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.
Doctor Coe
First, thank you for the generous amount of time you’re providing on this. I wonder whether you’ve seen this article – it seems to raise some questions about the use of soda as a potassium citrate provider. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827252/
Hi Gary, Thanks for the thoughtful comment. The article points out that no changes in urine chemistries occurred which would indicate increased or decreased stone risk. On a larger scale, the dark cola beverages are associated with increased risk of stones. The high citrate drinks in the article you comment on are not those that were studied in the paper you reference. They were selected for having the property of offering citrate alternative to pills. Regards, Fred Coe
Doctor Coe
First, thank you for the generous amount of time you’re providing on this. I wonder whether you’ve seen this article – it seems to raise some questions about the use of soda as a potassium citrate provider. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827252/
Hi Gary, Thanks for the thoughtful comment. The article points out that no changes in urine chemistries occurred which would indicate increased or decreased stone risk. On a larger scale, the dark cola beverages are associated with increased risk of stones. The high citrate drinks in the article you comment on are not those that were studied in the paper you reference. They were selected for having the property of offering citrate alternative to pills. Regards, Fred Coe
Fred,
For my patients with mild to moderate hypocitraturia, what are the advantages of potassium citrate pills vs dietary citrate therapy with crystal light, citrus juices, etc? Are the pills better because they are extended release?
What are your thoughts on lemonade vs OJ?
Ray
Hi Ray, Essentially citrate is citrate and the pills have only the advantages of portion control – we know how much is in them and people can count. Crystal Light happens to have a lot of total citrate (salt + acid form) and a higher pH so the citrate concentration is high. Citrus juices are far less reliable – for example a lower pH for a batch of lemons can make a big difference – and are caloric with all carbohydrates. Lemonade is variable depending on pH, and orange juice is very high in sugars. So I like to mix and match – Jill Harris’s article is pretty good about a mix of beverages, and your patients might find it helpful. Regards, Fred
Do you know who the manufacturer is? Do they provide support for those who cannot afford the price?
I believe Mission Pharmacal is the maker of Urocit K. Regards, Fred Coe
Do you know who the manufacturer is? Do they provide support for those who cannot afford the price?
I believe Mission Pharmacal is the maker of Urocit K. Regards, Fred Coe
I have been taking 60ml of CytraK /day for 2 yrs supplied by Express-Scripts -Medicare. Cost $65/90 days. The firm has dropped potassium citrate from its formulary. Walgreen cost $66 for 450ml. 7.5 days dosage. To help my search for alternative pricing, what is the pill equivalent (mEq or mg) to 60ml? Thanks.
Hi George, The pills are 10 mEq each which comes to about 1080 mg of potassium citrate. 5 ml of cytra K solution is about the same. There appears to be a shortage. Regards, Fred Coe
I have been taking 60ml of CytraK /day for 2 yrs supplied by Express-Scripts -Medicare. Cost $65/90 days. The firm has dropped potassium citrate from its formulary. Walgreen cost $66 for 450ml. 7.5 days dosage. To help my search for alternative pricing, what is the pill equivalent (mEq or mg) to 60ml? Thanks.
Dear Dr. Coe, I have had Two episodes of calcium oxalate stones in the past 10 years. My 24 hour urine test came back low citrates. I do not want to take Urocit at this point. What about Magnesium Citrate supplement (Calm by Natural Vitality)? Is it only Potassium Citrate that raises the citrate level? Thank you. Laurie
Hi Laurie, I looked up the product on the web and could not find the actual composition. It is a magnesium citrate. I would not use it for stone prevention because it is too hard to figure out what it contains – actual chemical materials by weight per dose. Use potassium citrate or any of the many alternatives in the comments to this article. Be sure and do a followup and see that your citrate rose, and check out your supersaturations to see that they fell. And remember water is better than anything. Regards, Fred Coe
Dear Dr. Coe, I have had Two episodes of calcium oxalate stones in the past 10 years. My 24 hour urine test came back low citrates. I do not want to take Urocit at this point. What about Magnesium Citrate supplement (Calm by Natural Vitality)? Is it only Potassium Citrate that raises the citrate level? Thank you. Laurie
Hi Laurie, I looked up the product on the web and could not find the actual composition. It is a magnesium citrate. I would not use it for stone prevention because it is too hard to figure out what it contains – actual chemical materials by weight per dose. Use potassium citrate or any of the many alternatives in the comments to this article. Be sure and do a followup and see that your citrate rose, and check out your supersaturations to see that they fell. And remember water is better than anything. Regards, Fred Coe
i take 12 pills a day,10 meq and that comes to about $580 a month, crazy
Dear Laurie, It is crazy, and profiteering and a kind of sin to mark up so simple a product this way. I am not happy to see it. Regards, Fred Coe
I was recently prescribed UROCIT-K10 and as previous posts have mentioned are very over priced. NOW foods has potassium citrate tablets 99mg 180 capsules for $5.15 can these be used vs UROCIT-K10? I believe the conversion would be about 4 tablets to equal 10 mEq.
