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.
Just picked up a 90 day supply of potassium citrate at CVS and the cost was $455!!
Just picked up a 90 day supply of potassium citrate at CVS and the cost was $455!!
Hello. I found this article with research that orange juice works better than lemon drinks because of the potassium in OJ. I was wondering your thoughts on this. http://www.utsouthwestern.edu/newsroom/news-releases/year-2006/orange-juice-is-better-than-lemonade-at-keeping-kidney-stones-away.html
Hi Chris, Let me offer a larger perspective on this important matter. Fruits and veggies are an excellent source of potassium, and that potassium is mostly in the form of potassium with organic anions like citrate (malate, fumarate, etc) which are metabolized in their acid forms meaning that their metabolism produces alkali in the form of bicarbonate – in the blood. That in turn liberates citrate into the urine – just like potassium citrate pills do. Any one fruit has the same potassium properties, in varying amounts. For example lemon juice is more acid than orange juice, so the organic acids are protonated – in their anion form, and will not produce new bicarbonate. But orange juice is high in sugar. The modern diet guidelines for US people ask for 6 servings a day of fruits and veggies which will add 60 mEq of potassium – like 6 10 mEq pills – mostly as the organic anion salts. I advocate for this, more or less in line with the articles, but not a mono diet. Assortments work better. Regards, Fred Coe
Hello, what if you just add some sodium bicarbonate into lemon juice? That would create a solution that wouldn’t be so acidic and there would be plenty of citrate in form of salt sodium citrate (Na3C6H5O7). it is very easy to make and u can calculate exactly how much you get. im sure the effect would be very similar to potassium citrate, in case of increasing urine pH. It is also used as a medicine for lowering urine pH.
And it would probably be the cheapest:)
https://www.drugs.com/cdi/citric-acid-sodium-citrate.html
Mistake in my last sentence. Correction : it is use as a medicine for increasing urine pH.
Hi Matjaz, You are correct that sodium bicarbonate would take up protons from the citric acid in lemon juice and the total citrate species in solution would be citrate ion itself mostly accompanied by sodium. It would increase urine pH more or less the same as sodium bicarbonate itself would. The citrate in medication or drinks is metabolized as citric acid in the KREB’s cycle, so each mole of citrate takes up a mole of protons. The removal of protons from blood – a bicarbonate buffered solution at a fixed pCO2 – produces new bicarbonate by shifting the equilibrium reactions from CO2 to carbonic acid to bicarbonate. For calcium stones, sodium alkali, sodium bicarbonate for example, will increase urine citrate but also increase urine calcium; it is not a good treatment. You need alkali without the sodium. For uric acid stones, where we only want to increase pH, sodium bicarbonate pills are fine alone or dissolved in lemon juice. But for the latter you will lose some bicarbonate as CO2. Regards, Fred Coe
Hello. I found this article with research that orange juice works better than lemon drinks because of the potassium in OJ. I was wondering your thoughts on this. http://www.utsouthwestern.edu/newsroom/news-releases/year-2006/orange-juice-is-better-than-lemonade-at-keeping-kidney-stones-away.html
A link with the scientific results of the study comparing orange juice to lemonade. http://m.cjasn.asnjournals.org/content/1/6/1269.full
A link with the scientific results of the study comparing orange juice to lemonade. http://m.cjasn.asnjournals.org/content/1/6/1269.full
Hello,
I’m a uric acid stone sufferer of 30y duration, I have been on and off urocit K for years. As of a day ago, I’m back on it and am agast at the price rises and new insurance policies regarding this medication! I’m a physicist by training, so I’m a bit uncertian of some of the chemistry involved…but I can add and divide.
I found food grade potassium citrate on amazon for 55.00 $ per 5 lbs. Assuming 10 meq, which is about 1.1 g of potassium citrate. At that price the 10 meq dose price would be .027$, about 2.7 cents/10 meq dose.
This alternative to the outrageously high priced commercial product would requires careful mass measurement on a mg scale,to avoid potassium toxicity…and monitoring.
What is your opinion of this approach?
Thanks for moderating this site,I greatly appreciate it.
