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 
water 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.
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
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
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
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
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
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
I just bought 600 10 mEq generic at Canada Pharmacy Online for $340, including shipping. This worked out to under $.57 per pill.
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
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.
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.
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.
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
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.
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
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.
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.
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
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.
I addition of sodium bicarbonate I am drinking “alkaline water”. it will help?
I addition of sodium bicarbonate I am drinking “alkaline water”. it will help?
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
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
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
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!
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!
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
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
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…..
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…..
For those in Canada looking for cheaper price on K – Citrate 10mg https://www.seaford.ca/
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
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.
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
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
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.
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
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!”
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!”
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.
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
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.
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.
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.
dear sir can we mixed potassium citrate +sodabicarb.
replay me
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.
dear sir can we mixed potassium citrate +sodabicarb.
replay me
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.
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?
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
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?
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
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.
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.
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.
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.
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
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
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.
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
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.
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.
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
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.
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
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-
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.
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-
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.
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 !!!!
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
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)
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
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?
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
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)
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
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?
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
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.
Correction to my post, take potassium citrate to higher the ph? My ph is usually less than 6 with no medication.
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
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
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.
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
Would a vegetarian diet solve my issue of excreting too much uric acid in the urine?
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
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!
correction: $176 per month.
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
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
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!
correction: $176 per month.
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
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
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.
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
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.
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
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.
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
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.
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.
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?
Hi Amy, 1080 mg is 10 mEq a standard pill by prescription. Urine test strips for pH are valuable for people with uric acid stones not for calcium stones – it is important to know what kind of stones he forms. Some diet drinks are a stone risk, others are not; here are lists of good and bad. Regards, Fred Coe
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?
Hi Amy, 1080 mg is 10 mEq a standard pill by prescription. Urine test strips for pH are valuable for people with uric acid stones not for calcium stones – it is important to know what kind of stones he forms. Some diet drinks are a stone risk, others are not; here are lists of good and bad. Regards, Fred Coe
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.
Hi Again, Amy, I now know the stones were calcium oxalate. Veterinary products are not approved for human use and I cannot recommend that your husband use such products. I have summarized the evidence that potassium citrate does indeed help prevent calcium oxalate stones, but as for the other materials you mention I believe no real evidence exists. That does not mean they do not, but the probability they will be helpful is low. Regards, Fred Coe