Hi Larry, The size is really small: round the amount from 99 to 100 mg, and compare to urocit which is a bit above 1000 mg. You need 10 of the small ones to match one of the big ones. Regards, Fred Coe
I was recently prescribed UROCIT-K10 and as previous posts have mentioned are very over priced. NOW foods has potassium citrate tablets 99mg 180 capsules for $5.15 can these be used vs UROCIT-K10? I believe the conversion would be about 4 tablets to equal 10 mEq.
Hi Larry, The size is really small: round the amount from 99 to 100 mg, and compare to urocit which is a bit above 1000 mg. You need 10 of the small ones to match one of the big ones. Regards, Fred Coe
I’ve been taking calcium citrate with Vitamin D3 (brand Citracal Maximum) as a dietary calcium supplement since I am lactose intolerant. It lists calcium as 630 mg and Vit. D3 as 500IU. Would this be a helpful alternative to Potasium citrate to boost citrates for stone issues? Or is it a problem with too much calcium? Yes, I have had stone issues too recently.
Hi Bill, the amount of calcium per unit of citrate will be high so this is not a way to get usual doses. If you need citrate – your urine citrate is low or your urine pH is too low and you have uric acid stones, you will need to do better than this. Check out all the alternatives in the comments. Regards, Fred Coe
I’ve been taking calcium citrate with Vitamin D3 (brand Citracal Maximum) as a dietary calcium supplement since I am lactose intolerant. It lists calcium as 630 mg and Vit. D3 as 500IU. Would this be a helpful alternative to Potasium citrate to boost citrates for stone issues? Or is it a problem with too much calcium? Yes, I have had stone issues too recently.
Hi Bill, the amount of calcium per unit of citrate will be high so this is not a way to get usual doses. If you need citrate – your urine citrate is low or your urine pH is too low and you have uric acid stones, you will need to do better than this. Check out all the alternatives in the comments. Regards, Fred Coe
Our dog has to take 18 potassium citrate a day. She was diagnosed with Distal Renal Tubular Acidosis after being poisoned by the chicken jerky dog treat issue. It’s the only thing that is basically keeping her alive. There are numerous vets locally and across the US that are prescribing this for pets. Our vet has several dogs that are on it. Was about 1996/97 when thousands of these dogs were affected, I’d be curious to see when the price hike occurred.
We buy ours from Canada and still pay $320 monthly!
Hi Janet, The price hike occurred in the past three years I believe. The product for dogs is not approved for human use. Regards, Fred Coe
Thanks, I meant to put the year as 2007/2008, we have been paying this price since she was diagnosed in 2006
Our dog has to take 18 potassium citrate a day. She was diagnosed with Distal Renal Tubular Acidosis after being poisoned by the chicken jerky dog treat issue. It’s the only thing that is basically keeping her alive. There are numerous vets locally and across the US that are prescribing this for pets. Our vet has several dogs that are on it. Was about 1996/97 when thousands of these dogs were affected, I’d be curious to see when the price hike occurred.
We buy ours from Canada and still pay $320 monthly!
Hi Janet, The price hike occurred in the past three years I believe. The product for dogs is not approved for human use. Regards, Fred Coe
Thanks, I meant to put the year as 2007/2008, we have been paying this price since she was diagnosed in 2006
Just mentally exploring the possibility of using the Crystal Light Lemonade but using a more concentrated mixture so as to drink less volume, provided it is still palatable. So the same measurement of Crystal Light could be added to one half or one quarter liter or 16oz /8oz glasses. This could reduce substantially the amount of needed to drink in a day making the load easier. Of course this is provided the mixture would still be palatable.
Just mentally exploring the possibility of using the Crystal Light Lemonade but using a more concentrated mixture so as to drink less volume, provided it is still palatable. So the same measurement of Crystal Light could be added to one half or one quarter liter or 16oz /8oz glasses. This could reduce substantially the amount of needed to drink in a day making the load easier. Of course this is provided the mixture would still be palatable.