Hi Mike, Being a physicist, and quantitative by nature, you have caught up the dilemma. One could measure out doses or pay a manufacturer to do it for you, as that is mostly the value of the pills. Some – read the comments – are measuring and those who do it seem capable lab people. Most cannot because of mg scale issues and the dangers of potassium excess. Sodium bicarbonate is also alkali, and can be bought cheaply, but the sodium can raise blood pressure – as the bicarbonate not the chloride salt this may be a lesser problem. Crystal light lemonade contains 20 mEq of potassium alkali in a liter and costs almost nothing. Fruits and vegetables in 6 servings a day provide about 60 mEq of potassium almost all in the form of anions metabolized to bicarbonate. I would advise a mix and match approach to minimize pill use. Regards, Fred Coe
Dr. Coe,thanks for the reply! Interesting and helpful.
I’ll try the Kcit weighing approch,but cautiously! As chance would have it, a hobby is reloading rifle cartridges, so I have equip to dry measure powders by volume easily, and check weight on a balance precise to 6.5mg. I’ll also measure both by volume and by weight 20 doses and check the deviation, before proceeding. Nasty outcomes for sloppy work in both activities.
(Also intend to check ph of urine to verify effectiveness).
Also checking into crystal light option. As locally available, the basic packets make. 2 quarts of drink / 15g packet , if mixed per pkg instructions. But no detailed chemical anylsis evident in the pkg as bought.
Just to verify,
20 meq Kcit per 1 lt of drink; mixed as directed
(not 20meq/15g packet? )
Interesting that Vegatables metabolize to produce alkali…I never suspected that! Are there any types that are more alkali productive than others? (I also need to control oxlate, I’m told….sort of a mutually exclusive set of parameters…coping with both uric acid and oxylate, my stones were 80% uric,20% oxylate)
Sodium bicarb?..alas…BP issues….but apealingly priced.
Interesting website,too. I appreciate the depth.
We share a fondness for walking in the eastern Alps,it seems. Gotta get these stones managed and get back there…
Again, sincere thanks!
Hello,
I’m a uric acid stone sufferer of 30y duration, I have been on and off urocit K for years. As of a day ago, I’m back on it and am agast at the price rises and new insurance policies regarding this medication! I’m a physicist by training, so I’m a bit uncertian of some of the chemistry involved…but I can add and divide.
I found food grade potassium citrate on amazon for 55.00 $ per 5 lbs. Assuming 10 meq, which is about 1.1 g of potassium citrate. At that price the 10 meq dose price would be .027$, about 2.7 cents/10 meq dose.
This alternative to the outrageously high priced commercial product would requires careful mass measurement on a mg scale,to avoid potassium toxicity…and monitoring.
What is your opinion of this approach?
Thanks for moderating this site,I greatly appreciate it.
Hi Mike, Being a physicist, and quantitative by nature, you have caught up the dilemma. One could measure out doses or pay a manufacturer to do it for you, as that is mostly the value of the pills. Some – read the comments – are measuring and those who do it seem capable lab people. Most cannot because of mg scale issues and the dangers of potassium excess. Sodium bicarbonate is also alkali, and can be bought cheaply, but the sodium can raise blood pressure – as the bicarbonate not the chloride salt this may be a lesser problem. Crystal light lemonade contains 20 mEq of potassium alkali in a liter and costs almost nothing. Fruits and vegetables in 6 servings a day provide about 60 mEq of potassium almost all in the form of anions metabolized to bicarbonate. I would advise a mix and match approach to minimize pill use. Regards, Fred Coe
Dr. Coe,thanks for the reply! Interesting and helpful.
I’ll try the Kcit weighing approch,but cautiously! As chance would have it, a hobby is reloading rifle cartridges, so I have equip to dry measure powders by volume easily, and check weight on a balance precise to 6.5mg. I’ll also measure both by volume and by weight 20 doses and check the deviation, before proceeding. Nasty outcomes for sloppy work in both activities.
(Also intend to check ph of urine to verify effectiveness).
Also checking into crystal light option. As locally available, the basic packets make. 2 quarts of drink / 15g packet , if mixed per pkg instructions. But no detailed chemical anylsis evident in the pkg as bought.
