soft drinks a day. (I have never been a frequent user of soft drinks). I have no concern about accurately measuring out 4 gms of PC per day (as I accurately measure small amounts of chemicals for my wine making hobby) and adding this to the 2 or so liters of water I conscientiously consume daily. Any reason to NOT do this? As the Part D annual costs will be cycling in about 3 weeks I’d like to get started on this for 2017 if you see no risk. I’ve discussed this with my urologist and he is a bit ambivalent on the question not feeling qualified to establish a weight equivalence between a 10 mEQ tablet and a given measure of PC.

    Reply
    • Fredric Coe, MD

      Hi Stanley, I take it you use 4 ten mEq K citrate daily, and presumably because your 24 hour urines showed a low urine citrate or you have uric acid kidney stones. I say this because we need to understand why you take the material and if you need it. Have you been fully evaluated? Lets assume you have been and need this particular agent. You would need to add two 1080 mg (1.080 gm) pill equivalents (2,160 mg) to – let us say – 1.5 liters of fluid – and imbibe two of these beverages daily. The taste being vile you would need to somehow flavor it – probably with some kind of diet concentrate like Crystal light but not that particular brand. Essentially you would me making a kind of ersatz soft drink, even though we don’t think of it that way. The only reason to not do this is safety – you really need to measure right – I know a gram may be large for your measuring technique but potassium can be dangerous. If you decide to do it let your physician know so someone is responsible for you. Likewise what you flavor this with could interact with the potassium or citrate so be sure that is not a problem; your physician is educated in these matters and can be a guide. Do not do this without your physician’s understanding and agreement. Regards, Fred Coe

      Reply
      • Stanley Gage

        I didn’t know that PC carried a bad taste. I don’t try chewing the tablets. Maybe should try one out. If adding PC to water might present a problem I don’t see any challenge in filling gelatin capsules and taking them like any other medication.
        You have stressed in your communication the need to measure accurately which, as I said, I don’t see that this needs to be a technical challenge. The question I have though is that seeing as the nominal dosages of PC seems to be 5, 10, or 20 mEq it would suggest that the prescribed dosage can really only be conveniently varied in 5 mEq steps (nominally about 0.5 gms) As such, I’m ascribing perhaps incorrectly, that a 20 or 30 milligram (2% – 3%) weighing error should not present a significant risk. Since I’d be taking in the range of 4.32 gms per day, an occasional QC check of the total weight of 4 capsules (accounting as well for the Tare weight of the gelatin capsule) would be sufficient to insure that the dosage is not running amok. I use a 20 gm max milligram scale that has a resolution of 1 mg and a calibration weight that can be utilized to check the accuracy periodically. [Note: In our wine making, we are generally working on ~ 500 – 1000 # (~225 – 450 Kg) batches. The first step, for example is to dose the crushed grapes with 20 to 50 ppm metabisulfite – we like to stay on the low side. This calls for weighing 4.5 – 22 gms of a white powder materiel similar to PC.} Titrating acidity often calls for lower quantities of various additives.]

        Reply
        • Fredric Coe, MD

          Hi Stanley, I have no doubt you have the technical expertise and intellectual skills to do this perfectly, and that your skills in wine making are transferable. I urge nevertheless you discuss the program with your physician because in the final analysis your drug treatment is his/her responsibility. Putting the powder in capsules will probably be a less unpleasant gustatory experience. I also have said and say again be sure there is a reason for the drug – not all patients need it or benefit. That is your physician’s job to help with. I believe several people who read the site are doing their own weighing out – they have made comments about it. Perhaps you might contact each other and see how it is going. Regards, Fred

          Reply
  14. Mike Babowicz

    Hello,
    I’m a uric acid stone sufferer of 30y duration, I have been on and off urocit K for years. As of a day ago, I’m back on it and am agast at the price rises and new insurance policies regarding this medication! I’m a physicist by training, so I’m a bit uncertian of some of the chemistry involved…but I can add and divide.

    I found food grade potassium citrate on amazon for 55.00 $ per 5 lbs. Assuming 10 meq, which is about 1.1 g of potassium citrate. At that price the 10 meq dose price would be .027$, about 2.7 cents/10 meq dose.

    This alternative to the outrageously high priced commercial product would requires careful mass measurement on a mg scale,to avoid potassium toxicity…and monitoring.

    What is your opinion of this approach?
    Thanks for moderating this site,I greatly appreciate it.

    Reply
    • Fredric Coe, MD

      Hi Mike, Being a physicist, and quantitative by nature, you have caught up the dilemma. One could measure out doses or pay a manufacturer to do it for you, as that is mostly the value of the pills. Some – read the comments – are measuring and those who do it seem capable lab people. Most cannot because of mg scale issues and the dangers of potassium excess. Sodium bicarbonate is also alkali, and can be bought cheaply, but the sodium can raise blood pressure – as the bicarbonate not the chloride salt this may be a lesser problem. Crystal light lemonade contains 20 mEq of potassium alkali in a liter and costs almost nothing. Fruits and vegetables in 6 servings a day provide about 60 mEq of potassium almost all in the form of anions metabolized to bicarbonate. I would advise a mix and match approach to minimize pill use. Regards, Fred Coe

      Reply
      • Mike Babowicz

        Dr. Coe,thanks for the reply! Interesting and helpful.
        I’ll try the Kcit weighing approch,but cautiously! As chance would have it, a hobby is reloading rifle cartridges, so I have equip to dry measure powders by volume easily, and check weight on a balance precise to 6.5mg. I’ll also measure both by volume and by weight 20 doses and check the deviation, before proceeding. Nasty outcomes for sloppy work in both activities.
        (Also intend to check ph of urine to verify effectiveness).
        Also checking into crystal light option. As locally available, the basic packets make. 2 quarts of drink / 15g packet , if mixed per pkg instructions. But no detailed chemical anylsis evident in the pkg as bought.
        Just to verify,
        20 meq Kcit per 1 lt of drink; mixed as directed
        (not 20meq/15g packet? )
        Interesting that Vegatables metabolize to produce alkali…I never suspected that! Are there any types that are more alkali productive than others? (I also need to control oxlate, I’m told….sort of a mutually exclusive set of parameters…coping with both uric acid and oxylate, my stones were 80% uric,20% oxylate)
        Sodium bicarb?..alas…BP issues….but apealingly priced.
        Interesting website,too. I appreciate the depth.
        We share a fondness for walking in the eastern Alps,it seems. Gotta get these stones managed and get back there…
        Again, sincere thanks!

        Reply
        • Fredric Coe, MD

          Hi Mike, It is 20 mEq/liter which is about a quart. We measured the citrate directly so the label is not helpful. Check the article and look at the graph. Plants and animals have a lot of potassium in their cells most of which is not chloride. Plants have a lot more potassium on a weight basis than animals used as food and the counter anion is usually one of the Krebs Cycle intermediates – citrate, pyruvate, etc. these anions are metabolized as the acid so a protein is taken up per molecule metabolized, thence the production of bicarbonate; blood is PCO2 stated so removing a proton obligates production of new bicarbonate. Fruits are the ideal in having a maximum of potassium anion. Be careful weighing but if you are good to the nearest 7 mg I have no concerns – 7/1080 is a good precision. As for urine oxalate, is yours high? Is your urine supersaturated appreciably with respect to calcium oxalate? Do the uric acid thing and take a look at the whole 24 hour urine test when you do your followup. Regards, Fred Coe

          Reply
  15. Chris

    A link with the scientific results of the study comparing orange juice to lemonade. http://m.cjasn.asnjournals.org/content/1/6/1269.full

    Reply
  16. Chris

    Hello. I found this article with research that orange juice works better than lemon drinks because of the potassium in OJ. I was wondering your thoughts on this. http://www.utsouthwestern.edu/newsroom/news-releases/year-2006/orange-juice-is-better-than-lemonade-at-keeping-kidney-stones-away.html

    Reply
    • Fredric Coe, MD

      Hi Chris, Let me offer a larger perspective on this important matter. Fruits and veggies are an excellent source of potassium, and that potassium is mostly in the form of potassium with organic anions like citrate (malate, fumarate, etc) which are metabolized in their acid forms meaning that their metabolism produces alkali in the form of bicarbonate – in the blood. That in turn liberates citrate into the urine – just like potassium citrate pills do. Any one fruit has the same potassium properties, in varying amounts. For example lemon juice is more acid than orange juice, so the organic acids are protonated – in their anion form, and will not produce new bicarbonate. But orange juice is high in sugar. The modern diet guidelines for US people ask for 6 servings a day of fruits and veggies which will add 60 mEq of potassium – like 6 10 mEq pills – mostly as the organic anion salts. I advocate for this, more or less in line with the articles, but not a mono diet. Assortments work better. Regards, Fred Coe

      Reply
  17. Lois Lloyd

    Just picked up a 90 day supply of potassium citrate at CVS and the cost was $455!!

    Reply
  18. David Goldstone

    Would potassium citrate help prevent future calcium citrate stones? I have had 3 of them over the past 20 years, each requiring hospitalization. I am 67 years old.
    Thank you
    David

    Reply
  19. Marian

    Very informative article. I too take potassium citrate and have for 6 years with no further stones. Also have seen prices double and more. I am thinking of trying out an online site – Swanson’s – that carries 5 brands of pot. cit. Their own brand is 99mg of 120 tabs for $2.49. I take 2/day of the prescription so I think 8/day of the Swanson’s would be equivalent. That would be 15 days for $2.49. Much less than my current co-pay. I have taken Swanson’s cranberry tabs to prevent UTIs for a couple of years and find they work better than Costco’s cranberry tabs and for much less. I will check back and see if you have commented on this. Thanks for your great article and research.

    Reply
    • Fredric Coe, MD

      Hi Marian, The small size – 99 mg is about 1/10th of a single 10 mEq tablet (1080 mg) so you would need 10 of the small ones to make up one of the big ones. Many have come to these small tablets and realized the problem of sheer numbers. Many have been appalled by the rise in price which is altogether unjustifiable. Regards, Fred Coe

      Reply
      • Marian

        Thank you for your answer and thanks for setting me straight on the amount. I don’t have a problem with taking 10 pills twice a day rather than one each time when the price of the ten is under $3 for a 12 day supply versus 5 or 10 times that price with the prescription. Plus ordering a certain amount from Swanson’s provides free shipping – amount depends on the current deal they are giving. I agree with you – the rise in price of the prescription “is altogether unjustifiable.” Thanks Dr Coe.

        Reply
        • fredric coe

          Marian, Lukasz Wojciechowski corrected my error. The label indicates the 99 refers to potassium not potassium citrate, so in fact 4 of them would provide 10 mEq of potassium or one standard 10 mEq tablet. So you are right and you would need 8 daily to replace your 2 present tablets. Sorry! The picture of the label was ambiguous but I found the package information. Regards, Fred Coe

          Reply
          • Marian

            Thank you for letting me know of the correction. At first I am going to take half doses of the prescription and half doses of the Swanson product. Will see at next years Sept checkup if all is well. If so may go 100% with the OTC and forget the prescription after discussing with my doc. Thanks again. Glad I re visited this site. 😊

            Reply
            • Fredric Coe, MD

              Hi Marian, Just a word of caution. I do not know the quality of OTC potassium and potassium is dangerous. Let your physician know what you are doing and have your blood potassium checked after a couple of weeks of taking the material. There is risk to any potassium product. Regards, Fred Coe

              Reply
  20. B.Sachdeva

    Use an empty gelatin to fill up bulk K citrate, would need to weigh one time and determine what weight fills one Cap.
    https://www.amazon.com/Empty-Gelatin-Capsules-Size–1000/dp/B000ACUJRW/ref=sr_1_1_a_it?ie=UTF8&qid=1477540363&sr=8-1&keywords=capsule%2Bshells&th=1

    1080 mg of k citrate will be 10 meq of k and 10 meq of citrate.
    Humans can vary the oral intake widely, and common sources of K will be banana (5-8 meq), Tomatoes (10-20 meq), Potatoes (10-20 meq)
    if you do start taking oral bulk citrate, you have to recheck blood and urine labs

    Reply
    • Fredric Coe, MD

      Hi, Many have pointed out the economic advantages of bulk potassium citrate. My view has to be this: Potassium is dangerous in excess, so please do not measure out medicinal potassium for yourself unless you have requisite skills and do it with the cooperation of your personal physicians. Some people cannot tolerate potassium loads, some people are not skilled in measuring things out at the gram level. Most common scales are not accurate at that level, one needs a balance designed to measure out a gram – the amount in a pill is 1.080 gm. ALways have your physician’s input and agreement for this particular undertaking, meaning that physician takes responsibility for your doing it. If your physician will not assume responsibility, do not do it. Regards, Fred Coe

      Reply
      • Larry B

        Hi Dr. Coe,

        One of the OTC potassium magnesium citrate supplements available in the US contains 140 mg K and 70 mg Mg per capsule. This is probably a mixture of K3(C6H5O7) and Mg3(C6H5O7)2. If so, each capsule would contain 70/12.1 = 5.8 mEq Mg; 140/39.1 = 3.6 mEq K; and 9.4 mEq citrate. The mass of this mixture would be about 800 mg. This is about what I found when I broke open a capsule and weighed the contents.

        The formulation patented by Pak et al assigned to Mission Pharmacal (US5219889) contained 3.5 mEq Mg; 7.0 mEq K; and 10.5 mEq citrate. The mass of this composition would be 978 mg.

        The supplement contains a little less citrate and much less K than the patented formulation. The cost of each OTC capsule is about $0.13.

        For me, use of the supplement has been effective in suppressing oxalate stone formation for over three years. It also seems less hazardous than weighing out bulk potassium citrate. What is your opinion of this?

        I enjoy reading your site. Thanks! Larry B

        Reply
        • Fredric Coe, MD

          Hi Larry, Good discovery. The high Mg to K ratio is a problem as there is no trial of a drug like that. But it is a lot safer than weighing things out at home. Your arithmetic looks right to me. Of course, no trial means folks like me have to say ‘no trial’ so no evidence. The high Mg should in theory be fairly neutral vs. potassium. Regards, Fred Coe

          Reply
  21. Chuck S.

    I have been buying a 90-day supply, 180 tablets, for $145 at Walmart. This price is after the standard Medicare payment. Give good ‘ol Walmart a try!

    Reply
  22. Doug Nicholson

    Search “food grade potassium citrate”. (My first hit is 5 lb bag at amazon.com for $55.) With some careful calculation of dose this could be a viable alternative?

    Reply
    • Fredric Coe, MD

      Hi Doug, You have found what many have found – bulk potassium citrate is indeed available and for human consumption. The problem is weighing out the doses that are indicated and safe which are about 1000 mg/dose – not exact. Not everyone has the skill and instruments to do this and if weighed out inaccurately a high potassium intake could be dangerous or even lethal. So if you wish to use bulk potassium citrate do it with your physician’s cooperation and help. Be sure you know how much to use and can weight out the doses without error. Regards, Fred Coe

      Reply
    • Luke

      First thing – Professor Coe, if you don’t like me replying to others’ post, my apologies. Please just delete this in moderation, I won’t ask why this time.