Exploring possibility of using Crystal Light Lemonade formula but more concentrated so as one would need to drink significantly less volume. Based on 4 pills a day which mixture would require 2 liters, one could put same measurement of Crystal Light into a 16oz glass drinking half in morning and half in evening, provided still palatable. Also splitting it up to lessen the potential for nausea etc.
Hi Frank, The idea sounds scientifically reasonable. The taste may be another matter! Let us know. Regards, Fred Coe
DR Coe, thanks for your reply. Just to clarify, The 99mg pills available from health food stores are used as a potassium supplement the 99mg on the label refers only to the amount of potassium in each pill. The amount of the whole compound potassium citrate is 258mg per pill. The Rx pill 10 mEq is 1080MG ,would not 4 of the health food pills be close to the equal one of the 10 mEq pills? I talked to someone from Swansons health supplements (120 pills for $2.49) and they calculated it out and said 4 of the 99mg(258mg) potassium nitrate pills would be close to the Rx pill. I also found another brand of 99mg potassium nitrate pills that stated on the label it was 99mg of potassium/ 258 mg of potassium citrate per pill. I am getting conflicting info?
Thanks, Larry; Great researching of a vexed issue. I agree with you. I do not know about potassium nitrate – that would not be what you would want. Nitrate is not citrate. One last item: These health food items are not necessarily reviewed by FDA and need not comply with US standards as applied to drugs. That is always a reservation. So be sure you get the right urine pH and/or citrate changes when they are taken. I am not happy with the terrible prices for authentic potassium citrate, but I am worried about non – inspected products really substituting. Regards, Fred Coe
Hi Larry and Fred. Great website thank you. Swansons brand (120 for $2.49) is Potassium Citrate NOT Potassium nitrate. I think Larry simply did a typo? So this is the very cheapest alternative online by a long way. I have found Swansons health products to be of excellent quality over the years. It’s not rocket science to make such a simple product. If health and quality standards are adhered to (which they are in reputable companies) then why pay Big Pharma 10 times the price? Taking 4 tablets per day is no big deal. iHerb also sells several great brands but they do cost more than double Swansons. Regards, Carole, Australia
Thanks, Carole; I am in agreement but do not know if quality standards are the same for these products as for standard drugs. This is not knowledge talking, it is my own ignorance of product inspection. Regards, Fred Coe
DR Coe, thanks for your reply. Just to clarify, The 99mg pills available from health food stores are used as a potassium supplement the 99mg on the label refers only to the amount of potassium in each pill. The amount of the whole compound potassium citrate is 258mg per pill. The Rx pill 10 mEq is 1080MG ,would not 4 of the health food pills be close to the equal one of the 10 mEq pills? I talked to someone from Swansons health supplements (120 pills for $2.49) and they calculated it out and said 4 of the 99mg(258mg) potassium nitrate pills would be close to the Rx pill. I also found another brand of 99mg potassium nitrate pills that stated on the label it was 99mg of potassium/ 258 mg of potassium citrate per pill. I am getting conflicting info?
Thanks, Larry; Great researching of a vexed issue. I agree with you. I do not know about potassium nitrate – that would not be what you would want. Nitrate is not citrate. One last item: These health food items are not necessarily reviewed by FDA and need not comply with US standards as applied to drugs. That is always a reservation. So be sure you get the right urine pH and/or citrate changes when they are taken. I am not happy with the terrible prices for authentic potassium citrate, but I am worried about non – inspected products really substituting. Regards, Fred Coe
Hi Larry and Fred. Great website thank you. Swansons brand (120 for $2.49) is Potassium Citrate NOT Potassium nitrate. I think Larry simply did a typo? So this is the very cheapest alternative online by a long way. I have found Swansons health products to be of excellent quality over the years. It’s not rocket science to make such a simple product. If health and quality standards are adhered to (which they are in reputable companies) then why pay Big Pharma 10 times the price? Taking 4 tablets per day is no big deal. iHerb also sells several great brands but they do cost more than double Swansons. Regards, Carole, Australia
Thanks, Carole; I am in agreement but do not know if quality standards are the same for these products as for standard drugs. This is not knowledge talking, it is my own ignorance of product inspection. Regards, Fred Coe
DR Coe I made a mistake, sorry, I meant potassium citrate NOT potassium nitrate I should have proof read my post. I researched some more since, and found that 38.3 percent of the weight of potassium citrate is potassium. So I assume that 4 of the 99mg(258) potassium citrate pills available at most health food stores would equal the 10mEq (1080mg) Rx pill. The Rx pills are extended release where as the supplement pills are not extended release is that an issue? I must commend you on your quick response to my question on a Sunday none the less!! My pharmacist is very interested in what I find out as he has customers that cannot afford the Rx pills and wants to know if he can suggest the supplemental pills and or the crystal light. The dose conversion from 10mEq to mg is something most people cannot make.