Just to verify,
20 meq Kcit per 1 lt of drink; mixed as directed
(not 20meq/15g packet? )
Interesting that Vegatables metabolize to produce alkali…I never suspected that! Are there any types that are more alkali productive than others? (I also need to control oxlate, I’m told….sort of a mutually exclusive set of parameters…coping with both uric acid and oxylate, my stones were 80% uric,20% oxylate)
Sodium bicarb?..alas…BP issues….but apealingly priced.
Interesting website,too. I appreciate the depth.
We share a fondness for walking in the eastern Alps,it seems. Gotta get these stones managed and get back there…
Again, sincere thanks!
Hi Mike, It is 20 mEq/liter which is about a quart. We measured the citrate directly so the label is not helpful. Check the article and look at the graph. Plants and animals have a lot of potassium in their cells most of which is not chloride. Plants have a lot more potassium on a weight basis than animals used as food and the counter anion is usually one of the Krebs Cycle intermediates – citrate, pyruvate, etc. these anions are metabolized as the acid so a protein is taken up per molecule metabolized, thence the production of bicarbonate; blood is PCO2 stated so removing a proton obligates production of new bicarbonate. Fruits are the ideal in having a maximum of potassium anion. Be careful weighing but if you are good to the nearest 7 mg I have no concerns – 7/1080 is a good precision. As for urine oxalate, is yours high? Is your urine supersaturated appreciably with respect to calcium oxalate? Do the uric acid thing and take a look at the whole 24 hour urine test when you do your followup. Regards, Fred Coe
I have had 2 bouts with stones that required removal. Since the second bout I have been taking Potassium Citrate (PC) 4 pills a day of the 10 mEq strength. No further stones for past 18 months. As with others the cost is a factor particularly as the PC cost combined with the cost of Pradaxa blood thinner drives me quickly into the Part D doughnut hole with a net increase in prescription drugs nearing $1500 per year. It seems as though from reading your material that alternate sources of PC are a viable alternative but I can’t see myself ingesting 2 liters or 4 liters of soft drinks a day. (I have never been a frequent user of soft drinks). I have no concern about accurately measuring out 4 gms of PC per day (as I accurately measure small amounts of chemicals for my wine making hobby) and adding this to the 2 or so liters of water I conscientiously consume daily. Any reason to NOT do this? As the Part D annual costs will be cycling in about 3 weeks I’d like to get started on this for 2017 if you see no risk. I’ve discussed this with my urologist and he is a bit ambivalent on the question not feeling qualified to establish a weight equivalence between a 10 mEQ tablet and a given measure of PC.
Hi Stanley, I take it you use 4 ten mEq K citrate daily, and presumably because your 24 hour urines showed a low urine citrate or you have uric acid kidney stones. I say this because we need to understand why you take the material and if you need it. Have you been fully evaluated? Lets assume you have been and need this particular agent. You would need to add two 1080 mg (1.080 gm) pill equivalents (2,160 mg) to – let us say – 1.5 liters of fluid – and imbibe two of these beverages daily. The taste being vile you would need to somehow flavor it – probably with some kind of diet concentrate like Crystal light but not that particular brand. Essentially you would me making a kind of ersatz soft drink, even though we don’t think of it that way. The only reason to not do this is safety – you really need to measure right – I know a gram may be large for your measuring technique but potassium can be dangerous. If you decide to do it let your physician know so someone is responsible for you. Likewise what you flavor this with could interact with the potassium or citrate so be sure that is not a problem; your physician is educated in these matters and can be a guide. Do not do this without your physician’s understanding and agreement. Regards, Fred Coe
I didn’t know that PC carried a bad taste. I don’t try chewing the tablets. Maybe should try one out. If adding PC to water might present a problem I don’t see any challenge in filling gelatin capsules and taking them like any other medication.