      Hello again. For a while I am visiting Chicago… that means I have to be extra careful since I can’t afford any checks for three months… measuring urine pH everytime now; thats a pain… well, I suppose better that than the pain of stones.

      Anyway, for people who aren’t sure how to weigh a proper dose – and can’t drink CrystalLight, – I suppose OTC potassium citrate capsules will be the best solution.One 99 mg potassium citrate capsule has ~2,53 mEq, so 4 capsules are roughly an equivalent of one 10 mEq pill. Since 500 capsules can be bought for $15 (or 3-pack for $41) it gives about 9,4 cents per 10 mEq of potassium.
      Of course, if someone has enough skill to measure exact dose, bulk potassium citrate is the cheapest. However, I’d strongly advise using lab-grade weighing scales or get two jeweller scales and check the weight on each one. Preferrably twice. Also, remember to callibrate the scales often, when it comes to our own (or someone else) health, there is no place for mistakes. For 5lbs bag (assuming it is tripotassium citrate monohydrate) its about 2100X 10 mEq doses and $55 price – ~2,62 cents of 10 mEq dose.

      Regards
      Luke

      Reply
      • Joe

        I’m not so sure that this calculation is correct. My understanding is that the 99mg referred to on the label is the amount of potassium per tablet. I saw somewhere else that really there is 275 mg potassium citrate in these tablets, and therefore that is the beginning point of the calculation. Can Dr. Coe confirm the true meq in these 99mg labeled capsules?

        Reply
        • Fredric Coe, MD

          Hi Joe and Luke – I do not have a label, so I cannot help. But with the label it should be possible to tell these two apart. Sorry, Fred Coe

          Reply
        • Luke

          Hello
          Yes, I meant PC pills with 99 mg of potassium – thats about 275 mg of potassium citrate monohydrate; 99 mg is the maximum amount of potassium that can be sold in OTC supplements in US
          (though some suppliers aren’t exactly respecting that… – earlier I have posted link to potassium bicarbonate tablets with over 500mg of potassium per tablet).

          Here is the label of PC pills I linked to earlier:
          https://images-na.ssl-images-amazon.com/images/I/61sCMBaICvL._SL1000_.jpg

          Potassium (as potassium citrate) – 99mg (3% DV), this is about 2,35 mEq of potassium.

          Reply
          • Luke

            And yet again I have posted too early… I am sorry.

            Thanks for this correction – I was unclear with 99mg pills. Of course I meant 99 mg of potassium, not 99mg of potassium citrate.

            And seriously, I can’t understand why the pills like Urocit K can be so pricey. Potassium citrate is not patented!

            Regards
            Luke

            Reply
          • Fredric Coe, MD

            Thank you, Luke for providing the label. 99 mg of potassium as potassium citrate is as you say 99/39.1 = 2.53 mEq of potassium. Regards, Fred Coe

            Reply
    • Larry Thomas

      Why not just donate platelets? You can get paid $50 a session, and citrate is used as an anticoagulant in the process? They let you donate twice every 7 days. No more stones, and a little more jingle in your pocket.

      Reply
      • Fredric Coe, MD

        Hi Larry, I do not believe the citrate is infused into the donor but is used to prevent the platelets from clotting together. Intravenous citrate is a complex matter and not a solution for kidney stones. Regards, Fred Coe

        Reply
        • Vashra Araeshkigal

          Have you used EDTA in your treatment of stones, Doctor? My husband found it online and took 400mg/day for 30 days and it seemed to whittle down his stones to ‘no longer causing him that much pain. He only did the EDTA for 30 days, alternating between it and a 30 day regimen of higher than normal calcium/potassium/magnesium/C/D (because the EDTA isn’t picky about what it removes).

          I was wondering if it’s a safer alternative to messing about with potassium citrate and jeweler’s scales.

          Reply
          • Fredric Coe, MD

            Hi Vashra, EDTA is potentially toxic and complex chelation treatment and has no place in stone disease. In the one study apart from removal of toxic metals, sodium EDTA was infused into patients in attempts to remove calcium from vascular lesions. It did not confer significant benefits. Intravenous infusion is the only way this drug class has been used medically. I know that EDTA is a popular complementary medicine practice but its role in stone disease has no basis whatever at this time. Regards, Fred Coe

            Reply
  23. Mike

    SAM’S club has recently increased the price of a 90 day supply of potassium citrate pills to $266.00

    Reply
  24. Athanasios K

    Hey, Doc.

    So I was looking around for some potassium citrate for my father’s Kidney stones and found it in bulk on amazon ($13.96 for 250 g , $29.96 for 1 Kg, and $126.96 for 5 Kg)

    https://www.amazon.com/BulkSupplements-Potassium-Citrate-Powder-grams/dp/B00ENSA942/ref=sr_1_2_a_it?ie=UTF8&qid=1473040623&sr=8-2&keywords=potassium%2Bcitrate

    But that doesn’t seem cheap at all. Am I missing something? Also, I recently discovered that the daily value of potassium is 4,700 mg. Does the potassium in potassium citrate go to meeting that daily value?

    Thanks in advance!

    -Athanasios

    Reply
    • Fredric Coe, MD

      Hi Athanasios, Many have found bulk potassium citrate – see the comments on this article but how will you safely make up doses? Potassium is potentially dangerous and you should not try to use bulk material unless you and your physician are sure you can safely measure out the 1000 mg in a dose reliably. Do not use it without that precaution. Regards, Fred Coe

      Reply
      • Athanasios K

        My apologies, Dr. I tried to open up as many comments as time permitted and use ctrl+f to look for terms like ‘bulk’, ‘cheap’, etc., but to no avail. :/

        At any rate, could I use a sensitive kitchen scale (with precision down to at least mgs) + weigh boat like in a chemistry lab? (What dilution do you recommend for this?)

        Also, looking for the bulk potassium citrate had me discover the common claim on the internet that, “98% of individuals are deficient in potassium to some extent”. At first, I thought, “Quackery! Marketing scams!” But apparently a number studies have confirmed this. [] So the FDA lists 4,700 mg of potassium as the RDA. But i’ve found that supplements—-even those purposed for potassium—-rarely have anything above 3% of the RDA. [] Moreover, I don’t think I get anywhere near this daily 4,700mg of potassium, but i’ve had my potassium tested, and it’s not out of the normal range! How could this be? Is the normal simply not the ideal (4,700 mg)? To complicate things a bit more, I can’t find an Upper Limit for potassium intake, but the dangers of overdose are substantial. What gives? Why is the RDA 4,700, but supplements only offer 3% of that?

        All of this gets to one final question: can potassium citrate be used by those with (and without) kidney stones to safely reach their potassium requirements (while also inhibiting kidney stone formation)? (Seeing as potassium citrate is a little under 40% potassium by mass, I’d think that it’d take something like 12,000 mg of potassium citrate per day to meet the RDA for potassium by potassium citrate—-could that amount really be safe?)

        Reply
        • Fredric Coe, MD

          Hi Athanasios, Potassium is highly abundant in living cells so most cellular foods provide a lot of it. The recommendations are like this: ‘ WHO recommends an increase in potassium intake from food to reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults (strong recommendation1 ). WHO suggests a potassium intake of at least 90 mmol/day (3510 mg/day) for adults (conditional recommendation2.’ This is a high side number and is for food potassium. You probably are getting something like this from eating. As for weighing out bulk potassium as a drug I cannot recommend such a thing unless you are skilled in laboratory measurements and are doing this with your physicians. Potassium excess can be lethal, and the tolerance for potassium is affected by diseases – like diabetes or kidney disease, and also by medications. Regards, Fred Coe

          Reply
  25. Ariel M

    Dr Coe,
    I found this information very useful. I am a nephrologist in NJ. In practice for about 8 years. I love treating kidney stones,
    but I have to tell you that over the last 3 years the complaints regarding the price of Potassium citrate have become increasing numerous and have made treatment exceedingly more difficult (and less gratifying). Your article and suggestions will be very valuable going forward. Given how valuable the information is,,, any way you can get this published as an editorial in CJASN.
    Thank you.
    Ariel

    Reply
    • Fredric Coe, MD

      Hi Ariel, Thanks for the note. I don’t think CJASN would have any intentions of publishing from the web – the journals have their own lives. I have long been part of that world and understand – as you do – it is part of an older tradition. Personally, I have become so addicted to using diet and fluid change as a base I often get away with little medication, but the pricing of K citrate is so outrageous that when I need citrate I begin with crystal light. Warm regards, Fred

      Reply
  26. Michelle Groleu

    I have been trying to see if anyone else has asked this question and did not see it. If lemonade is good….why not just take a shot of pure lemon juice a couple times a day and then wash it down with some water? If this would help for the kidney stones I am thinking it might also be better for tooth enamel then to slowly drink lemonade all day. You can pretty much swallow the shot without any touching your teeth.

    Reply
    • Fredric Coe, MD

      Hi Michelle, I did not say that lemonade was so good, other have said it. The amount of citrate can be rather low because the material is acidic so citric acid predominates and that will not help stones. Crystal light is a common beverage that has a significant amount of citrate – not citric acid, and will not damage teeth. Regards, Fred Coe

      Reply
  27. Wayne Lee

    Do patients with a history of recurrent calcium oxalate stones who are taking calcium citrate supplements need to take potassium citrate? Is there a concern that a patient could take too much citrate? Please advise. Thanks.

    Reply
  28. Tanya Kane

    I form stone about every 2 years. My urologist started me with drinking nothing but high citrate drinks (I look for citrate being the number 1 ingredient). Recently she added a potassium citrate pill to my regime. Here is my dilemma, I recently had a hysterectomy and have been experiencing what would be described as a uti. The labs all came back as negative and it was suggested I cut out all citrate. I did and feel so much better. My urologist suggested I take just the pill and drink lots of water. The pain came right back. I don’t want to form stones but I also can’t deal with the discomfort when I have the citrate. Do you have any suggestions on what I should do now?

    Reply
    • Fredric Coe, MD

      Hi Tanya, The issue here is what is wrong in the first place that is being treated with citrate, and what happened to your urine chemistries when you used the citrate. Take a look at the way to evaluate the causes of stones – and choose a treatment, and be sure this was done and there is a need for citrate. If so, what happened in your urine when follow up measurements were made while you were taking the citrate. Pain would have to be from crystals – citrate itself is not able to cause bladder pain, so 24 hour testing should show some of the problems. Another approach is for your physician to see if crystals were in the urine, or blood. Regards, Fred Coe

      Reply
  29. Joel Rolley

    Dr., I had multiple calcium kidney stones until I was diagnosed with an extreme citrate deficiency. Having a 24-hour Urorisk profile I believe the normal range for that test was between 500-1000 (forgot the unit of measurement dg/ng/etc). I was at 42. I was placed on 40Meq a day. An amazing side effect was an immediate loss of weight (over 10% of total body weight in just four months and 20% of total body weight over 12 months). Is that normal? Can a citrate deficiency cause the body to retain water? Losing weight was so difficult before, now it is so easy it feels like cheating.

    Reply
    • Fredric Coe, MD

      Hi Joel, That certainly is a very low urine citrate! I presume treatment raised it and I hope that ends your stone disease. I know of no reason shy citrate treatment would cause a loss of weight. I presume this was a loss of fat, not muscle or edema fluid. Maybe the citrate reduced your appetite? Regards, Fred Coe

      Reply
  30. matt c.

    Is it possible to take citric acid only? Powdered citric acid is relatively cheap. If it can be used as an alternative, how much needs to be used per day for stone prevention?

    Reply
    • Fredric Coe, MD

      Hi Matt, This question was asked and an experiment done. No. You get of increase of urine citrate or pH. So, no. It is a great question as it took a scientific experiment to get the answer. Regards, Fred

      Reply
  31. Amy Farmer

    Hello Dr. Coe,

    I was just put on (4) 10 Meq a day of Potassium Citrate and was FLOORED when I picked up my script. WITH my insurance, a 90 day supply was $350.00. This is SINFUL and I cannot afford it. I am going to try for 2 pills a day plus the crystal light to stretch my pills. I have another 24 urine test in November and I will see how it’s going. I am just shocked and appalled what big Pharma makes us do to survive. My current citrate level is 213–which is up from 170 on the Crystal Light therapy alone from 6 months ago..do you think he is be aggressive with 4 pills a day?

    Reply
    • Fredric Coe, MD

      Hi Amy, Everyone is unhappy with what the drug makers have done. Take a look at the comments on this article, some of which offer nifty workarounds if you can use them. Your urine citrate seems very low and did not rise much so perhaps you really need more. Regards, Fred Coe

      Reply
  32. Luke

    Hmmm… and another thought – if sodium bicarbonate is considered as an alternative, what about potassium bicarbonate? I saw 240 capsules of 1,35 gram KHCO3 ( ~13,5 mEq of potassium) for $17. While pills of that size can be problematic, for some people it can be a cheap alternative…
    PS. And out of curiosity, why my previous post is still in moderation?

    Regards
    Luke

    Reply
    • Fredric Coe, MD

      Hi Luke, Sodium bicarbonate is not a substitute if one wants to use potassium citrate in treatment of calcium stones because the sodium will increase urine calcium. I did not know about these potassium bicarbonate pills – They could be a substitute. Can you reference their source. If your prior comment is in moderation it is an error, and I will check through as I wanted it to be up. Regards, Fred Coe

      Reply
      • Luke

        Hello again.

        I was just wondering if the posts with links are moderated more carefully… thats why I asked.

        I saw the portion about sodium bicarbonate (I understand that it is helpful with uric acid stones but potentially harmful in oxalate and really bad in the case of apatite stones… ) in the article, and so wondered if potassium bicarbonate would be even better than sodium? It isn’t about me – I am using potassium citrate measuring the dose myself, so the cost is like 20$/year , but maybe for someone else reading this, it would be helpful to have cheap alternative. The bicarbonate pills in my link are really large, so should be used with caution.