Thank you!
Hi Larry, I thought so. My only reservation which your pharmacist no doubt shares is uniformity and reliability of these products. Perhaps the pharmacy profession has an opinion on that subject which would be welcome indeed on this site. As for whether or not he can suggest substitutions, that is his professional opinion, and I cannot substitute for it. All I can say here is that if the calculated mEq of potassium citrate is the same in so many of these pills as it is in so many of another pill they would be equivalent for me provided one could rely on the product itself to be safe and to have in it what it says it has in it. Regards, Fred Coe
DR Coe I made a mistake, sorry, I meant potassium citrate NOT potassium nitrate I should have proof read my post. I researched some more since, and found that 38.3 percent of the weight of potassium citrate is potassium. So I assume that 4 of the 99mg(258) potassium citrate pills available at most health food stores would equal the 10mEq (1080mg) Rx pill. The Rx pills are extended release where as the supplement pills are not extended release is that an issue? I must commend you on your quick response to my question on a Sunday none the less!! My pharmacist is very interested in what I find out as he has customers that cannot afford the Rx pills and wants to know if he can suggest the supplemental pills and or the crystal light. The dose conversion from 10mEq to mg is something most people cannot make.
Thank you!
Dr. Coe, I ran this by my Kidney Dr. and he is fine with me using the supplemental potassium citrate. I may get the Rx pill also as you stated for convenience when traveling, backpacking etc. 3 vs 12 pills a day, if the shelf life is long enough. Because of the deductible once it is met it would make sense as well to get a years supply and use over time if the shelf life allows for that. I thought others may be interested in my Kidney doctors opinion.
Thanks
Hi Larry, Thank you for contributing this useful information to the site. Warm Regards, Fred Coe
Dr. Coe, I ran this by my Kidney Dr. and he is fine with me using the supplemental potassium citrate. I may get the Rx pill also as you stated for convenience when traveling, backpacking etc. 3 vs 12 pills a day, if the shelf life is long enough. Because of the deductible once it is met it would make sense as well to get a years supply and use over time if the shelf life allows for that. I thought others may be interested in my Kidney doctors opinion.
Thanks
Hi Larry, Thank you for contributing this useful information to the site. Warm Regards, Fred Coe
I found Effer K 20 mEq potassium bicarbonate/citrate for about $10 for 30 at a bunch of stores. http://www.goodrx.com/effer-k. This sounds reasonable, but I did not find it in time for the original article. Fred Coe
I was diagnosed with Medullary Sponge Kidney (MSK) after my urologist received my results from my first litholink test he said I had a very high PH and a very low potassium level. He prescribed potassium citrate 15 mEq and I had to take 2 pills 2 times a day. The first prescription my insurance paid it no problem but when I tried to fill it the 2nd time they wanted to charge me 300 dollars (30 day supply). This is not in my budget I told my urologist he hasn’t done anything for me besides give me a few samples. So I haven’t had any medicine and I’m currently looking for a nephrologist.
I was diagnosed with Medullary Sponge Kidney (MSK) after my urologist received my results from my first litholink test he said I had a very high PH and a very low potassium level. He prescribed potassium citrate 15 mEq and I had to take 2 pills 2 times a day. The first prescription my insurance paid it no problem but when I tried to fill it the 2nd time they wanted to charge me 300 dollars (30 day supply). This is not in my budget I told my urologist he hasn’t done anything for me besides give me a few samples. So I haven’t had any medicine and I’m currently looking for a nephrologist.
I’ve settled into a routine. I make 3 2L bottles of Crystal Light up and add 13 grams of Potassium Citrate to each bottle. Each 2 L bottle I evenly divide between 4 20 oz soda bottles. I take 1 soda bottle a day and pour 1/2 into a 32 oz mug ice and top off with cold water twice a day.