You have stressed in your communication the need to measure accurately which, as I said, I don’t see that this needs to be a technical challenge. The question I have though is that seeing as the nominal dosages of PC seems to be 5, 10, or 20 mEq it would suggest that the prescribed dosage can really only be conveniently varied in 5 mEq steps (nominally about 0.5 gms) As such, I’m ascribing perhaps incorrectly, that a 20 or 30 milligram (2% – 3%) weighing error should not present a significant risk. Since I’d be taking in the range of 4.32 gms per day, an occasional QC check of the total weight of 4 capsules (accounting as well for the Tare weight of the gelatin capsule) would be sufficient to insure that the dosage is not running amok. I use a 20 gm max milligram scale that has a resolution of 1 mg and a calibration weight that can be utilized to check the accuracy periodically. [Note: In our wine making, we are generally working on ~ 500 – 1000 # (~225 – 450 Kg) batches. The first step, for example is to dose the crushed grapes with 20 to 50 ppm metabisulfite – we like to stay on the low side. This calls for weighing 4.5 – 22 gms of a white powder materiel similar to PC.} Titrating acidity often calls for lower quantities of various additives.]
Hi Stanley, I have no doubt you have the technical expertise and intellectual skills to do this perfectly, and that your skills in wine making are transferable. I urge nevertheless you discuss the program with your physician because in the final analysis your drug treatment is his/her responsibility. Putting the powder in capsules will probably be a less unpleasant gustatory experience. I also have said and say again be sure there is a reason for the drug – not all patients need it or benefit. That is your physician’s job to help with. I believe several people who read the site are doing their own weighing out – they have made comments about it. Perhaps you might contact each other and see how it is going. Regards, Fred
I have had 2 bouts with stones that required removal. Since the second bout I have been taking Potassium Citrate (PC) 4 pills a day of the 10 mEq strength. No further stones for past 18 months. As with others the cost is a factor particularly as the PC cost combined with the cost of Pradaxa blood thinner drives me quickly into the Part D doughnut hole with a net increase in prescription drugs nearing $1500 per year. It seems as though from reading your material that alternate sources of PC are a viable alternative but I can’t see myself ingesting 2 liters or 4 liters of soft drinks a day. (I have never been a frequent user of soft drinks). I have no concern about accurately measuring out 4 gms of PC per day (as I accurately measure small amounts of chemicals for my wine making hobby) and adding this to the 2 or so liters of water I conscientiously consume daily. Any reason to NOT do this? As the Part D annual costs will be cycling in about 3 weeks I’d like to get started on this for 2017 if you see no risk. I’ve discussed this with my urologist and he is a bit ambivalent on the question not feeling qualified to establish a weight equivalence between a 10 mEQ tablet and a given measure of PC.
Hi Stanley, I take it you use 4 ten mEq K citrate daily, and presumably because your 24 hour urines showed a low urine citrate or you have uric acid kidney stones. I say this because we need to understand why you take the material and if you need it. Have you been fully evaluated? Lets assume you have been and need this particular agent. You would need to add two 1080 mg (1.080 gm) pill equivalents (2,160 mg) to – let us say – 1.5 liters of fluid – and imbibe two of these beverages daily. The taste being vile you would need to somehow flavor it – probably with some kind of diet concentrate like Crystal light but not that particular brand. Essentially you would me making a kind of ersatz soft drink, even though we don’t think of it that way. The only reason to not do this is safety – you really need to measure right – I know a gram may be large for your measuring technique but potassium can be dangerous. If you decide to do it let your physician know so someone is responsible for you. Likewise what you flavor this with could interact with the potassium or citrate so be sure that is not a problem; your physician is educated in these matters and can be a guide. Do not do this without your physician’s understanding and agreement. Regards, Fred Coe
I didn’t know that PC carried a bad taste. I don’t try chewing the tablets. Maybe should try one out. If adding PC to water might present a problem I don’t see any challenge in filling gelatin capsules and taking them like any other medication.