        Reply
        • Fredric Coe, MD

          Hi LUke, These are the 13 mEq of potassium you mentioned, I presume. I am surprised that OTC products can be so high. For people who can tolerate potassium – most healthy people not on drugs that might cause problems this could be a useful agent. I cannot see the amount per pill on the label – are you sure about the quantity?? As for curating, Jill Harris and I do almost all of it, and I use links whenever needed. You are rather sophisticated and seem to know very well what you are doing, so I just take what you say and try to understand if there are problems for patients. Can you confirm the dosage? Is it simply potassium bicarbonate? Thanks a lot, Regards, Fred Coe

          Reply
      • Luke

        My apologies for sending comment too soon by accident…

        I have a pretty complicated case, with hard soda addiction (for few years was drinking 2 liter and more per day… now I am fighting it but still got a low willpower…). 6’3” tall with 300 pounds weight.
        My uric acid was borderline high, urine pH about 5, with also high phosphates and calcium. While I didnt develop any stones (yet), my doctor warned me that with my lifestyle it is ‘highly likely’… unfortunately our healthcare while free for all people, is pretty underfunded and most of the lab checks I had to do commercially – with my limited funds it was sometimes hard.
        Now, with potassium citrate – 50-80 mEq /day, I am measuring urine pH everyday to keep it in 6,2-6,5 range, fortunately that prevention is successful so far.
        Working on my food habits as well. The soda addiction is one of worst things …

        PS. I am sorry for any grammar mistakes I did probably make…

        Regards
        Luke

        Reply
        • Fredric Coe, MD

          Hi Luke, None I can see. So you are preventing what is a real physical risk from turning into reality. Just be sure your serum potassium is being monitored. I gather your physician is aware of what you are doing and will unsure safety. Warm regards, Fred Coe

          Reply
          • Luke

            Yes, I am checking my sodium/potassium and urea/creatinine monthly. So far potassium is in range of 4,2-4,5 mmol/dm3 while sodium is 139-144; urea and creatinine are slightly below normal. Also I am taking the citrate in 10 mEq doses (5-8 times a day).
            My Doctor is aware of it and approves (a little reluctantly though). I know hyperkalemia symptoms (also saw what severe hypekalemia looks like when my dog developed Addinson’s disease… ).

            Regards
            Luke

            Reply
  33. Jackie Wong

    Does Kool Aid brand work?

    Reply
  34. Luke

    Hmmm… I can see a food grade potassium citrate on Amazon for 55$ / 5lbs (and in Poland I can buy 1 kg (~2.2lbs) for $10 ). Since 10 mEq of potassium can be found in ~1,1g of potassium citrate( 0,039 ounces…)
    …Talk about overpriced pills.

    If anyone has a problem with potassium citrate pills, then crystaline one works better – just dissolve it with at least glass of water per 10 mEq, for toning down the taste, you can add something acidic (lemon juice works fine, keep in mind though it has a pretty good amount of potassium as well, about 1 mEQ / fl oz).

    Reply
    • Fredric Coe, MD

      Hi Luke, all true and thanks. But be sure – everyone!! – you know the amount of the stuff, potassium is potentially dangerous and not everyone knows how to weigh out 1.1 gm accurately. Obviously you do. Regards, Fred Coe

      Reply
      • Luke

        Jeweller weighing scale with 0.01g accuracy is doing nicely. I am measuring the weight on two scales to ensure a malfunction of one won’t cause a bigger dose than needed. Dissolving 5,5 gram in 100 mililiters of water, then using a 20 mililiter syringe for adding solution into a drink…
        Seriously, I am wondering why potassium citrate pills are so expensive…

        Reply
        • Fredric Coe, MD

          Hi Luke, You seem to be skilled beyond most people and have a knowledge of measurement. So in your case this kind of work around is safe and reasonable. Just be sure your physician wants you to use this agent, and that it is safe for you. In general, how can I recommend this to a general public? Most people do not have your skills and cannot achieve them safely. They need premeasured doses. That the price has been so increased is offensive to me, and a grasping and unfair behavior by drug manufacturers. They are shameful. But, what can one do? Regards, Fred Coe

          Reply
          • Luke

            Hello again.

            Looking on Amazon, I can see a 500 capsules of potassium citrate, with 99mg potassium in each capsule for 14,95$… since 1 capsule have around 2,5 mEq of potassium it would be 4 capsules instead of one 10 mEq …

            Regards
            Luke

            Reply
            • Fredric Coe, MD

              Hi Luke, I found your comment and I am sorry it is delayed in posting! My error. These small size pills are fine apart from the nuisance of their size. Regards and apologies, Fred Coe

              Reply
  35. Larry T

    Crystal Light is a powdered drink mix, correct? What would be the effect of mixing the entire packet (enough to make 1 liter of the drink) into a single glass of water rather than a full liter? A dose that could be easily consumed in a small amount of time vs a full liter of drink mix (or two if your doc has you taking one 10 meg tablet in the morning and another in the evening) during the course of your day – something not always practical. Thanks!

    Reply
    • Fredric Coe, MD

      Hi Larry, In theory, perhaps. But the stuff is complex chemically and not approved for use as a concentrate, so I would not recommend it. Anyway stone prevention needs a lot of fluids. Regards, Fred Coe

      Reply
      • Larry T

        Thanks. LITHOSOLV sold by a company called BIOHEALTH in Italy seems to be the same stuff but costs less than $25 per 100. The best price I can find for potassium citrate in the USA is $175!

        Reply
  36. john

    My doc has me on cytra K crystals..to raise my Ph. to above 7. I cant take the taste of the fruit flavor….is there somthing eles i can use…i have 2 uric acid stones in left kidney

    Reply
    • Fredric Coe, MD

      Hi John, Given uric acid, you are on the right treatment. How about potassium citrate pills – no taste, costly, big. Perhaps some Crystal Light – one liter is like 20 mEq of potassium citrate. I think the best bet is mix and match- use pills, the citra K, crystal light to make up the dose – or get to the pH – your physician wants so the taste is not so overwhelming. Regards, Fred Coe

      Reply
  37. Tracy d

    My md has me on 4 20meq t x daily the pills are large and some times cause me to to choke I also have damage to my stomach and esophagus, I do dissolve them in water, but I hate drinking it. I do Have frequent sore throats and reflux. There needs to be something else.

    Reply
    • Fredric Coe, MD

      Hi Tracy, This is not ideal. The pills are not really made for being soaked so you need an alternative. I believe the pills are 10 mEq – if they are really 20 mEq that is twice the usual size and you can use the smaller ones. There are 5 mEq size, too, but pricing might become an issue. An alternative is a liquid formulation – ask your pharmacist what is available – be sure it is the citrate not chloride form of potassium. Finally, are you sure you need this exact treatment? Check out your prevention plan and be sure everything points to this as opposed to alternatives that might be better tolerated. Regards, Fred Coe

      Reply
  38. Greg Purdy

    Wonderful website!
    One can buy a supplement Potassium Citrate from Piping Rock, 275 mg quick release tablets. Also if you go thru Canada you can get Urocit-k made by the same manufacturer in Turtkey as in the US in for $54/100.

    Reply
  39. sbobet

    Almost every restaurant in Ireland offers soda bread with their meals. It is a hearty bread with many different

    Reply
    • Fredric Coe, MD

      Hi Sbobet, I have made it at home, and it is very good. But it is not an alkali because the baking soda is neutralized to produce CO2. Regards, Fred Coe

      Reply
  40. Maria azqueta

    Hi, in Costa rica we have a Lab that prepares the formula in liquid form. A month’s supply is $100. I have an 8 mm stone, snd I am hoping it will help.

    Reply
  41. Rowena Lynch

    So expensive in Australia as well, it makes me mad! Not part of our pharmaceuticals benefits scheme so they can charge what they like. Very very expensive if you need multiple pills a day!!

    Reply
  42. Mick

    How about just buying potassium citrate powder. I’m in Australia and can get 25kg of pure potassium citrate for around $800 AUD (about $600US). My citrate excretion is near zero so I need to take 12 grams per day. The 25KG, properly stored, should last me about 5 years. That’s $13 AU per month.

    Reply
  43. Mike gettelman

    Last year, with Medicare blueRX, I got 180 tabs 10 meqs for $12. This year, $300, they say it’s tier 4 of 5. Going to try Canadian Costco.

    Reply
  44. Halina

    My brother suggested I might like this website.
    He was once entirely right. This publish actually made my day.

    You can not imagine simply how much time I had spent for this info!
    Thanks!

    Reply
  45. Yvonne

    That is happening with other supplements as well. Iodine is another that has gone up considerably. a few years when I looked into it you could get a bottle for $7, now a small dropper bottle is $17. It depends on what is in the news and hot. Very sad.

    Reply
  46. Anne Kimber

    Aside from running a home lab, why aren’t we talking about the reason these pharm companies are charging so much all of a sudden, and what we can do about it? This is not a patented drug, it’s not even a very sophisticated molecule, so why on earth are we being gouged?

    Reply
    • Fredric Coe, MD

      Dear Anne, We are being gouged because they can do it. I am not a politically active person, but that is what it would take to change this pattern of behavior. Potassium citrate is not the only old and simple drug where this is happening. Regards, Fred Coe

      Reply
  47. Rudolf Galan

    As for the lowest cost of Potassium Citrate, I have been buying it from a Canadian Costco Pharmacy at the cost of 100 pills of 10 mEq tablets for $18.49 CAD (~ $14.25 USD). That represents a cost of 14.3 cents per one 10 mEq tablet. It is typically available as a special OTC order without a prescription.

    Reply
    • Fredric Coe, MD

      Hi Rudolf, Thanks for this valuable source. I would simply caution everyone who reads it to be sure they need and will benefit from potassium citrate, and also to be sure that they can tolerate the extra potassium; these are points for which you do need a physician even if the drug is OTC. Regards Fred Coe

      Reply
    • Nina

      Hi. Can you give me the Canadian website where you bought them? Just had a 13 mm stone crushed and i have to take Acalka tablets which is Potassium citrate. Here in Denmark they are 150$ for 100 and i have to take 4 each day. I cant afford that!!

      Reply
  48. Rick Cordray

    30 tablets of 5mEq per day at my local pharmacy including my insurance company’s rate is about $43. This is up from about $12 a few years ago. I checked the online mail order pharmacy operated by my insurance company (Premera), and was floored. 30 tablets there are $1473 my cost, with insurance claiming they pay $2732 of the total $4205 cost. For 90 tablets, I would pay $2917 and insurance would pay $8511 of the total $11,428 cost.

    This is insane.

    Reply
  49. Ron Micci

    The price of potassium citrate is through the roof. I talked to a pharmacist at length and she said the price has risen dramatically in recent years. (I write this as of 5/10/16.) My urologist prescribed it because the citrate level in my urine is low — potassium citrate 10 MEQ (1080 MG) SR tablet (UROCIT-K), 20 mEq, Oral, BID. That’s four tablets twice a day. The cheapest price I have been able to find for this — 120 tablets/month — is $125 (and this is with one of those Internet discount cards). This is outrageous. I am on Medicare with no Part D. You think I’m spending more than a thousand bucks a year on glorified citric acid? No way. Crystal Lite here I come.

    Reply
  50. Elizabeth Perez

    I have had multiple procedures (litho, etc) for kidney stones for over 25 years, including a hospitalization for kidney infection and renal failure. My physician has recommended Crystal Lite and I am most happy to comply, except that it causes severe gastric distress in-spite of my use of omeprazale or Nexium on a daily basis. In such cases, is the use of less irritating products such as diet 7-up a good substitute? What ‘dosage’ would you recommend?

    Reply
    • Fredric Coe, MD

      Hi Elizabeth, Given all of the stones, and miseries, have you had a proper evaluation to guide prevention?? Be sure? Crystal light is just a way to get potassium citrate without paying a high price for the pills, as noted in the article. A list of alternatives are in the article and the many comments to it. Diet 7- up may not contain potassium citrate, as an example. But one does not use this agent or beverage substitutes for it unless an evaluation has been made and thought about. With kidney failure and multiple procedures be sure everyone is informed about why you form stones and is directing treatment to the causes of the stones. Regards, Fred Coe

      Reply
  51. Fern Lin-Healy

    I posted a comment last week, but it doesn’t seem to have gone through. I’m wondering if you can put the Crystal Light powder in empty gelatin capsules (health supplement stores and Amazon sell them) and take the capsules in lieu of drinking so much Crystal Light.

    Reply
    • Fredric Coe, MD

      Hi Fern, I am sorry – somehow it must have been lost. Here, I am uncertain. These commercial powders are certainly safe for people but I do not know if when swallowed as a powder – in a capsule – it might damage the linings of the esophagus or stomach. The manufacturer has no responsibilities if injury occurs in such an adventure. I cannot recommend it lacking knowledge of risks. Sorry, Regards, Fred Coe

      Reply
  52. Fern Lin-Healy

    Thanks so much for this article! It’s very helpful for multiple-time kidney stone veterans like me. I was wondering whether you can put Crystal Light powder into empty gel capsules (you can get them online or in vitamin/supplement stores) and take them that way instead of drinking so much Crystal Light.

    Reply
  53. J Underwood

    Price of Potassium Citrate Tab 1620 mg in 2015 for my insurance plan ran from $347.25 to $362.54.

    Reply
  54. rob davidson

    1028 milligrams or 10 meq ( 3x a day with meals) of potassium citrate has been prescribed for my recurring kidney stone problems. (.0362 ounces) Re: Calcium renal calculi prevention.
    Cannot afford it.
    Am going to take 1028 milligrams(10 meq) of potassium citrate powder(bought in quantity from Pure Bulk) 3 times a day by adding 1028 mg x3 to a quart of water and drinking a third of quart each time.
    Bought a small scale off the internet . It appears to work well. Probably need to calibrate it to be sure.
    Doctor and stone expert at clinic begrudgingly said it was ok after some initial hesitance. Doctor also said it would be a good idea to check potassium levels on occasion.
    Am assuming that it is ok to take the powder form instead of the time release form and am assuming that an appropriate level of .potassium citrate will be maintained in my body.
    Is this a workable regime? My physiology tends to run on the acidic side( my sweat often smells like vinegar).
    The only place where there might be problems is in the weighing of the powder and the purity of powder.
    Pure Bulk sells for human consumption and tests for purity . ( each batch is tested independently)
    Shelf live is an unknown. Intend to calibrate scale with a known gram weight.
    Any comments??

    Reply
    • Fredric Coe, MD

      Hi rob, Others who have commented on this article propose the same thing. The problem is in the weighing. Be sure your balance is accurate enough to weight out the 3 grams. Perhaps a better alternative is to weigh out four times that amount – so the percent error is low – and add it to a four liter container. It is not at all hard to siphon off one liter from a four liter container, and the material is very stable if kept in the fridge. If the material is approved for human use, you can use it. Being a stable salt, shelf life is very long. Be sure you have no diseases which might compromise potassium removal by the kidneys: diabetes, hypertensive kidney disease, use of potassium sparing diuretics are examples – ask your physicians. A fasting serum potassium after a week or so of treatment is a good idea. Regards, Fred Coe

      Reply
  55. Gary Johansen

    I’ve settled into a routine. I make 3 2L bottles of Crystal Light up and add 13 grams of Potassium Citrate to each bottle. Each 2 L bottle I evenly divide between 4 20 oz soda bottles. I take 1 soda bottle a day and pour 1/2 into a 32 oz mug ice and top off with cold water twice a day.

    Costs
    $13 for 1 lb food grade Potassium Citrate**
    $15 – $2.49 ea for 6 2L packs of Crystal Light 36 total 2L bottles (Walmart)

    $28 for 135 days of 4 grams of Potassium Citrate drinks per day

    Approx $.21 a day, $1.47 a week and $6.30 a month, as opposed to $53 a month my cost after insurance from pharmacy.