Costs
$13 for 1 lb food grade Potassium Citrate**
$15 – $2.49 ea for 6 2L packs of Crystal Light 36 total 2L bottles (Walmart)
$28 for 135 days of 4 grams of Potassium Citrate drinks per day
Approx $.21 a day, $1.47 a week and $6.30 a month, as opposed to $53 a month my cost after insurance from pharmacy.
I like the lemonade so this works for me, I know that some folks won’t find the drinking the same thing every day boring so this won’t work for them.
I’m cheap so . . .
** 1 pound food grade potassium citrate from Amazon $12.99 plus $5.99 ea shipping sealed in retort pouchs – however if you purchase 3 they throw in free shipping (last I saw).
Hi Gary, I think you win the prize – a complete story and a food approved product. You are putting 13,000 mg of K citrate into 2 liters and drinking 3 of these a day which is a lot of the product. 1,080 mg of potassium citrate is 10 mEq and a high dose is 6 or just a bit over 6,000 mg of potassium citrate. You seem to be getting 39,000 mg. Please check out your quantities. I am concerned. Regards, Fred Coe
Not sure how accurate the information is, maybe someone who knows could comment. My kidney specialist did warn me of the possibility of the potassium citrate losing strength (for want of a more accurate term) if left dissolved in water for a long period. I was dissolving my citrate (12g per day) in 2L of water and when tested my citrate level had actually gone down lower than when taking 6g per day as capsules (still home made). There were three possibilities:
1) My kidney citrate excretion was even worse then before. He thought unlikely given how bad it already was and the fact my kidney function is otherwise perfect.
2) I was ripped off when buying the PC – a possibility.
3) It was losing strength sitting in the bottle all day.
Cheers
Mick
Hi Mick, Being a simple molecule citrate is not likely to degrade if kept refrigerated – of course any bacteria could eat the citrate as a nutrient! But why do things this way? Make it fresh daily if possible. Very low urine citrate is not common; perhaps there is a reason such as potassium depletion, or even renal tubular acidosis. From this distance, I cannot be very specific. Regards, Fred Coe
I’ve settled into a routine. I make 3 2L bottles of Crystal Light up and add 13 grams of Potassium Citrate to each bottle. Each 2 L bottle I evenly divide between 4 20 oz soda bottles. I take 1 soda bottle a day and pour 1/2 into a 32 oz mug ice and top off with cold water twice a day.
Costs
$13 for 1 lb food grade Potassium Citrate**
$15 – $2.49 ea for 6 2L packs of Crystal Light 36 total 2L bottles (Walmart)
$28 for 135 days of 4 grams of Potassium Citrate drinks per day
Approx $.21 a day, $1.47 a week and $6.30 a month, as opposed to $53 a month my cost after insurance from pharmacy.
I like the lemonade so this works for me, I know that some folks won’t find the drinking the same thing every day boring so this won’t work for them.
I’m cheap so . . .
** 1 pound food grade potassium citrate from Amazon $12.99 plus $5.99 ea shipping sealed in retort pouchs – however if you purchase 3 they throw in free shipping (last I saw).
Hi Gary, I think you win the prize – a complete story and a food approved product. You are putting 13,000 mg of K citrate into 2 liters and drinking 3 of these a day which is a lot of the product. 1,080 mg of potassium citrate is 10 mEq and a high dose is 6 or just a bit over 6,000 mg of potassium citrate. You seem to be getting 39,000 mg. Please check out your quantities. I am concerned. Regards, Fred Coe
I think Gary said he makes three 2L bottles at a time, but he only drinks 1/4 of each bottle per day.
Thanks, I missed that. Regards, Fred Coe
I’ll do the math to show how I arrived at the quantities. Working from 1.08 g for 10 mEq, Each liter crystal light 21.7 mEq (times 2 per Crystal light pack), 4.34 X 1.08= 4.69 g
4.7g – Crystal Light in each 2L bottle
13.0 g – Added food grade Potassium Citrate
17.6 / 4 = 4.69 g per day or 81.89 mEq daily.
Yes I could fine tune it better but 13 g is easy for me to remember. The reason I make 3 2 L bottles at a time is that’s all the space in the fridge my wife will let me take, anyway it’s 12 days worth.
The daily mEq should have read
17.7 / 4 (days) = 4.425 g
4.456g / .1080 converted to mEq) = 40.9 mEq daily
Have you had lab tests for potassium since you started taking the formula you came up with. I am trying it out and will have tests in a couple of months.
