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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.


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.


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.


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.


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.


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.


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.


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.


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.


  1. 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 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!


    • 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

  2. 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.

    • 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

  3. Mike Babowicz

    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.

    • 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

      • 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!

        • 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

  4. Chris

    A link with the scientific results of the study comparing orange juice to lemonade.

  5. 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.

    • 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

  6. Lois Lloyd

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


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