    I like the lemonade so this works for me, I know that some folks won’t find the drinking the same thing every day boring so this won’t work for them.

    I’m cheap so . . .

    ** 1 pound food grade potassium citrate from Amazon $12.99 plus $5.99 ea shipping sealed in retort pouchs – however if you purchase 3 they throw in free shipping (last I saw).

    Reply
    • Fredric Coe, MD

      Hi Gary, I think you win the prize – a complete story and a food approved product. You are putting 13,000 mg of K citrate into 2 liters and drinking 3 of these a day which is a lot of the product. 1,080 mg of potassium citrate is 10 mEq and a high dose is 6 or just a bit over 6,000 mg of potassium citrate. You seem to be getting 39,000 mg. Please check out your quantities. I am concerned. Regards, Fred Coe

      Reply
      • Lyndon

        I think Gary said he makes three 2L bottles at a time, but he only drinks 1/4 of each bottle per day.

        Reply
        • Fredric Coe, MD

          Thanks, I missed that. Regards, Fred Coe

          Reply
        • Gary Johansen

          I’ll do the math to show how I arrived at the quantities. Working from 1.08 g for 10 mEq, Each liter crystal light 21.7 mEq (times 2 per Crystal light pack), 4.34 X 1.08= 4.69 g

          4.7g – Crystal Light in each 2L bottle
          13.0 g – Added food grade Potassium Citrate

          17.6 / 4 = 4.69 g per day or 81.89 mEq daily.

          Yes I could fine tune it better but 13 g is easy for me to remember. The reason I make 3 2 L bottles at a time is that’s all the space in the fridge my wife will let me take, anyway it’s 12 days worth.

          Reply
          • Gary Johansen

            The daily mEq should have read
            17.7 / 4 (days) = 4.425 g
            4.456g / .1080 converted to mEq) = 40.9 mEq daily

            Reply
            • Steve Crabtree

              Have you had lab tests for potassium since you started taking the formula you came up with. I am trying it out and will have tests in a couple of months.
              Thanks.

              Reply
          • Fredric Coe, MD

            Hi Gary, I have not checked the math here, but I am sure you have. Be sure your physician knows how much you use just as a precaution. Although lots of potassium from foods is generally a good idea, and potassium from pills more or less likewise, some people have problems that would limit desirable potassium intake. So just be sure about the dose with your physician as he/she is your actual care person, and responsible for your health. I know this can sound like a nostrum or my desires to be careful but really it is true – stuff happens and physicians do know a lot and need to be in the loop. With all that, you are really contributing here, and others may well use your ideas. Each person who does should check the math, though, as it is a big deal to circumvent the drug industry, Regards, Fred

            Reply
    • Mick

      Not sure how accurate the information is, maybe someone who knows could comment. My kidney specialist did warn me of the possibility of the potassium citrate losing strength (for want of a more accurate term) if left dissolved in water for a long period. I was dissolving my citrate (12g per day) in 2L of water and when tested my citrate level had actually gone down lower than when taking 6g per day as capsules (still home made). There were three possibilities:
      1) My kidney citrate excretion was even worse then before. He thought unlikely given how bad it already was and the fact my kidney function is otherwise perfect.
      2) I was ripped off when buying the PC – a possibility.
      3) It was losing strength sitting in the bottle all day.
      Cheers
      Mick

      Reply
      • Fredric Coe, MD

        Hi Mick, Being a simple molecule citrate is not likely to degrade if kept refrigerated – of course any bacteria could eat the citrate as a nutrient! But why do things this way? Make it fresh daily if possible. Very low urine citrate is not common; perhaps there is a reason such as potassium depletion, or even renal tubular acidosis. From this distance, I cannot be very specific. Regards, Fred Coe

        Reply
  56. Carly

    I was diagnosed with Medullary Sponge Kidney (MSK) after my urologist received my results from my first litholink test he said I had a very high PH and a very low potassium level. He prescribed potassium citrate 15 mEq and I had to take 2 pills 2 times a day. The first prescription my insurance paid it no problem but when I tried to fill it the 2nd time they wanted to charge me 300 dollars (30 day supply). This is not in my budget I told my urologist he hasn’t done anything for me besides give me a few samples. So I haven’t had any medicine and I’m currently looking for a nephrologist.

    Reply
  57. Fredric Coe, MD

    I found Effer K 20 mEq potassium bicarbonate/citrate for about $10 for 30 at a bunch of stores. http://www.goodrx.com/effer-k. This sounds reasonable, but I did not find it in time for the original article. Fred Coe

    Reply
  58. Larry Schuh

    Dr. Coe, I ran this by my Kidney Dr. and he is fine with me using the supplemental potassium citrate. I may get the Rx pill also as you stated for convenience when traveling, backpacking etc. 3 vs 12 pills a day, if the shelf life is long enough. Because of the deductible once it is met it would make sense as well to get a years supply and use over time if the shelf life allows for that. I thought others may be interested in my Kidney doctors opinion.

    Thanks

    Reply
  59. Larry Schuh

    DR Coe I made a mistake, sorry, I meant potassium citrate NOT potassium nitrate I should have proof read my post. I researched some more since, and found that 38.3 percent of the weight of potassium citrate is potassium. So I assume that 4 of the 99mg(258) potassium citrate pills available at most health food stores would equal the 10mEq (1080mg) Rx pill. The Rx pills are extended release where as the supplement pills are not extended release is that an issue? I must commend you on your quick response to my question on a Sunday none the less!! My pharmacist is very interested in what I find out as he has customers that cannot afford the Rx pills and wants to know if he can suggest the supplemental pills and or the crystal light. The dose conversion from 10mEq to mg is something most people cannot make.

    Thank you!

    Reply
    • Fredric Coe, MD

      Hi Larry, I thought so. My only reservation which your pharmacist no doubt shares is uniformity and reliability of these products. Perhaps the pharmacy profession has an opinion on that subject which would be welcome indeed on this site. As for whether or not he can suggest substitutions, that is his professional opinion, and I cannot substitute for it. All I can say here is that if the calculated mEq of potassium citrate is the same in so many of these pills as it is in so many of another pill they would be equivalent for me provided one could rely on the product itself to be safe and to have in it what it says it has in it. Regards, Fred Coe

      Reply
  60. Larry Schuh

    DR Coe, thanks for your reply. Just to clarify, The 99mg pills available from health food stores are used as a potassium supplement the 99mg on the label refers only to the amount of potassium in each pill. The amount of the whole compound potassium citrate is 258mg per pill. The Rx pill 10 mEq is 1080MG ,would not 4 of the health food pills be close to the equal one of the 10 mEq pills? I talked to someone from Swansons health supplements (120 pills for $2.49) and they calculated it out and said 4 of the 99mg(258mg) potassium nitrate pills would be close to the Rx pill. I also found another brand of 99mg potassium nitrate pills that stated on the label it was 99mg of potassium/ 258 mg of potassium citrate per pill. I am getting conflicting info?

    Reply
    • Fredric Coe, MD

      Thanks, Larry; Great researching of a vexed issue. I agree with you. I do not know about potassium nitrate – that would not be what you would want. Nitrate is not citrate. One last item: These health food items are not necessarily reviewed by FDA and need not comply with US standards as applied to drugs. That is always a reservation. So be sure you get the right urine pH and/or citrate changes when they are taken. I am not happy with the terrible prices for authentic potassium citrate, but I am worried about non – inspected products really substituting. Regards, Fred Coe

      Reply
      • Carole Carrick

        Hi Larry and Fred. Great website thank you. Swansons brand (120 for $2.49) is Potassium Citrate NOT Potassium nitrate. I think Larry simply did a typo? So this is the very cheapest alternative online by a long way. I have found Swansons health products to be of excellent quality over the years. It’s not rocket science to make such a simple product. If health and quality standards are adhered to (which they are in reputable companies) then why pay Big Pharma 10 times the price? Taking 4 tablets per day is no big deal. iHerb also sells several great brands but they do cost more than double Swansons. Regards, Carole, Australia

        Reply
        • Fredric Coe, MD

          Thanks, Carole; I am in agreement but do not know if quality standards are the same for these products as for standard drugs. This is not knowledge talking, it is my own ignorance of product inspection. Regards, Fred Coe

          Reply
  61. Frank Concerto

    Exploring possibility of using Crystal Light Lemonade formula but more concentrated so as one would need to drink significantly less volume. Based on 4 pills a day which mixture would require 2 liters, one could put same measurement of Crystal Light into a 16oz glass drinking half in morning and half in evening, provided still palatable. Also splitting it up to lessen the potential for nausea etc.

    Reply
  62. Frank Concerto

    Just mentally exploring the possibility of using the Crystal Light Lemonade but using a more concentrated mixture so as to drink less volume, provided it is still palatable. So the same measurement of Crystal Light could be added to one half or one quarter liter or 16oz /8oz glasses. This could reduce substantially the amount of needed to drink in a day making the load easier. Of course this is provided the mixture would still be palatable.

    Reply
  63. Janet

    Our dog has to take 18 potassium citrate a day. She was diagnosed with Distal Renal Tubular Acidosis after being poisoned by the chicken jerky dog treat issue. It’s the only thing that is basically keeping her alive. There are numerous vets locally and across the US that are prescribing this for pets. Our vet has several dogs that are on it. Was about 1996/97 when thousands of these dogs were affected, I’d be curious to see when the price hike occurred.
    We buy ours from Canada and still pay $320 monthly!

    Reply
    • Fredric Coe, MD

      Hi Janet, The price hike occurred in the past three years I believe. The product for dogs is not approved for human use. Regards, Fred Coe

      Reply
      • Janet

        Thanks, I meant to put the year as 2007/2008, we have been paying this price since she was diagnosed in 2006

        Reply
  64. Bill Kolofa

    I’ve been taking calcium citrate with Vitamin D3 (brand Citracal Maximum) as a dietary calcium supplement since I am lactose intolerant. It lists calcium as 630 mg and Vit. D3 as 500IU. Would this be a helpful alternative to Potasium citrate to boost citrates for stone issues? Or is it a problem with too much calcium? Yes, I have had stone issues too recently.

    Reply
    • Fredric Coe, MD

      Hi Bill, the amount of calcium per unit of citrate will be high so this is not a way to get usual doses. If you need citrate – your urine citrate is low or your urine pH is too low and you have uric acid stones, you will need to do better than this. Check out all the alternatives in the comments. Regards, Fred Coe

      Reply
  65. Larry Schuh

    I was recently prescribed UROCIT-K10 and as previous posts have mentioned are very over priced. NOW foods has potassium citrate tablets 99mg 180 capsules for $5.15 can these be used vs UROCIT-K10? I believe the conversion would be about 4 tablets to equal 10 mEq.

    Reply
    • Fredric Coe, MD

      Hi Larry, The size is really small: round the amount from 99 to 100 mg, and compare to urocit which is a bit above 1000 mg. You need 10 of the small ones to match one of the big ones. Regards, Fred Coe

      Reply
  66. laurie bowen

    i take 12 pills a day,10 meq and that comes to about $580 a month, crazy

    Reply
    • Fredric Coe, MD

      Dear Laurie, It is crazy, and profiteering and a kind of sin to mark up so simple a product this way. I am not happy to see it. Regards, Fred Coe

      Reply
  67. Laurie

    Dear Dr. Coe, I have had Two episodes of calcium oxalate stones in the past 10 years. My 24 hour urine test came back low citrates. I do not want to take Urocit at this point. What about Magnesium Citrate supplement (Calm by Natural Vitality)? Is it only Potassium Citrate that raises the citrate level? Thank you. Laurie

    Reply
    • Fredric Coe, MD

      Hi Laurie, I looked up the product on the web and could not find the actual composition. It is a magnesium citrate. I would not use it for stone prevention because it is too hard to figure out what it contains – actual chemical materials by weight per dose. Use potassium citrate or any of the many alternatives in the comments to this article. Be sure and do a followup and see that your citrate rose, and check out your supersaturations to see that they fell. And remember water is better than anything. Regards, Fred Coe

      Reply
  68. George

    I have been taking 60ml of CytraK /day for 2 yrs supplied by Express-Scripts -Medicare. Cost $65/90 days. The firm has dropped potassium citrate from its formulary. Walgreen cost $66 for 450ml. 7.5 days dosage. To help my search for alternative pricing, what is the pill equivalent (mEq or mg) to 60ml? Thanks.

    Reply
  69. ken sobel

    Do you know who the manufacturer is? Do they provide support for those who cannot afford the price?

    Reply
  70. Ray

    Fred,

    For my patients with mild to moderate hypocitraturia, what are the advantages of potassium citrate pills vs dietary citrate therapy with crystal light, citrus juices, etc? Are the pills better because they are extended release?

    What are your thoughts on lemonade vs OJ?

    Ray

    Reply
    • Fredric Coe, MD

      Hi Ray, Essentially citrate is citrate and the pills have only the advantages of portion control – we know how much is in them and people can count. Crystal Light happens to have a lot of total citrate (salt + acid form) and a higher pH so the citrate concentration is high. Citrus juices are far less reliable – for example a lower pH for a batch of lemons can make a big difference – and are caloric with all carbohydrates. Lemonade is variable depending on pH, and orange juice is very high in sugars. So I like to mix and match – Jill Harris’s article is pretty good about a mix of beverages, and your patients might find it helpful. Regards, Fred

      Reply
  71. Gary Kay

    Doctor Coe
    First, thank you for the generous amount of time you’re providing on this. I wonder whether you’ve seen this article – it seems to raise some questions about the use of soda as a potassium citrate provider. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827252/

    Reply
  72. Spencer Thomas

    THANK YOU for this valuable service in the true spirit of medicine.

    I’ve been enrolled in ‘automatic refills’ through my insurance provider’s mail order pharmacy for years. Fortunately, I had set a ceiling on approved amounts. When the pharmacy called to get permission to renew my potassium citrate, good grief! Forget the citrate, what do you have for price-induced heart failure?? $535 for a three month supply. I declined without hesitation and started searching.

    The information you’ve provided is terrific. Again, THANK YOU.

    Reply
    • Fredric Coe, MD

      Hi Spencer, Join the unhappy parade. The article and comments add a lot of ideas, and one needs them because of the prices. Be sure you need this drug. Did your 24 hour urine tests mandate it? Your stone type? Good luck, Fred Coe

      Reply
      • Spencer Thomas

        Yes, my tests mandate it. And today my company’s “discount pharmacy” informed me that a 30 day supply (120 generic tabs) now costs $4,930.17! That is AFTER my company’s share of more than three-thousand dollars. This in insane.

        I notice that there are 99mg potassium citrate supplements available for about $5. How might those compare?

        And thanks again for this valuable service.