Thanks.
Hi Gary, I have not checked the math here, but I am sure you have. Be sure your physician knows how much you use just as a precaution. Although lots of potassium from foods is generally a good idea, and potassium from pills more or less likewise, some people have problems that would limit desirable potassium intake. So just be sure about the dose with your physician as he/she is your actual care person, and responsible for your health. I know this can sound like a nostrum or my desires to be careful but really it is true – stuff happens and physicians do know a lot and need to be in the loop. With all that, you are really contributing here, and others may well use your ideas. Each person who does should check the math, though, as it is a big deal to circumvent the drug industry, Regards, Fred
Not sure how accurate the information is, maybe someone who knows could comment. My kidney specialist did warn me of the possibility of the potassium citrate losing strength (for want of a more accurate term) if left dissolved in water for a long period. I was dissolving my citrate (12g per day) in 2L of water and when tested my citrate level had actually gone down lower than when taking 6g per day as capsules (still home made). There were three possibilities:
1) My kidney citrate excretion was even worse then before. He thought unlikely given how bad it already was and the fact my kidney function is otherwise perfect.
2) I was ripped off when buying the PC – a possibility.
3) It was losing strength sitting in the bottle all day.
Cheers
Mick
Hi Mick, Being a simple molecule citrate is not likely to degrade if kept refrigerated – of course any bacteria could eat the citrate as a nutrient! But why do things this way? Make it fresh daily if possible. Very low urine citrate is not common; perhaps there is a reason such as potassium depletion, or even renal tubular acidosis. From this distance, I cannot be very specific. Regards, Fred Coe
1028 milligrams or 10 meq ( 3x a day with meals) of potassium citrate has been prescribed for my recurring kidney stone problems. (.0362 ounces) Re: Calcium renal calculi prevention.
Cannot afford it.
Am going to take 1028 milligrams(10 meq) of potassium citrate powder(bought in quantity from Pure Bulk) 3 times a day by adding 1028 mg x3 to a quart of water and drinking a third of quart each time.
Bought a small scale off the internet . It appears to work well. Probably need to calibrate it to be sure.
Doctor and stone expert at clinic begrudgingly said it was ok after some initial hesitance. Doctor also said it would be a good idea to check potassium levels on occasion.
Am assuming that it is ok to take the powder form instead of the time release form and am assuming that an appropriate level of .potassium citrate will be maintained in my body.
Is this a workable regime? My physiology tends to run on the acidic side( my sweat often smells like vinegar).
The only place where there might be problems is in the weighing of the powder and the purity of powder.
Pure Bulk sells for human consumption and tests for purity . ( each batch is tested independently)
Shelf live is an unknown. Intend to calibrate scale with a known gram weight.
Any comments??
Hi rob, Others who have commented on this article propose the same thing. The problem is in the weighing. Be sure your balance is accurate enough to weight out the 3 grams. Perhaps a better alternative is to weigh out four times that amount – so the percent error is low – and add it to a four liter container. It is not at all hard to siphon off one liter from a four liter container, and the material is very stable if kept in the fridge. If the material is approved for human use, you can use it. Being a stable salt, shelf life is very long. Be sure you have no diseases which might compromise potassium removal by the kidneys: diabetes, hypertensive kidney disease, use of potassium sparing diuretics are examples – ask your physicians. A fasting serum potassium after a week or so of treatment is a good idea. Regards, Fred Coe
1028 milligrams or 10 meq ( 3x a day with meals) of potassium citrate has been prescribed for my recurring kidney stone problems. (.0362 ounces) Re: Calcium renal calculi prevention.
Cannot afford it.
Am going to take 1028 milligrams(10 meq) of potassium citrate powder(bought in quantity from Pure Bulk) 3 times a day by adding 1028 mg x3 to a quart of water and drinking a third of quart each time.
Bought a small scale off the internet . It appears to work well. Probably need to calibrate it to be sure.
Doctor and stone expert at clinic begrudgingly said it was ok after some initial hesitance. Doctor also said it would be a good idea to check potassium levels on occasion.
Am assuming that it is ok to take the powder form instead of the time release form and am assuming that an appropriate level of .potassium citrate will be maintained in my body.
Is this a workable regime? My physiology tends to run on the acidic side( my sweat often smells like vinegar).
The only place where there might be problems is in the weighing of the powder and the purity of powder.
Pure Bulk sells for human consumption and tests for purity . ( each batch is tested independently)
Shelf live is an unknown. Intend to calibrate scale with a known gram weight.