You have stressed in your communication the need to measure accurately which, as I said, I don’t see that this needs to be a technical challenge. The question I have though is that seeing as the nominal dosages of PC seems to be 5, 10, or 20 mEq it would suggest that the prescribed dosage can really only be conveniently varied in 5 mEq steps (nominally about 0.5 gms) As such, I’m ascribing perhaps incorrectly, that a 20 or 30 milligram (2% – 3%) weighing error should not present a significant risk. Since I’d be taking in the range of 4.32 gms per day, an occasional QC check of the total weight of 4 capsules (accounting as well for the Tare weight of the gelatin capsule) would be sufficient to insure that the dosage is not running amok. I use a 20 gm max milligram scale that has a resolution of 1 mg and a calibration weight that can be utilized to check the accuracy periodically. [Note: In our wine making, we are generally working on ~ 500 – 1000 # (~225 – 450 Kg) batches. The first step, for example is to dose the crushed grapes with 20 to 50 ppm metabisulfite – we like to stay on the low side. This calls for weighing 4.5 – 22 gms of a white powder materiel similar to PC.} Titrating acidity often calls for lower quantities of various additives.]
Hi Stanley, I have no doubt you have the technical expertise and intellectual skills to do this perfectly, and that your skills in wine making are transferable. I urge nevertheless you discuss the program with your physician because in the final analysis your drug treatment is his/her responsibility. Putting the powder in capsules will probably be a less unpleasant gustatory experience. I also have said and say again be sure there is a reason for the drug – not all patients need it or benefit. That is your physician’s job to help with. I believe several people who read the site are doing their own weighing out – they have made comments about it. Perhaps you might contact each other and see how it is going. Regards, Fred
Dr. Coe, this is Jack Scott from Greenville, SC who saw you at the University of Chicago in February, 2000. I trust that you’ll recall my visit… one that I’ll never forget, primarily because of the patience you afforded me at a time in my life where my production of kidney stones was such that I was very much concerned about the practicality of life and an overwhelming desire to find a solution to my problem. I bumped into this site tonight while looking for a way to afford the Potassium Citrate pills you prescribed for me (6/day, 180/month, or 2,160 per year). My problem is that I’m on Medicare Part D and the use of this one drug will put me into the famed “donut hole”. Unfortunately Crystal Light is not a possibility for me because I’m allergic to synthetic sweeteners. What I’ve found, however, is a website called GoodRX.com where I can get a year’s supply today (12/6/2016) for $1,190.58 which I will be doing as soon as I can get my Internist to write me a prescription for 2,160 pills for Potassium Citrate (10MEQ). Note that I could’ve purchased the same number of pills on 7/12/2016 for $1,015.60 (that’s an increase of $174.98 in as little as a few days short of 5 months.
I would like to take this opportunity to ask you a couple of questions. When I originally saw you and you prescribed Chlorthalidone (25mg), 1 tablet daily, I was thinking that you told me that I might have to begin taking Potassium Citrate if taking the diuretic alone caused me to experience dizziness. Was my thinking at that time correct? If so, has Potassium Citrate now become part of the “daily regimen” for kidney stone producers because of other benefits it brings to the table?
I want you to know, in case you didn’t for some reason, that I worked briefly with Demetrius Bagley in Philadelphia when I was working in the City as a consultant for Wyeth Pharmaceuticals, and I was very fond of him as a physician and friend. We considered using a procedure he used on other patients to clean out my kidneys, but he suggested that I see James Lingeman in Indianapolis instead. So, I had Dr. Lingeman’s surgical procedure, Percutaneous Lithotripsy, and I was told that he had removed 55 stones from my left and right kidneys. It was like being given a new life and a new chance to live again as a normal person. And I owe all of this to you!!!
I did have a rather large stone several months ago, and it took almost 3 months for me to pass it. I asked Dr. Lingeman to look at a CT Scan of my kidneys, bladder, etc. and he said I was in significantly better shape than when he had operated on me. I assume that this large stone I passed was an aberration in that I was told that there were very small stones in my kidneys, but nothing to come close to the large stone I’d passed.
Note that I’ve been seeing a physician in Winston-Salem, NC at Bowman-Gray by the name of Jorge Gutierrez-Aceves MD. Would you happen to know of him and would you have any negative feelings about me continuing to see him?
Thank you for all you have done to help me, Dr. Coe. I can’t tell you how much you’ve improved my life, both for myself and for my family!