        Reply
        • Fredric Coe, MD

          Hi Spencer, the problem is their small size – about 1/10th of a single pill. The comments on this article give a lot of alternatives. The price you quote must be a world record. I get a price of $41.08 per pill! That is shocking and I suspect a mistake. If not, we are in a bad world when so simple a chemical as potassium citrate can go for $41 per 10 mEq; that is $4 per mEq and you can buy – no doubt – pounds of it for $40 – but not approved for human use. Sorry. Use one of the suggestions from the others who have written in. Regards, Fred Coe

          Reply
  73. Kirk Gardner

    Regarding the cost of Uriocit K 1000 – I had been paying $15 for 90 caps until about 2 years ago when the price suddenly shot up to well over $100 for the same amount. Today the price is $152.32 for the same amount of pills. When I asked the pharmacist why the price was so high he said there was only one drug company making it for pharmaceutical distribution and they decided they could squeeze that much money out of patients, so they did. This is not a complex salt – there must be sources that can make money and still charge something in the range of the old price of $15/90 tabs of 1000 each.

    Reply
    • Fredric Coe, MD

      Hi Kirk, You and your pharmacist have it about right. It is called gauging. You might benefit from the many comments about alternatives and the few in the article. Regards Fred Coe

      Reply
  74. Ryan

    Dr. Coe,

    I am a fellow researcher and would like to look into citrate content as alkali in other beverages. Would you be able to shed light on how Dr. Eisner and Dr. Asplin were able to ascertain the citrate as alkali content?

    Reading their papers it seems this required knowledge of the pKa of citrate and malate, as well as the concentrations of citrate and malate in their respective solutions. Also required was the pH of solution. If I have all of this data, how do I plug it all in? Looking back on my chemistry days it seems related to the henderson hasselbalch equation.

    As a generality, however, I take it that the higher the pH of a solution, the more the citrate and/or malate will exist as base (the good kind for stone prevention)

    Cheers
    Ryan

    Reply
    • Fredric Coe, MD

      Hi Ryan, Yes, one needs to measure the total citrate and malate contents and the pH. Values for the dissociation constants of malic and citric acid are well established and do not need to be measured. The concentration of the salt forms is calculated directly from the measured total concentrations of the species in question, the dissociation constants and the pH. The salt forms are metabolized as the acids with uptake of protons making them base equivalents. It is John Asplin who did the measurements; Dr Eisner is a urologist. You can reach John at Litholink. He is a close friend of mine and would certainly welcome company in this arcane business of beverage analysis. If you get data be sure and publish it so I can post the results here. Best, Fred Coe

      Reply
  75. Ron S

    I found this page while searching for a way to get potassium citrate at a lower price. Out of pocket cost for a one month 90 pill supply is approximately $224 from my pharmacy. I just went on Cobra health insurance and the co-pay fee for this med went up to approx. $89 a month. That’s over $1000 a year! Are there no alternatives for me? This seems outrageous.

    Reply
    • Fredric Coe, MD

      Hi Ron, You have joined the club. There are 129 others so far who have offered comments and ideas. The article offers alternatives that are a lot less expensive. Take a look at both. The pricing is outrageous and the manufacturers should be ashamed of themselves. Regards, Fred Coe

      Reply
  76. wally mayfield

    I was just prescribed 10 meq of potassium citrate it was $50 for a months supply. ( two pills a day)

    Im suppose to take 2 pills a day..Amazon has it in a powder form in 17.6 oz for $20.

    its called Pure potassium citrate powder what would the dose be? Its made by Bulk Supplements

    thanks

    Reply
    • wally mayfield

      One other thing,,I take 300mg of Allupurinal for gout, Im wondering if the potassium citrate could replace the gout med, I also take Hydrochlorothiazide 25 mg and 100mg of Losartan Potassium for Blood Psi..any conflicts??

      Thanks again

      Reply
      • Fredric Coe, MD

        Hi Again Wally, Allopurinol will lower serum uric acid and is used for treatment of gout. Potassium citrate cannot substitute for allopurinol in treating gout. The diuretic and losartan are a good pairing for hypertension as losartan lowers serum uric acid. Regards, Fred Coe

        Reply
    • Fredric Coe, MD

      Hi Wally, A lot of people have commented on powder form. The problem is weighing out the correct dose. Check out the comments for this post because several people have offered proper equipment and techniques for doing so. Warning: Potassium is dangerous. Weighing out your own doses is not advised by anyone unless you know what you are doing. An overdose could be lethal. Be careful!!! Fred Coe

      Reply
  77. Jay

    My urologist told me potassium supplements from the store will not help as the stomach acid eats it up before it can be absorbed. I’ve been prescribed potassium citrate ER as it is coated with wax to prevent it from being dissolved before it can be absorbed. Sound right to you?

    Reply
    • Fredric Coe, MD

      Potassium citrate is potassium citrate and so long as it is in the right dose and approved for human consumption will do what it is intended to do. The coatings delay absorption, but citrate needs to be metabolized so its action is not immediate. Given the high pricing if you can use cheaper materials – with the two provisos I have just mentioned, I can see no reason why not. Fred Coe

      Reply
  78. Dennis Weifenbach

    Well you didn’t try too hard to find out what the cost of this drug is. All it takes is to contact some local pharmacies. I was shocked. This is a very simple formulary. But, I found that at 3 local pharmacies this was going to cost me $80 a week. This appears to be another drug made by only a few companies which jacked up the price “because they could”.

    Reply
    • Fredric Coe, MD

      Hi Dennis, I did work pretty hard at this and came up with high prices. The purpose of the article was to find low ones, or ways to lower the costs. You are right; prices are indeed high, the drug is made by only a few companies, and they raised the price because they could. Many comments offer workarounds, as does the article. Regards, Fred Coe

      Reply
  79. Joe Febeeetz

    For people who want to just take pills or capsules, there are capsule filling “machines” avail usually on Amazon for $15-$20 or so (not currently, check Swanson) and then a bag of 1000 empty “00” or “0” size capsules will run just over $10-$12 dlv. A scale to weigh the potassium citrate powder will cost abt $10-$15 on Amazon (check the ratings) and finally the powder will cost $30/kg from Bulk Supplements of Pure Bulk etc. For $50 out of pocket just one time plus $30 for the 1 kg powder, you will have potassium citrate for years.

    also, my local Dollar Tree has 32 ounce bottles of lemon juice from concentrate for $1.

    dont let the health “care” industry rip you off.

    Reply
    • Fredric Coe, MD

      Wow, Joe, this is the US enterprize spirit in full bloom. But I would not count on the lemon juice to raise urine pH unless you check out how much is needed. Thanks, Fred Coe

      Reply
      • Joe Febeeetz

        Yes, you’re prob right on the lemon juice but i thought someone else mentioned it as a source of citrate.
        Also, i hope that you might consider editing the article to recommend that people purchase the bulk powder. If the pills really do cost around $144 every 3 months then one cannot in good conscience just say “shop around for the lowest price of the pills”
        The supplement industry will put these clowns out of business.

        Reply
        • Fredric Coe, MD

          Hi Joe, let me respond to both of your comments. Bulk potassium citrate is certainly available. The problem is to weigh out the right amount per dose. Potassium salts are dangerous if not given in the right dosages, and many people may not be as equipped as you are to undertake the needed measurements. For that reason I cannot medically endorse bulk products and home weighing out of doses. One of the many commentators on this article has identified a proper balance scale and he seems able to use it. I imagine you are the same. But I caution you and everyone that weighting out 1080 mg is not easy and mistakes can be dangerous and even fatal. Another issue is suitability of a particular bulk product for human use. I imagine the products you are buying are indeed suitable, but not everyone will know as much as you do about making sure. Regards, Fred Coe

          Reply
      • Joe Febeeetz

        btw, for those concerned about Sodium Bicarb i also see Potassium Bicarbonate avail in bulk for $6.50/lb in 5 lb lots (USP grade) and there is also Magnesum Citrate avail if its only the citrate portion thats needed. Good quality Arm + Hammer baking soda is only $1/lb or less. looks like the manufacturer of the pills is charging 80 cents per gram for the potassium citrate while the Amazon bulk sellers charge abt 3 cents per gram. I see one website that sells it for $4.50/lb plus ship in 100 lb lots (USP grade) – 1 cent per gram so potassium citrate is very cheap. no reason for 8000% markup

        Reply
  80. Susan

    I have been prescribed potassium citrate pills for stones associated with an incomplete distal RTA. However, I also have gastroparesis and have not been able to tolerate the potassium citrate – it makes my gastroparesis worse. Are there some options that I may be more likely to tolerate?

    Reply
    • Fredric Coe, MD

      Hi Susan, I suspect the finding in your case is a low urine citrate level with perhaps a more alkaline urine pH than normal and calcium phosphate stones – that is the usual basis for this diagnosis. If you cannot tolerate the potassium citrate, ask your physician for a work around. For example, perhaps your urine calcium is higher than 200 mg daily and can be lowered with reduced salt intake and possibly a thiazide diuretic; perhaps your urine oxalate is high and your stones are calcium oxalate. Gastroparesis is often from diabetes; what is yours from? In other words, your problem is complex and perhaps this one pill is not the ideal. Another alternative is a liquid alkali form: SImple crystal light lemonade has 20 mEq of potassium citrate in a liter, and that might serve instead of the pills. There are liquid medicinal forms of potassium citrate. Regards, Fred Coe

      Reply
      • Susan

        Thanks very much for your reply. The etiology of my gastroparesis is uncertain, although I do have a diagnosis of lupus with possible Sjogrens – currently the thought is that that is likely the explanation for the incomplete distal RTA and the gastroparesis. The next thing we are going to try is potassium bicarbonate citrate, which will dissolve in liquid, and see how that goes. Thanks again.

        Reply
        • Fredric Coe, MD

          Dear Susan, It should work. Incidentally, the RTA of Sjogren syndrome is often complete indeed. Be sure the urine calcium, if high, falls with the alkali treatment. If it does not, then you need additional measures to lower it. High urine calcium from RTA does not always fall when the RTA is treated. Regards, Fred Coe

          Reply
      • Michael Allison

        I am currently facing the loss of insurance coverage for potassium citrate. My prescribe does is 3000mg three times daily. The best cash price is Walgreens at $100 per month–this is for potassium citrate-citric acid crystals, delivering the above potassium citrate plus 1000mg citric acid. A bottled/mixed liquid version is twice that price. I suppose I could measure 3000mg doses of pot citrate bulk and dissolve in 8-12 oz of some beverage. That would be the only practical option for me. I would have to drink 4 plus liters of Crystal Light which is far too much. By the way, the piil form never worked for me, never raised the ph. The above dosage raises my urine ph from 5.0 to 6.5. My low ph is from Type II diabetes. My urologist says uric acid stones will not form above 5.5.

        Reply
        • Fredric Coe, MD

          Hi Michael, Let me move backward in your comment. It is true that at a pH above 6 uric acid stones will not form; 5.5 is right on the borderline. Your dose of potassium citrate is 30 mEq 3 times daily, or 90 mEq, very high, but in diabetes I do sometimes see such requirements. The Walgreen preparation seems alright – why not use it. Perhaps some Crystal Light can be added to fill in for some of the crystals. Being diabetic, potassium handling might be askew so have your physician check serum potassium from time to time. The weighing out of bulk potassium citrate worries me because most people do not have accurate enough balances and potassium is not entirely safe when in excess. Regards, Fred Coe

          Reply
  81. Laurence Shore

    Not being in North America, I am a little confused. I buy alkasolve (300 mg KCitrate and 300 mg NaCitrate per tablet) 180 tablets for 16$ (actually about half of that from my HMO) which is about .09 dollars/tablet. The recommended dosage is 4 tablets/two times/day. (4 tablets is a little hard to sqallow but 3 tablets is no problem) That doesn’t even come close the prices you r quoting.

    Reply
    • Fredric Coe, MD

      Hi Laurence, the 300 mg size requires 3 -4 tabs for a standard 10 mEq dose – approximately so for a day the minimum would be 6 -8 2 times a day. That is not unreasonable. In the US we do not have the 300 mg size available, so the OTC pills, being a low smaller, would be unworkable. You are fortunate in not sharing the price inflation here, which is rather recent and a combination of increased MFR prices and a decision by insurance carriers to reduce payment for the drug. Regards, Fred Coe

      Reply
  82. Michael Lang

    Dr. Coe,
    It seems to me that the price increase of the Potassium Citrate might coincide with the inclusion of the timed release
    technology. What was the typical pill size and accompanying dosing instructions before these larger timed release pills
    became available?

    Reply
  83. Dennis

    Is it not possible to purchase bulk Potassium Citrate and Citric Acid and duplicate the quantities present in Cytra-K Crystals?

    Reply
    • Fredric Coe, MD

      Hi Dennis, people have purchased food grade potassium citrate and measured out the correct doses. Check out the comments to this article and you will find it. Chemical grade is not appropriate as it is not approved as a human food. Fred Coe

      Reply
  84. Robert Gates

    OK; thanks. i knew I was missing something simple. Found the same Crystal Light pouches at local Sam’s Club tonight = $6/pouch of 16 packets, each of which makes 2qts. So 3 such pouches = same as the Amazon offering, at $18 instead of $26. And I can quit making lemon Kool-Aid daily, w/ Sweet-n-Low…..triple-whammy savings for me…..thanks for the research!

    Reply
  85. Robert Gates

    I am a stone former (calcium oxalate) of decades’ standing. Current urologist Rxs K-citrate, and even w/ insurance coverage it is way too expensive (why so much for a simple salt?). What I have gleaned from reading here is the marvelous complexity of the kidney and its functions and the interrelated metabolic pathways, but cannot follow the evidence and logic well enough to keep from asking this Q: why not use Ca-citrate, as it is much cheaper than the K-salt, and available OTC?

    Reply
    • Fredric Coe, MD

      Hi Robert, It is the calcium. In order to get 40 mmol of potassium you would need that much calcium, and it is a lot of calcium – 40 mg/mmol or 1,600 mg of calcium a day. That is too much altogether. The comments from others give a lot of workarounds, however, some of them rather good. Regards, Fred Coe

      Reply
  86. Robert Gomes

    Dr. Fredric Coe,
    I was asked to take 10 mEq tablet or Potassium Citrate (K-Citra brand). I choked on the pill when I tried to swallow it. I thought about breaking/cutting it in half but the bottle clearly states to not “break” the pill.

    Do they come in smaller sizes? If there is a smaller dosage size, could I take two? Would it have the same efficacy?