Any comments??
Price of Potassium Citrate Tab 1620 mg in 2015 for my insurance plan ran from $347.25 to $362.54.
Price of Potassium Citrate Tab 1620 mg in 2015 for my insurance plan ran from $347.25 to $362.54.
Thanks so much for this article! It’s very helpful for multiple-time kidney stone veterans like me. I was wondering whether you can put Crystal Light powder into empty gel capsules (you can get them online or in vitamin/supplement stores) and take them that way instead of drinking so much Crystal Light.
Thanks so much for this article! It’s very helpful for multiple-time kidney stone veterans like me. I was wondering whether you can put Crystal Light powder into empty gel capsules (you can get them online or in vitamin/supplement stores) and take them that way instead of drinking so much Crystal Light.
Hi Fern, OOPS, I guess this was already up, I am slow to get it. I answered you above. Best, Fred Coe
I posted a comment last week, but it doesn’t seem to have gone through. I’m wondering if you can put the Crystal Light powder in empty gelatin capsules (health supplement stores and Amazon sell them) and take the capsules in lieu of drinking so much Crystal Light.
Hi Fern, I am sorry – somehow it must have been lost. Here, I am uncertain. These commercial powders are certainly safe for people but I do not know if when swallowed as a powder – in a capsule – it might damage the linings of the esophagus or stomach. The manufacturer has no responsibilities if injury occurs in such an adventure. I cannot recommend it lacking knowledge of risks. Sorry, Regards, Fred Coe
I posted a comment last week, but it doesn’t seem to have gone through. I’m wondering if you can put the Crystal Light powder in empty gelatin capsules (health supplement stores and Amazon sell them) and take the capsules in lieu of drinking so much Crystal Light.
Hi Fern, I am sorry – somehow it must have been lost. Here, I am uncertain. These commercial powders are certainly safe for people but I do not know if when swallowed as a powder – in a capsule – it might damage the linings of the esophagus or stomach. The manufacturer has no responsibilities if injury occurs in such an adventure. I cannot recommend it lacking knowledge of risks. Sorry, Regards, Fred Coe
I have had multiple procedures (litho, etc) for kidney stones for over 25 years, including a hospitalization for kidney infection and renal failure. My physician has recommended Crystal Lite and I am most happy to comply, except that it causes severe gastric distress in-spite of my use of omeprazale or Nexium on a daily basis. In such cases, is the use of less irritating products such as diet 7-up a good substitute? What ‘dosage’ would you recommend?
Hi Elizabeth, Given all of the stones, and miseries, have you had a proper evaluation to guide prevention?? Be sure? Crystal light is just a way to get potassium citrate without paying a high price for the pills, as noted in the article. A list of alternatives are in the article and the many comments to it. Diet 7- up may not contain potassium citrate, as an example. But one does not use this agent or beverage substitutes for it unless an evaluation has been made and thought about. With kidney failure and multiple procedures be sure everyone is informed about why you form stones and is directing treatment to the causes of the stones. Regards, Fred Coe
I have had multiple procedures (litho, etc) for kidney stones for over 25 years, including a hospitalization for kidney infection and renal failure. My physician has recommended Crystal Lite and I am most happy to comply, except that it causes severe gastric distress in-spite of my use of omeprazale or Nexium on a daily basis. In such cases, is the use of less irritating products such as diet 7-up a good substitute? What ‘dosage’ would you recommend?
Hi Elizabeth, Given all of the stones, and miseries, have you had a proper evaluation to guide prevention?? Be sure? Crystal light is just a way to get potassium citrate without paying a high price for the pills, as noted in the article. A list of alternatives are in the article and the many comments to it. Diet 7- up may not contain potassium citrate, as an example. But one does not use this agent or beverage substitutes for it unless an evaluation has been made and thought about. With kidney failure and multiple procedures be sure everyone is informed about why you form stones and is directing treatment to the causes of the stones. Regards, Fred Coe
The price of potassium citrate is through the roof. I talked to a pharmacist at length and she said the price has risen dramatically in recent years. (I write this as of 5/10/16.) My urologist prescribed it because the citrate level in my urine is low — potassium citrate 10 MEQ (1080 MG) SR tablet (UROCIT-K), 20 mEq, Oral, BID. That’s four tablets twice a day. The cheapest price I have been able to find for this — 120 tablets/month — is $125 (and this is with one of those Internet discount cards). This is outrageous. I am on Medicare with no Part D. You think I’m spending more than a thousand bucks a year on glorified citric acid? No way. Crystal Lite here I come.