Jack
Hi Jack, Thank you for the follow up information. I work closely with Jim Lingeman and never knew he operated on you. It was a good choice. Do I take it you had made new stones or were these leftovers? The store you found was found by others as well and is an excellent resource. Being on medications and all you should certainly be tested yearly with 24 hour urines, and things adjusted as needed – we do not want more stones! Please feel free to keep in touch. Warm regards, Fred
Dr. Coe, this is Jack Scott from Greenville, SC who saw you at the University of Chicago in February, 2000. I trust that you’ll recall my visit… one that I’ll never forget, primarily because of the patience you afforded me at a time in my life where my production of kidney stones was such that I was very much concerned about the practicality of life and an overwhelming desire to find a solution to my problem. I bumped into this site tonight while looking for a way to afford the Potassium Citrate pills you prescribed for me (6/day, 180/month, or 2,160 per year). My problem is that I’m on Medicare Part D and the use of this one drug will put me into the famed “donut hole”. Unfortunately Crystal Light is not a possibility for me because I’m allergic to synthetic sweeteners. What I’ve found, however, is a website called GoodRX.com where I can get a year’s supply today (12/6/2016) for $1,190.58 which I will be doing as soon as I can get my Internist to write me a prescription for 2,160 pills for Potassium Citrate (10MEQ). Note that I could’ve purchased the same number of pills on 7/12/2016 for $1,015.60 (that’s an increase of $174.98 in as little as a few days short of 5 months.
I would like to take this opportunity to ask you a couple of questions. When I originally saw you and you prescribed Chlorthalidone (25mg), 1 tablet daily, I was thinking that you told me that I might have to begin taking Potassium Citrate if taking the diuretic alone caused me to experience dizziness. Was my thinking at that time correct? If so, has Potassium Citrate now become part of the “daily regimen” for kidney stone producers because of other benefits it brings to the table?
I want you to know, in case you didn’t for some reason, that I worked briefly with Demetrius Bagley in Philadelphia when I was working in the City as a consultant for Wyeth Pharmaceuticals, and I was very fond of him as a physician and friend. We considered using a procedure he used on other patients to clean out my kidneys, but he suggested that I see James Lingeman in Indianapolis instead. So, I had Dr. Lingeman’s surgical procedure, Percutaneous Lithotripsy, and I was told that he had removed 55 stones from my left and right kidneys. It was like being given a new life and a new chance to live again as a normal person. And I owe all of this to you!!!
I did have a rather large stone several months ago, and it took almost 3 months for me to pass it. I asked Dr. Lingeman to look at a CT Scan of my kidneys, bladder, etc. and he said I was in significantly better shape than when he had operated on me. I assume that this large stone I passed was an aberration in that I was told that there were very small stones in my kidneys, but nothing to come close to the large stone I’d passed.
Note that I’ve been seeing a physician in Winston-Salem, NC at Bowman-Gray by the name of Jorge Gutierrez-Aceves MD. Would you happen to know of him and would you have any negative feelings about me continuing to see him?
Thank you for all you have done to help me, Dr. Coe. I can’t tell you how much you’ve improved my life, both for myself and for my family!
Jack
Hi Jack, Thank you for the follow up information. I work closely with Jim Lingeman and never knew he operated on you. It was a good choice. Do I take it you had made new stones or were these leftovers? The store you found was found by others as well and is an excellent resource. Being on medications and all you should certainly be tested yearly with 24 hour urines, and things adjusted as needed – we do not want more stones! Please feel free to keep in touch. Warm regards, Fred
I would like to let you know about my results using OTC Potassium Citrate. I am unable to afford the Urocit-K prescription and I had asked for advice prior. My PC level was a 60–yes SIXTY–after my lithrotripsy procedures and I was still making stones. I did the Crystal Light for many months and was able to get my PC up to the low 200’s–still way under normal for my age. I began taking (4) 99mg (just over 3.5 pills equals 10 meq) OTC Potassium Citrate pills from Swanson (mail order, recommended to me by a Health Food store locally) 3 times a day–yes, that is a lot of pills, but the capsules are small and easy to swallow. I am happy to report that, after a follow up with my Nephrologist and a full 24 hour urine test and blood panel, that my reports show that my Pot. Cit. levels are now at 700! This is only after 2 months of the OTC pills. The better news that each 120 capsule bottle is about $2.49–I just bought a bunch on sale at $1.86 during Swanson’s Black Friday sale. With free shipping, that is less than $8.00 a month compared to $350.00 for 3 months via prescription. I am pleased and so is my Nephrologist..he told me to “keep on keeping on” and we will run tests again in 6 months.