    Thank-you,

    Reply
    • Fredric Coe, MD

      Hi Robert, They do come in a 5 mEq size – 1/2 the dose. Your physician can prescribe them and they are smaller. You will need twice as many and price wise this could be a problem. I have had one patient warn me that these smaller pills are coated and might not deliver the medication well. I have no way to know if this is true. The manufacturer has not indicated a problem with the smaller pill. All the best, Fred Coe

      Reply
  87. Tom

    Maybe this is addressed in the older comments.. sorry if it is a repeat question. I can buy pharmaceutical grade Potassium Citrate for about $15 / 500g. I have a .01 gram Ohas scale, so I can get a consistent weight. Is there any reason I can not just get my citrate this way? I ‘m on a 4 x 10meq pills per day. Would you have a recommendation of how to take the pure form? Instructions were posted on one site that said mix with 4 oz water/juice and drink slowly over a 5 – 10 min period. Take within 30 min of a meal and do not lie down for 30 min…
    Thank you – Tom

    Reply
    • Fredric Coe, MD

      Hi Tom, yes this has been on the site but why not again. A 10 mEq tablet – standard dose – of potassium citrate is 1080 mg of the salt so you need 1.080 grams. Two pills worth is an easy weigh for your scale. I would indeed dissolve the stuff as the pills are slow release and I would drink the potion with meals. My taste in volume would he higher – about 8 ounces of water or juice and drink it over 10 to 20 minutes. Be sure your physician knows and that your kidney function is adequate with respect to potassium because you are receiving the material without any slow release provision. Ultimately your physician needs to be in the loop and responsible. Regards, Fred

      Reply
      • Jason

        I think it might help to explain what mEq means to your readers. How was it determined that there are 10 mEq in 1080 mg of the potassium citrate salt?
        If one tablet is 10 mEq then it contains 391 mg elemental potassium, which is about 12% RDA.
        Knowing how to do this conversion would be helpful in determining what supplier is giving you the best bang for your buck and I would think for determining best dosage based on kidney function status, pregnancy status, cardiac arrhythmia risk etc.

        Potassium citrate molecular weight = 306.4 g/mol
        Potassium RDA = 4700 mg
        Potassium atomic weight = 39.1

        Reference: http://www.pkdiet.com/pages/alkalizers/potassiumcitratefaq.htm

        Reply
        • Fredric Coe, MD

          Hi Jason, Usually when concerned with kidney function, pregnancy and arrhythmia mEq/liter is all one uses. So conversion to mh is not an issue. The 1080 mg contains 1080/306.4 = 3.52 millimoles of potassium citrate. Citrate has more than one valence – open charged sites binding potassium, which depends upon the pH at which it is made – it is a weak acid. In the product, the valence needed to give 10 milliequivalents is 10/3.52 = 2.84. To make all three valence sites (oxygen atoms in the structure) available to bind potassium, which means removing all protons from all three sites, would require a very high pH in production. Because most protons have been removed, and it is metabolized as citric acid – all three sites occupied with protons, when this product is metabolized in the liver to bicarbonate – in the Krebs cycle – you get 2.84 mEq of base – bicarbonate – per millimole of the citrate. If it were fully protonated and just citric acid you would get no bicarbonate and it would not be an alkali agent. Regards, Fred Coe

          Reply
          • Dave Rathbun

            Where you said “protons” in your explanation I believe you meant “electrons.” Atoms have electrons in their valence orbitals, while the protons are contained in their nuclei. Chemical reactions, the binding of atoms into molecules, involve the exchange of electrons, not protons. The “exchange” of protons would be a nuclear reaction, usually involving radioactive decay, nuclear fission, or particle accelerators. Additionally, if you do indeed remove one or more protons from an atom it becomes a completely different element altogether.

            By the way, while it was an interesting and informative reply, you never actually answered the basic request to explain just what an “mEq” is; i.e. what is the definition of an mEq. Thanks. 🙂

            Reply
            • Fredric Coe, MD

              Hi Dave, Thanks for your comment. I meant protons – which non covalently bind with anion sites of weak acids like uric acid, phosphoric acid, or oxalic acid. I am not speaking of covalent binding but of acid base chemistry. I had thought I did mEq but I certainly will look and do it if I did not. I think I may need to edit the article to make myself clearer and therefore I appreciate your comment a lot! Thanks, Fred

              Reply
  88. James

    What about drinking limited amounts of alkali water (ph 9.5)? There is no sodium. Would this help?

    Reply
    • Fredric Coe, MD

      Hi James, It is hard to predict what such water will do. Mostly water has so low a buffering capacity that whatever its pH it imposes a very slight alkali load on the body and is not likely to alter urine pH or urine citrate. So I think the result will be that of drinking water. If the water had a greater alkali concentration that I have encountered before, and you used a lot of it, it could raise the urine pH just like potassium citrate does. If your stones were calcium phosphate this might make stone formation worse. So the answer is as I said: Mostly nothing will happen apart from the benefits of water. Regards, Fred Coe

      Reply
  89. Peter

    Would it be possible for you to share how you calculate the citrate in the Crystal Lite ? I want to measure how much I’m getting from other sources and I think it would be instructive to see how this calculation is done. TIA.

    Reply
    • Fredric Coe, MD

      Hi Peter, There is no secret. My colleague Dr John Asplin measured total citrate conventionally along with pH and calculated the molar concentration of citrate – unprotonated citric acid. If you are a lab person, I can put you in touch with John who would be pleased to share technical details of handling the food product. The key is to allow for pH: Citric acid will not help in raising urine citrate as it does not consume a proton when metabolized. Best, Fred Coe

      Reply
  90. Kathy

    I have had one calcium kidney stone. I had this last year at age 65. My uric acid count is 5 and doctor prescribed potassium citrate. The cost was $135 for 30 pills…a month supply. I am not taking them due to the cost. Potassium citrate was $131 for a month supply. There is OTC potassium citrate (99 mg / pill) but I would have to take 10 pills a day. The OTC has 180 pills for around $10.00. I have decided to drink water with lemon juice concentrate and 2-4 OTC pills. Time will tell!

    Reply
    • Fredric Coe, MD

      Hi Kathy, The problem of cost for this simple compound has vexed everyone and a few of our commenters have offered ingenious workarounds. I cannot comment on the wisdom of your choice, but given only one stone I would hope that you maintain a high urine volume by staying well hydrated. The lemon juice is of dubious benefit, but Crystal Light does have considerable potassium citrate in it and one liter will provide 20 mEq (equivalent to two full size prescription pills). The level of blood uric acid – I am guessing the ‘5’ is that level has no bearing on calcium kidney stones. At the very least be sure and get proper 24 hour urine testing to identify your key risk factors. First stones at 65 are uncommon but not rare. Being uncommon it is always best to know why. Regards, Fred Coe

      Reply
  91. Anthony P

    Dr, Coe Thank you for your great info. I have had stones for many years and am currently trying cytra-k oral solution very very costly to try to dissolve my current stone condition. Would crystal light work as well?
    Anthony

    Reply
    • Fredric Coe, MD

      Hi Anthony, If potassium citrate is indeed the best treatment for your stones, crystal light will provide 20 mEq per liter as noted in the article, provided the manufacturer has not changed the preparation. Of the stone types, only uric acid stones will dissolve with such treatment. Calcium oxalate stones will not dissolve, but under the right circumstances citrate will reduce their recurrence. Regards, Fred Coe

      Reply
      • Anthony P

        I will continue taking Cytra-k solution at $89 per bottle 4 times a day a bottle a week, as directed, and not paid for by insurance, until my next Doctors visit, and hoping my stones have dissolved by then. My question is I guess another ct scan is the only way to know if this is so?
        Anthony

        Reply
        • Fredric Coe, MD

          Hi Anthony, No stones dissolve except uric acid and cystine. Calcium stones do not dissolve. The citrate can reduce new calcium stone formation. I would not expect you will find stones disappearing. IF they do, they probably are one of the two I mentioned. Regards, Fred Coe

          Reply
          • Anthony P

            Dr. Coe Thanks again for the info I have had both uric and calcium, was in the hospital last summer and stone was uric, I am praying the stones are uric and the cytra -k works. The pain I was having seems to have subsided.

            Reply
  92. Chris

    Is there a difference between the Crystal Light Pure Lemonade (made with Truvia) and Crystal Light Lemonade Sugar Free with regards to the amount of citrate? I noticed that Pure does not list potassium citrate but does have sodium citrate, but the normal sugar free kind has both. I am low on citrate, so I was prescribed 15mg potassium citrate tablets once per day. After reading this article, I am going to try substituting Crystal Light, and would prefer the Pure if possible. However, I want to make sure that I am getting what I believe I am (21.7 mEq per liter as stated in the above article). Any help you could provide would be greatly appreciated.

    Reply
  93. Jim Stevens

    I have been taking Urocite-K 10meq 3 times per day for over 2 years. No change in urine PH, so the doctor raised the prescription to 6x per day. Still no change in urine PH. I discovered a few weeks ago those pills were passing right threw me!!
    I changed to Crystal Potassium Citrate and now my PH is now normal. Costs went from 0.84 per dose to 0.11 dose..

    Reply
    • Fredric Coe, MD

      Hi Jim, often what you see passing through is just the wax matrix from which the active material has been eluted. But in your case it may be some fault in the release of the alkali. Could you tell if the urine ammonia – on the usual 24 hour urine panel – fell with the urocit K? That is the best indicator of effectiveness. Regards, Fred Coe

      Reply
  94. Ellis

    A kilogram, 2.2 lbs, is $30 on Amazon.

    Reply
  95. Alan

    I am in the same boat as the others here. I saw this article some time ago and thought it might be an option. I take 3 tabs daily and just 4 years ago I paid $20.00 for a 90 day supply. When the insurance for the big companies started to change a few years back it left me paying full price until my deductible was met. In 2015 for a 90 day supply of Urocit K went to $657.00. Not something I can afford.

    I spoke with my urologist and she said she was fine that I try alternate in form of a liquid drink. I am getting started immediately.

    Reply
    • Fredric Coe, MD

      Hi Alan, Lots alternatives have been proposed by other patients, so I would read them, too. I have commented on all of them, and some seem really excellent. Regards, Fred Coe

      Reply
  96. Karl Saal

    The price of Potassium Citrate was too much for me, if I remember right, the last script was for 2)600mg twice a day. I found potassium bicarbonate online for about $8/lb and it has kept my uric acid stones in check taking 1/4tsp twice a day. I haven’t heard much about potassium bicarbonate only that it’s better than sodium bicarb. Any thoughts?

    Reply
  97. Jackie

    I have seen steep price increases for Pot Citrate ER 100’s 10MEQ since 2014. I get 4 tabs/90 day supply (360 tabs) and these have been the prices through Express Scripts (I’m required to do the mailorder pharmacy for maintenance drugs): January 2014: $315.84; June 2014: $361.71; October 2014: $414.11; August 2015: $542.72. I only take 2 tabs a day, so my 90 day supply lasts 180 days. But with my high deductible medical plan, I’m 100% out of pocket and $542.72 is rather pricey to me!

    Reply
    • Fredric Coe, MD

      Hi Jackie, Oh My! This is a widespread problem. The most imaginative ideas are in the many comments for this article, some of which seem practical to me. One person buys food grade potassium citrate and weighs out what he needs. Others have found sources. I suggest you read their ideas and try which ones seem to fit. Here is an area where the ideas of those I have written for far outshine my own. Certainly the small number of manufacturers who produce this product have chosen to take advantage of things. They are not kindly to those who buy their products and will eventually suffer the consequences. Good hunting, Fred Coe

      Reply
  98. Sherry G.

    I through in the towel several years ago and have been ordering my Urocit-K form northwestpharmacy.com; a canadian company. The cost for (100) 10meq pills is $75. If you order generic it’s a little cheaper but since it’s coming from outside the U.S. I order the brand name.

    Reply
  99. Alan

    Dear Dr. Coe,

    As I previously mentioned, I have been taking magnesium citrate in addition to potassium citrate for my calcium oxalate stones. I did this because several studies had used this combination successfully. Could you comment on the use of this combination compared with potassium only? What is better? Thanks, Alan

    Reply
    • Fredric Coe, MD

      One study of potassium citrate and one of a combination of magnesium and potassium citrate both showed efficacy in reducing calcium stones in patients whose 24 hour urine citrate excretion was below normal. The potassium citrate should be as effective as the combination. The trial results apply to the patients with reduced urine citrate. A third trial in which citrate dose was adjusted to maintain a specific urine pH was negative: The drug did not work. The link is to an article which has all the numbers from the trials. Best, Fred

      Reply
  100. Amy Scaling

    My husband, Sam currently has a stint in and is on antibiotics before the doctor can blast an 18mm stone along with many smaller stones. His last bout was 7 years ago and those stones were calcium oxalate.

    We are in search of an affordable source of potassium citrate; a mineral that should not require a prescription to obtain, but now apparently does. As we look, how many mg of Potassium Citrate is equal to 10 mEq?

    Also, please evaluate the veterinary product below. 100 tablets cost $21.
    http://www.allivet.com/p-5494-potassium-citrate-plus-cranberry-100-chewable-tablets.aspx?gclid=CMuTyKKk08YCFRCCaQodQF8Nqg

    Active Ingredients (per chewable tablet):
    Potassium Citrate (micro-encapsulated) 680.0 mg
    Cranberry Extract 113.3 mg
    Inactive Ingredients: Cellulose, Hydrolyzed Vegetable Protein, Iron Oxide, Liver Powder, Magnesium, Stearate, Silicone Dioxide, Stearic Acid, Sucrose and Whey.

    How Potassium Citrate Plus Cranberry, 100 Chewable Tablets work?
    Potassium citrate helps decrease the possibility of calcium oxalate stone formation and cranberry extract has been shown to enhance urinary tract health.
    Cranberry Extract works by minimizing the bacterial colonization of the bladder mucosa.
    Echinacea helps to support the pet’s bacterial resistance and boosts the animal’s immune system.
    Oregon Grape Root contains the alkaloid berberine, known as an anti-bacterial and anti-inflammatory compound. Beneficial and effective anti-oxidant.
    Sodium Ascorbate is beneficial in boosting the pet’s immune system to improve resistance (Vitamin C) to infection.

    Reply
  101. Amy Scaling

    My husband’s current bout with kidney stones yielded an 18mm stone and many smaller ones. He has a stint and is on antibiotics for infection before the stones can be blasted. It has been 7 years since he had a stone. After 3 years of being very diligent with water he returned to his old ways, diet soft drinks, unsweet tea, probably not enough water or lemon. Last night I read your article to him and we have some questions.

    1) If we are able to find an affordable over the counter source of potassium citrate how many mgs would be equal to 10 mEq?

    2) Are urinary alkalinity test strips readily available for home use?

    3) Could consuming large quantities of diet soda, 2L per day of Diet Dr. Pepper, play a part in developing calcium oxalate stones?

    Reply
  102. Alan

    Dear Dr. Coe – Thanks for publishing this web page – it’s very informative.

    It is possible to buy food grade potassium citrate powder. I buy mine here:
    http://pforlife.com/potassium-citrate-tripotassium-citrate-anhydrous-food-grade-fine-granular.html
    It currently sells for $13 per pound plus shipping.

    They also sell food grade magnesium citrate:
    http://pforlife.com/magnesium-citrate-usp-granular-supplement.html
    It’s $13 for 12 oz plus shipping. It should be kept in mind that the tolerable upper limit for magnesium supplements is 350 mg per day as set by the government. Magnesium citrate is 11.3% magnesium.