Hi Ron, Join the unhappy club. Take a look at the many comments, some are very innovative indeed. Regards, Fred Coe
The price of potassium citrate is through the roof. I talked to a pharmacist at length and she said the price has risen dramatically in recent years. (I write this as of 5/10/16.) My urologist prescribed it because the citrate level in my urine is low — potassium citrate 10 MEQ (1080 MG) SR tablet (UROCIT-K), 20 mEq, Oral, BID. That’s four tablets twice a day. The cheapest price I have been able to find for this — 120 tablets/month — is $125 (and this is with one of those Internet discount cards). This is outrageous. I am on Medicare with no Part D. You think I’m spending more than a thousand bucks a year on glorified citric acid? No way. Crystal Lite here I come.
Hi Ron, Join the unhappy club. Take a look at the many comments, some are very innovative indeed. Regards, Fred Coe
30 tablets of 5mEq per day at my local pharmacy including my insurance company’s rate is about $43. This is up from about $12 a few years ago. I checked the online mail order pharmacy operated by my insurance company (Premera), and was floored. 30 tablets there are $1473 my cost, with insurance claiming they pay $2732 of the total $4205 cost. For 90 tablets, I would pay $2917 and insurance would pay $8511 of the total $11,428 cost.
This is insane.
Hi Rick, Yes, it is insane. Apparently this has happened over a number of simple and older drugs. Regards, Fred Coe
As for the lowest cost of Potassium Citrate, I have been buying it from a Canadian Costco Pharmacy at the cost of 100 pills of 10 mEq tablets for $18.49 CAD (~ $14.25 USD). That represents a cost of 14.3 cents per one 10 mEq tablet. It is typically available as a special OTC order without a prescription.
Hi Rudolf, Thanks for this valuable source. I would simply caution everyone who reads it to be sure they need and will benefit from potassium citrate, and also to be sure that they can tolerate the extra potassium; these are points for which you do need a physician even if the drug is OTC. Regards Fred Coe
Hi. Can you give me the Canadian website where you bought them? Just had a 13 mm stone crushed and i have to take Acalka tablets which is Potassium citrate. Here in Denmark they are 150$ for 100 and i have to take 4 each day. I cant afford that!!
As for the lowest cost of Potassium Citrate, I have been buying it from a Canadian Costco Pharmacy at the cost of 100 pills of 10 mEq tablets for $18.49 CAD (~ $14.25 USD). That represents a cost of 14.3 cents per one 10 mEq tablet. It is typically available as a special OTC order without a prescription.
Hi Rudolf, Thanks for this valuable source. I would simply caution everyone who reads it to be sure they need and will benefit from potassium citrate, and also to be sure that they can tolerate the extra potassium; these are points for which you do need a physician even if the drug is OTC. Regards Fred Coe
Hi. Can you give me the Canadian website where you bought them? Just had a 13 mm stone crushed and i have to take Acalka tablets which is Potassium citrate. Here in Denmark they are 150$ for 100 and i have to take 4 each day. I cant afford that!!
Aside from running a home lab, why aren’t we talking about the reason these pharm companies are charging so much all of a sudden, and what we can do about it? This is not a patented drug, it’s not even a very sophisticated molecule, so why on earth are we being gouged?
Dear Anne, We are being gouged because they can do it. I am not a politically active person, but that is what it would take to change this pattern of behavior. Potassium citrate is not the only old and simple drug where this is happening. Regards, Fred Coe
Aside from running a home lab, why aren’t we talking about the reason these pharm companies are charging so much all of a sudden, and what we can do about it? This is not a patented drug, it’s not even a very sophisticated molecule, so why on earth are we being gouged?
Dear Anne, We are being gouged because they can do it. I am not a politically active person, but that is what it would take to change this pattern of behavior. Potassium citrate is not the only old and simple drug where this is happening. Regards, Fred Coe
That is happening with other supplements as well. Iodine is another that has gone up considerably. a few years when I looked into it you could get a bottle for $7, now a small dropper bottle is $17. It depends on what is in the news and hot. Very sad.
That is happening with other supplements as well. Iodine is another that has gone up considerably. a few years when I looked into it you could get a bottle for $7, now a small dropper bottle is $17. It depends on what is in the news and hot. Very sad.
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