    Reply
    • Fredric Coe, MD

      Hi Alan, How do you measure out a dose, and what dose do you take? Others have commented on this kind of product put given the hazards of excess potassium I have been leery of its use. Thanks, Fred Coe

      Reply
      • Alan

        Dear Dr. Coe:

        Measuring dosage is very easy. I bought a milligram scale (e.g. http://www.amazon.com/Smart-Weigh-GEM20-Precision-Milligram/dp/B00ESHDGOI for $25) and a set of very small measuring spoons (e.g. http://www.amazon.com/Norpro-3080-Stainless-Measuring-smidgen/dp/B0009X1P9S for $6) which measure down to 1/64th of a teaspoon. I measured which spoon would provide the dosage I wanted and use that spoon to dispense the quantity I want. Buying food grade potassium and magnesium citrate is far less expensive than any other alternative.

        I take two grams of potassium citrate and one gram of magnesium citrate per day. I have calcium oxalate stones.

        I fill a 2 quart container with water and dissolve 2 grams of potassium citrate in it. I drink it all day long and it is effectively a time release version of potassium citrate. I can’t do that with the magnesium citrate because it’s not that soluble in water.

        The research I have done indicates that there is little risk of excess potassium in people with normal kidney function (in fact, that is the reason why the Institute of Medicine declined to set an Upper Limit for potassium). I have my blood and urine tested every year and my kidney function is normal (creatinine, GFR, BUN). Potassium citrate is about 38% potassium so 1 gram (or about 10 mEq) contains 380 mg of potassium, about the amount in one banana.

        Your thoughts on this would be most welcome.

        Reply
        • Fredric Coe, MD

          Dear Alan, what a thoughtful and precise approach! 1.080 gm is indeed 10 mEq of potassium citrate, and common doses for stone prevention are in the range of 40 mEq/day spaced out as best as possible. So you are at the low end. I agree that potassium is quite safe if kidney function is normal but on a public university medical site I have to urge some care. Diabetes, even mild urinary obstruction, hypertensive renal disease in some cases, and certain classes of drugs can interfere with renal potassium excretion even if the serum creatinine and blood urea nitrogen levels are normal. It is for that reason I always demur. But it would seem you have adequate medical backup and testing. For those who can match your remarkable ingenuity and flair for instrumentation, you seem to have found a wonderful way around the high price of potassium citrate. Even so, I have to warn those who read this: Alan is a craftsman of considerable skill; if you mean to do what he is doing be sure to match his level of precision. Respectfully, Fred Coe

          Reply
          • Alan

            Dear Dr. Coe – Thank you for your kind words.

            Since we are discussing the dangers of excess potassium, perhaps you could shed some light on an issue that has long puzzled me. The govt has limited potassium pills to 99 mg each. Yet there are no restrictions or warning labels on high potassium foods such as bananas (425 mg per medium banana), pinto beans (400 mg per half cup, cooked) and milk (350+ mg per cup). A potassium ion is a potassium ion whether it comes from a supplement or a food. So why the inconsistency? I think the limit should be raised to at least the equivalent of a banana.

            Reply
            • Fredric Coe, MD

              Dear Alan, I think it is because of worries that with pills one can get a lot of potassium. The foods you mention do contain 250 – 500 mg pf potassium and there are foods a lot higher than those. Given the atomic weight of potassium at 39 mg, one can get 5 – 20 mEq from foods easily. For example a cup of raisins has over 1000 mg of potassium. In people with kidney disease or the other states I mentioned, these foods must be limited. Perhaps the pills, if OTC, might be mistakenly used by some people who are potassium intolerant. Warm regards, Fred Coe

              Reply
        • Gary

          Alan thank you for sharing your work. I just got a prescription Potassium Citrate and was shocked, with insurance @ Walmart $103 a month. Thus the search on the web.

          I appreciate the time you have saved me – but have a question, What size measuring spoon(s) gives you the 2 grams of potassium citrate and 1 gram of magnesium citrate?

          I’m not sure if I’m going to use the magnesium citrate, why did you decide to use both? I’m leaning toward the qt of Crystal light with 3 grams of potassium citrate daily and get another 24 hr test in 6 months.

          Thank you again for your time and infromation.

          Reply
  103. Jessica

    Question. I am in school and because I’m a graduate student in a different state, I don’t currently have health insurance. I have interstitial cystitis and have had to be hospitalized three times in three years for kidney stones. I am 28. My doctor prescribed potassium citrate 1080 mg four times a day. The current cost for me is $176, which I cannot afford. Can I purchase the much cheaper over the counter version which is 12.99 for 300 pills at 99 mg each (http://www.vitaminshoppe.com/search?search=potassium+citrate#) ? I know I’d have to take as many as 30 pills per day to equal the dosage, but as long as it’s the same mg is it okay? I don’t know if there is a marketable difference between the otc and prescribed versions.

    Thank you!

    Reply
    • Jessica

      correction: $176 per month.

      Reply
      • Fredric Coe, MD

        OK. It is for a month. The savings are large. Still consider beverages and ask your physician for alternatives based on the causes of your stones. Regards, Fred Coe

        Reply
    • Fredric Coe, MD

      Hi Jessica, as far as I can know potassium citrate is a simple salt and the OTC version is the same as the larger size. The larger pills are often slow release, and I doubt that is true for the OTC version, but that may not be crucial. You would need 10 of the smaller pills to equal one large one, making 40 daily which comes to $1.73 daily or $51.90 a month. Is the $176 for a month or for 3 months? If for 3 months, then the savings is not so marked: $155.70. Be sure as the inconvenience of the many pills is apt to be wearing. Another alternative is to be sure your physician cannot devise a workaround. This site is in evolution so it does not by any means contain the full mix of alternatives and cannot for some time. Perhaps your underlying cause of stones – usually diagnosed via 24 hour urine testing with accompanying blood tests – can be treated without this expense. Likewise, beverages can help. Crystal Light contains 10 mEq (1080 mg) of citrate in a liter of the drink and costs almost nothing. Regards, Fred Coe

      Reply
  104. Anthony

    I do not have gout but I produce to much uric acid. I had uric acid stones. Taking allopurinol does the trick, but i do not like the potential long term side affects (plus a recent study from Taiwan about raising cancer risk in bladder and in general). Would it be ok to take potassium citrate to lower urine PH even though my kidneys can not properly “digest” purines?
    Thank you for your insight.

    Reply
    • Anthony

      Correction to my post, take potassium citrate to higher the ph? My ph is usually less than 6 with no medication.

      Reply
      • Fredric Coe, MD

        The low pH values are compatible with what I have written below. Potassium citrate raises urine pH. It is necessary that treatment be supervised by a properly skilled physician and with testing to assure a good outcome. One wants to raise average 24 hour urine pH but not excessively. YOu could have other urine chemistry disorders which might lead to calcium stones as pH is raised. This is discovered by 24 hour urine testing. Fred Coe

        Reply
    • Fredric Coe, MD

      If you have indeed produced uric acid stones it is important to have 24 hour urine studies to determine the average urine pH (acidity or alkalinity) and if the urine is acid – pH below 5.8 – raise it with appropriate doses of alkali. This cannot be done without skilled medical supervision; it is not reasonable to try to accomplish the needed changes without testing and physician direction. Allopurinol is not a treatment for uric acid stones. The effects of low pH (acid urine) so outweigh the changes in urine uric acid excretion from allopurinol that increase of pH is the only proper treatment. In the rare event of remarkably high urine uric acid excretions from genetic diseases or other causes, allopurinol might be employed as well – in addition – but this would be very uncommon. The likely reason for high urine uric acid losses is a diet too rich in purines. Changing diet simply for uric acid stones would not be effective but might be useful in a general medical sense. This, too, requires physician input if matters are to be conducted safely and to your advantage. Fred Coe

      Reply
      • Anthony

        Thank you for the information. This is helpful in my arming myself with knowledge.
        I dug up my last 24 hr test when I stopped taking allopurinol. ph 5.505, urine uric acid was 1.215 g/d. Urine Calcium, oxalate, citrate was in normal range. Do you believe Potassium Citrate alone can do the trick? I am under the care of a Dr. I just am researching this topic. Also, does increasing the PH automatically lower the uric acid excretion?
        Thank you.

        Reply
        • Fredric Coe, MD

          Hi, I am glad the information was useful to you. Your urine uric acid is high because your diet is high in purines which arise from the DNA and RNA in meats. The urine pH is in the right range to cause uric acid stones. Potassium citrate in the right dose will raise urine pH above 6 whereupon uric acid stones will not form. Of course, you need to be sure the stones are really uric acid. If the pH goes too high (above 6.5) it is possible to switch to calcium phosphate stones, so your doctor will want to measure pH with treatment. The urine uric acid excretion is fixed by diet and you can lower it if you wish by eating less purines. Regards, Fred Coe

          Reply
          • Anthony

            Would a vegetarian diet solve my issue of excreting too much uric acid in the urine?

            Reply
            • Fredric Coe, MD

              Hi Anthony, it would but you do not need to do it. If the stones are uric acid then increase of urine pH is ample for protection. If they are calcium, then it is a different matter. The increase of urine uric acid would not be the most likely cause, and other causes need to be sought. Stone analysis is really important here. Fred Coe

              Reply
  105. Dave Monk

    Dr. Coe,

    I’ve decided not to take the Crystal Light route due to high Aspartame content, which seems to bring a new set of potential issues to the table. Instead, I’ve read that fresh lemon juice sufficiently matches the positive qualities of potassium citrate in lowering urinary uric acid levels – see abstract:

    http://www.ncbi.nlm.nih.gov/pubmed/18946667

    I’d like to be sure my math is correct regarding how much lemon juice is required to match the 60mEq/day (6 tablets) of potassium citrate equivalent. According to the above paper, 85 cc/day is needed, which is 2.8+ ounces, or roughly 5.8 tbsp. A medium sized lemon yields approximately 2 – 3 tbsp of juice, so it looks like two lemons/day should do the trick. Does this sound correct to you?

    Thanks for your advice –

    Dave Monk (your favorite patient)

    Reply
    • Fredric Coe, MD

      Hi David, I read the paper. The table in the paper shows some complexity. The lemon juice people had lower urine creatinine levels, suggesting they were smaller and perhaps a higher fraction women than were those given potassium citrate. If you factor the citrate increases for the creatinine (take ratios) the potassium citrate is more effective. Likewise, the urine pH rose very little in the lemon juice people compared to the potassium citrate people. I think lemons will have some effect, and it may be dependent on the lemons. What matters is how low is the pH of the juice. If it is not alkaline enough the citrate will be citric acid and urine citrate – which arises when the liver uses citric acid as fuel in the Krebs cycle taking up a proton for each molecule of citrate used as citric acid – will be modest. A tablespoon contains 15 ml so 3 will be 75 ml meaning perhaps you need 3 lemons, and hope they are not too acid. The best way to be sure this is working is to make a repeat urine measurement on the juice and check the citrate. Overall I am a bit unsure about the results and – as I have indicated – about what the results in the paper you linked to really say. Regards, Fred Coe

      Reply
      • Dave Monk

        Thanks for your feedback, Dr. Coe. I’m at a loss as to what the best solution is, short of shelling out a gazillion dollars for potassium citrate tablets while following your advice on reducing oxalates and increasing calcium-rich foods. I know there is no magic solution, but do you have any recommendations regarding an effective combination for eliminating these god-forsaken stones?

        Reply
        • Fredric Coe, MD

          Hi David, My remarks related to the problem of using lemon juice. As for your entire care issues, these are best considered in a more private setting, and I have emailed you directly. Fred Coe

          Reply
  106. JERRY PAQETTE

    270 pills of 1000 mEq Potassium Citrate at Sam’s $355.00
    270 pills of same at Express Scripts $280.00
    270 pills of same at Meijer Stores $695.00
    270 pills of same at local pharmacy $815.00
    CRAZY !!!! RIP OFF !!!!

    Reply
    • Fredric Coe, MD

      Hi Jerry, True, it is ‘crazy’ and a terrible burden to a lot of people. Thank you for the update on pricing by retailer. Express Scripts looks like a temporary winner. Fred Coe

      Reply
  107. Doug Welker

    Since I began to take potassium citrate I have developed almost constant nausea. I have yet to vomit, though I often feel like I’d feel better if I did.

    I know that nausea is a likely side-effect of potassium citrate.

    Is there a substitute for K citrate that does not have nausea as a common side-effect? I have a good prescription drug plan that covers almost all of the cost of the K citrate pills, so another medication, even if it costs more than K citrate, might be OK.

    -doug-

    Reply
    • Fredric Coe, MD

      Dear Doug, In some people potassium citrate causes severe GI symptoms and it seems you are one of them. I presume you are taking the pill forms of potassium citrate. There are liquid forms, and powders which are dissolved in water and then taken. Here is a situation where your personal physicians really have to be at the center of everything. Do you have an underlying problem like gastritis or even an ulcer which is making you intolerant of the medication? Are there workarounds like taking the medication in relation to food? Chemically potassium citrate is just that – one compound – but it can be taken in different forms. A variety of formulations can be tried in hopes one will work for you. Potassium bicarbonate is also available. But often it is in fact the potassium ion itself that is causing the trouble and one must switch to a sodium alkali or even abandon alkali and try another approach to stone prevention. There are many other ways to lower supersaturation.

      Reply
  108. Anita Boddie

    My insurance covers potassium citrate tablets, although the co-pay is $25. I have recently returned from Japan, where due to their bizarre toilets and the low residue nature of a fish and rice diet, I noticed on several occasions the potassium citrate horse-pill sized tablets I choke down twice daily do not dissolve at all, but are excreted whole. The tablets are marked USL on one side and 071 on the reverse, from CVS mail order. This is both disappointing and worrisome as I put myself through this swallowing misery morning and night to avoid getting kidney stones. If the tablets do not dissolve the can’t be doing anything at all.

    Reply
    • Fredric Coe, MD

      Hi Anita. You are not the first to notice this worrisome but harmless phenomenon. The pills are formulated with the active ingredient – potassium citrate – embedded in a matrix which does not dissolve entirely but releases the chemical in a delayed fashion over time. This slow release is a benefit as it spreads out the time the material can be active in the urine. The matrix shells are often seen as you saw them, but they will have been emptied of their valuable freight. It is their design, and the design works. Fred Coe

      Reply
  109. Frederic Cohen

    Dear Dr. Coe:

    Thank you for your response to my question and for confirming my suspicion that something is very wrong here. I did some shopping today with my prescription, which is for 15 mEq oral tablet, extended release, 1 tablet every 12 hours. I was stunned to find that Wal-Mart could provide me a discount for AAA (American Automobile Association) members that brings the price down to $66.21 per month. Without this discount and with my insurance the price is $120.27 per month, almost the same as the cash price of $125.19. I find it deeply disturbing that the AAA can get a much bigger discount than my insurance plan and its pharmacy benefits manager, CVS/Caremark. What are these people being paid for and whose interests are they representing? The other prices I was given, at Walgreens, Costco and Sam’s Club, were all in the $120 per month range with my insurance.

    The pharmacy tech who helped me at Costco mentioned that the cash price for 10 mEq tablets is less than half of that for the 15 mEq tablets. From your answer to my previous question I’m guessing that one could achieve the 15 mEq dose by taking 1-1/2 10 mEq tablets. Is this correct? If so, it should save some people some money.

    Thank you again for your efforts.

    Reply
    • Fredric Coe, MD

      Dear Frederic, Once again you are a very helpful and constructive voice. The pills should not be broken unless scored by the manufacturer – I do not believe these are. You indicated you were told to take 15 mEq twice daily. The correct way to get 30 mEq daily from the 10 mEq pills is to take 1 pill three times daily. I hope others can benefit from the price savings your have achieved. Fred Coe

      Reply
  110. Dave Vella

    I live in Canada, and recently found these pills to be available locally. Although the bottle says Potassium Citrate, the size and description of the pill seems much different than how it is described in this publication. Can you please browse this link to tell me if these pills will be applicable…I have not taken any yet: http://www.naturalfactors.com/caen/products/detail/2862/potassium-citrate

    Reply
    • Fredric Coe, MD

      Hi Dave; Yes, these are potassium citrate but a standard dose is a bit over 1000 mg and these are less than 100. The reason is that medicinal potassium doses are not safe for some people and therefore limited to prescription status. You could use these but the numbers of pills would be remarkable and not practical. Fred Coe

      Reply
  111. Cappy Walls

    Would Special K20 Pink Lemonade Protein Water Mix work? It has Citric Acid, and Potassium Citrate in it just like Crystal Light. But I do not know if it amounts to 21 mEq like the Crystal Light. Are you able to find out? Or how can I find out? I just had a kidney stone and did a 48 hour urine test. Results showed very low urine volumne, marked hypocraturia, very low urine PH, High CaOx stone risk, and extreme uric acid supersaturation. Kidney funcion tests are ok. Recommended 20 to 60 mEq Potassium Citrate per day until PH reaches 6.3+. This has been an ongoing problem.

    Reply
    • Fredric Coe, MD

      The only way to know how much citrate the drink will deliver is to measure the pH. The lower the pH the higher the fraction of citric acid to citrate. Citric acid is metabolized as such and does not take up a proton. So it does not raise the pH of the urine. I know of no one who is doing beverage pH measurements right now. Given you have a low pH you might be best off using either the potassium citrate pills or Crystal Light whose pH we know. Likewise it sounds like a lot of fluids are in order. We have several excellent articles on this site by Jill Harris on how to drink; take a look.

      Reply
  112. Michael

    The price of potassium citrate has once again increased in my service area. With my part D supplement to medicare my co pay for a 90 day supply (40 meq per day) is $385. This is essentially the same price I have to pay if I get it through Canada drugs. To buy a 90 day supply at K-Mart is %585. It seems to me that food grade potassium citrate sold in bulk for about $35 per kilo may be a reasonable alternative. However, I do not know how to translate the bulk powder efficacy into meq equivelents. Any suggestions?

    Reply
    • Fredric Coe, MD

      Michael, I am appalled at the pricing increase and very sorry to hear about it. I do not know enough about the commercial food grade potassium citrate to make any helpful calculations. The pills are generally 10 mEq, and one could calculate the equivalent amount of the bulk material from the molecular weight of potassium citrate salt, but that would assume things about the exact product – degree of hydration which would alter the relationship between weight and amount of active material, presence of inert fillers as examples. I cannot personally find out about these matters, which probably fall into the venue of licensed pharmacists. Regrets for the nasty pricing and that I cannot do more. Regards, Fred Coe

      Reply
  113. khalid

    dear sir can we mixed potassium citrate +sodabicarb.
    replay me

    Reply
    • Fredric Coe, MD

      Potassium citrate and sodium bicarbonate are both alkali and can be used with each other or instead of each other. But the one is a potassium the other a sodium salt. For people who cannot tolerate high potassium intakes, the sodium salt is safer. For most people, the potassium form is preferable as salt loads can raise blood pressure. Even so, sodium bicarbonate raises blood pressure less than does sodium chloride. The problem is how to calculate the dose equivalents, as one does not want too much or too little. Please consult your physician for this.

      Reply
  114. Fredric Coe, MD

    I do not know if the product is food grade, which would be an important matter. In relation to prevention of kidney stones, potassium citrate has a proven role but with significant specifications. I would not use it yourself without a physician to help be sure it will do you some good and no harm. Like you I do believe the pricing is excessive and wish it were not so.

    Reply
  115. Trish

    I don’t know if this applies… but I am supposed to take 6 1080 mg potassium citrate pills a day… I used to get a 90 day supply for $30.00.. have not picked up my new pills at CVS yet… A am starting to take my pills again, after being noncompliant for a year or so… they are hard to swallow due to the size. The other problem is you can’t take them on an empty stomach… I did find out what the saline laxative effect was one time.

    No matter what I have to take these pills or substitute with Crystal light.. I have dRTA with the associated nephrocalcinosis and have been told if I live long enough, I will be on dialysis one day. My kidney function is stable right now and is not deteriorating .. I am somewhere in stage II or III of kidney failure. Honestly, I know this sounds morbid but I hope I die from something else first.

    I was not aware that the cost has gone up significantly and do not know if this applies for me… but pharmaceutical companies have programs for other expensive medications that lower the cost for the patient. I guess since this is generic that is what the problem is… but are there pills that are a name brand? If so, a program may exist to help with the cost.

    I know polycitra is a name brand… so maybe programs exist for that. There are some HMO’s and insurance companies that have specialists… pharmacists who search for these programs offered by the pharmaceutical companies. Then they tell you the requirements to enroll and help patients get the medication they need at a lower cost.

    If this problem exists, it seems to me that doctors, hospitals etc. have to do something to put pressure on the pharmaceutical companies so programs that reduce the price will be developed. It should not matter if the pills are generic or not.

    My husband and I already can’t afford our medical expenses and cost of health insurance… but he is still employed so Obamacare won’t help and our income is high enough we don’t qualify for any state help… We went through the same thing with thyroid pills for my husband… as the costs have gone from about $22.00 for a 90 day supply to over $75.00… my husband has no thyroid, and his doctor did not want him to take generic pills… but our internist said, with lab tests he could take them.. because he could adjust the dose, accordingly.

    Reply
    • Fredric Coe, MD

      Dear Trish; You are perfectly right: insurance carriers vary in what they will pay, and I hope your company pays for most of the cost as the drug is essential for you. With distal RTA you certainly need consistent treatment. Perhaps the beverage and the pills can be used in some alternation, for variety. Sometimes with RTA sodium retention is not much of a problem and sodium alkali can be used – they are a lot less expensive. I do not know about drug programs for potassium citrate, and I do not believe any of the many commentators on this post said anything about it. Perhaps other readers will know.

      Given only your first name I do not know if you are a patient here; if so you should let us know. If not, please keep your personal physician up to date about your treatment, and try to not let it lapse. As for dialysis, I would not be so pessimistic in general.

      Let your personal physician try to do more for you, so you will not have one year lapses in treatment. If one of us is indeed your personal physician, let us know. Regards, Fred Coe

      Reply
  116. Fredric L Coe

    My Colleague Dr. Elaine Worcester sent this note to me about a patient caught up in the potassium citrate price problem:
    “My patient will not drink the Crystal Light because it contains aspartame. She was told that her insurance will start charging $2000/month for her Urocit K (4 tabs daily)!! My research on GoodRx found approximate prices for equivalent doses of:
    Cytra K solution – $40/3 month supply
    Cytra K crystals – $90/3 month supply
    Klorcon EF tablets – $130/3 month supply
    Urocit K – $300/3 month supply
    Great website!”

    Reply
  117. Fredric Coe, MD

    Alan, Thank you for your thoughtful comment. Klorcon/EF is indeed potassium bicarbonate. Being a branded entity it has a price variation that seemed to me not so different from potassium citrate but I have not researched this topic fully. In theory, citrate should give a longer lived rise of urine citrate – being metabolized to bicarbonate – but in practical terms I know of no trials of relative efficacy. Regards, Fred

    Reply
    • Frederic Cohen

      Dear Dr. Coe:
      Thank you for addressing the issue of the cost of Urocit-K. I have been prescribed Urocit-K 15 mEq oral tablet, extended release, dispense 180, 1 tablet every 12 hours. I have seen prices on the Web for potassium citrate capsules of about $5 for 180 99-mg capsules of potassium citrate. Several questions:
      1. What is the equivalent in mg or 15 mEQ? (my doctor’s assistant could not answer this.)
      2. Is all potassium citrate essentially equal for the purpose of preventing kidney stones? Is there any reason why an over-the-counter supplement could be unsafe or ineffective?
      3. Can the ingredients of potassium citrate be purchased separately and combined at home? If so, where would they be available?
      4. Are any of the ingredients in PC particularly rare or expensive? Is there anything about the way this drug is manufactured that would justify the prices being charged? I have other prescriptions — pravastatin, lisinopril and allopurinol — that with my insurance are all in the $10-15 range for a 30-day supply. I can’t understand why PC would be so much more.
      My insurance company was of no help in explaining the cost of this drug or advising me on how to obtain it at an affordable price.
      Thank you for any help you can provide and for raising this issue.

      Reply
      • Fredric Coe, MD

        Dear Frederic, thank you for the thoughtful questions. The standard potassium citrate pill is 10 milliequivalents of the chemical. The molecular weight of the chemical is 324.4 mg/millimole each of which contains 3 equivalents giving 104.1 mg per milliequivalents. Since there are 10 mEq/pill each pill contains 1041 mg of the chemical – shere are slight rounding errors. The OTC pill is 99 mg, which is a bit below 1 mEq so you would need 10 for one prescribed pill. Because the minimum effective dose is about 2 – 3 pills daily this comes to 10 – 3- of the pills. As for the rest, the implications of your questions are all true: The OTC material and the pill are the same, the ingredients can be purchased in bulk – see other comments on this issue – the materials are remarkably cheap, and you are looking at gauging by the few manufacturers who produce the prescription medication. The article offers what I know, the many comments offer more, and I offer my sympathies to all patients concerned and my scorn to those companies who would do this. Regards, Fred Coe

        Reply
  118. Richard Cusson

    I contacted Canada Pharmacy Online and they have both brand and generic of potassium-citrate in stock at a good price. You have go to the online group…..

    Reply
  119. Kim gallagher

    Julian: I contacted the canada pharmacy and they said they do not carry the potassium citrate er. Can you give the telephone number or web address where you got your prescription Thank you

    Reply
  120. Stacy Cohen

    I have Blue Cross and get my prescriptions thru Prime Therapeutics aka Prime Mail. I have been doing Crystal Light Raspberry Lemonade where potassium citrate is the 2nd ingredient and there’s no sodium. The KLOR-CON is costing me $20.00 for a 3 months supply. When I recently checked on the price of Urocit-K of which I take 6 pills per day, the 90 day cost of the BRAND name was $200.00. If I get the generic Potassium Citrate it’s only $20.00 for the 90 days!

    Reply
  121. Sal Termini

    This is a typical site that sells citric acid in bulk:
    http://labelpeelers.com/cart.php?suggest=5422f69121a33
    I forgot to include this.
    Regards,
    Sal Termini

    Reply
  122. Sal Termini

    From what I can glean, food grade citric acid is marketed as anhydrous powder or monohydrate powder.
    I was skeptical that the free acid exists as a powder at ambient conditions, but that seems to be the case.
    The powder is widely sold in bulk ( 3 to 5 dollars a pound) for finishing the taste of wines. As a food product, it can
    be consumed…. So the trick is……what beverage can be mixed to get an even cheaper alternative to Crystal Light?
    Do you have any thoughts?
    Best regards,
    Sal Termini

    Reply
  123. Janet Skrzypek

    I addition of sodium bicarbonate I am drinking “alkaline water”. it will help?

    Reply
  124. Linda Matuszewski

    I am paying $88.39 for 180 Klor-Con/EF Potassium Bicarbonate Effervescent Tablets for Oral Solution. Medicare and Blue Cross Insurance pay nothing for this drug so it is all out of pocket.

    Reply
    • Fredric Coe, MD

      Dear Linda, thank you so much; this would make the cost reasonable for those who can use the oral solution. Can you reply with a link to the website so I can post it for everyone? I did not find this product at your price. Fred Coe

      Reply
    • Linda Matuszewski

      I am not buying it online. I get my Potassium at CVS and if you are a member to AARP you can apply for a prescription discount card and it will help you save a few dollars more. The prescription card does not cost you anything….you just have to be a member of AARP.

      Reply
  125. Vincent Turitto

    Well the cost seems to be in the final production product (the pill) not the actual chemical. One can buy food grade (I assume this grade would suffice) potassium citrate for about $100 for 1kg (1000 gm) which would make about 1000 pills (10 cents a pill)
    http://www.amazon.com/BulkSupplements-Potassium-Citrate-Powder-grams/dp/B00ENSA910
    So now the question is how to measure accurately enough in a simple manner to prepare your own dosage. I believe two pills would be about 2gm. It would be easy and cheap to fabricate a plate with wells whose volume holds exactly 2 gm. Fill the well and take the contents over cereal, in water, etc. More accurate than measuring with kitchen utensils. There is also bulk purchasing of potassium citrate as a food product additive in liquid form which can be diluted to the proper amount. Just some thoughts. Of course the easiest way is to buy the pill product for those that can afford it, but as you point out cost is a consideration for some.

    Reply
    • Fredric Coe, MD

      Vincent, Thanks for your thoughtful comment. But do you know if these products are indeed approved for human consumption. I found but could not endorse them because of uncertainty with regard to their safety as food supplements. Regards, Fred Coe

      Reply
  126. Julian Berkin

    I just bought 600 10 mEq generic at Canada Pharmacy Online for $340, including shipping. This worked out to under $.57 per pill.

    Reply
    • Fredric Coe, MD

      Thanks for writing, Julian. I missed that one. That is the best price so far. I hope everyone takes note of a good source. Regards, Fred

      Reply
      • Joseph Ventresca

        Whenever buying generic, and also an excellent idea when buying domestic, do a follow-up 24 urine analysis test to see if it is working right for you. That common sense “golden rule” of mine has saved my life.

        Reply
  127. Salvatore Termini

    Dear Dr. Coe,
    Citrate crystals are sold for making wine in the home. It is a food grade product, and quite cheap when purchased in bulk. Does this offer promise?
    Regards,
    Dr. Sal Termini

    Reply
    • Fredric Coe, MD

      Sal, a great comment. I saw potassium bicarbonate powder for wine making which was very cheap. But I could not be sure it was approved for human use. Do you know for sure whether it is? Thanks, Fred Coe

      Reply
    • John Asplin

      Sal,
      Whether the citrate crystals you mention can be used for stone disease also depends on what type of citrate salt is present. As mentioned in Fred’s post, it will make a difference if the citrate is citric acid, potassium citrate, sodium citrate or even some other kind of citrate salt such as calcium citrate or magnesium citrate. Regards, John Asplin

      Reply

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