Hello.
I am curious, how much lemonade did you drink before? Also, did you switch to PC tabs or added to lemonade drinking? I am asking because the lemonade has about 20,5 mEq of potassium citrate per quart, so 1,5 quarts should make the same dose as 3 daily X 4pcs of OTC potassium citrate pills).
I’d like to add (assuming dr Coe won’t mind) a small correction: I’d say that “a little less than 4 pills” is more exact than “just over 3,5”. 99mg of potassium = 2,53 mEq, so 4 pills = 10,12 mEq. Also, there is no “potassium citrate” in urine, just “citrate” (in solution, citrate anion won’t bind to potassium).
PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.
Regards
Luke
Luke–I was drinking approx 2 liters of the Crystal Light. That alone brought my Potassium level to only the low 200’s. I did not get the results from just the drink alone. I continue to drink it–along with another liter of water/lemon water or other beverages throughout the day. The addition of the PC capsules over the last couple of months has brought me up to 700. I assure you, I am in no way affiliated with Swanson’s..just trying to share “real life” results after clinical testing from before and after. We are all looking for a more reasonable alternative to the highway robbery of Urocit-K and the likes. My Dr. actually puffed himself up claiming the “miracle” that his prescribing UK to me and how it worked. I shut him down real quick with the bottle of the capsules I have been taking. I am sure he is disappointed that his kick back won’t be coming. I hope other can have the same success
“PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.”
IF I promoted a product and that is not allowed, I apologize, I just thought I would give the name of the product that worked FOR ME. Since we are correcting details, I think that you using the term “lemonade” is deceiving to the general reader. Lemonade is NOT Crystal Light and that is the product that is being touted for it’s PC usefulness.
Well, I didn’t want to offend you in any way, or suggest that you’re affiliated with any company. Also, mentioning a product is allowed and encouraged, as far as I know – and if it is not, only Dr Harris and Dr Coe can decide. I just wanted to point that posts like yours can be received as advertisements for some products (double mentioning the brand, emphasising on the price, saying ‘I am so happy now’ etc.).
I did not meant *you* are doing it and I apologize if you did take it this way.
So I understand you have added PC pills and still are drinking the Crystal Light? That explains my doubts – the dose of alkali increased nearly twice; could you post full results of 24h urine test before and after?…
By the way is it urinary *potassium* or *citrate* in your results?
Hi, I do not think anyone is promoting products. I would not permit that. Once we get into alternatives to prescription medications naming of products is inevitable, and sometimes can seem like promotion when it is simply identification. Regards, Fred
Looks like compulsory early posting is my habit… I will write in Notepad from now.
I guess your doctor is more proud than disappointed – prescribed medicine did work perfectly, you only have used a substitute. Much cheaper to be exact.
Also, I am not familliar with US regulations; possibly he was playing on the safe side – prescribe a controlled pill instead of advising cheaper but not so controlled alternative. So please don’t blame him for it.
Regards
Luke
Regards
Luke
US regulations permit physicians to use OTC materials. Use of bulk food products as an alternative to prescription grade is not common, and I have not been enthusiastic because of possible harm from measurement errors when it comes to potassium. Regards, Fred Coe
I would like to let you know about my results using OTC Potassium Citrate. I am unable to afford the Urocit-K prescription and I had asked for advice prior. My PC level was a 60–yes SIXTY–after my lithrotripsy procedures and I was still making stones. I did the Crystal Light for many months and was able to get my PC up to the low 200’s–still way under normal for my age. I began taking (4) 99mg (just over 3.5 pills equals 10 meq) OTC Potassium Citrate pills from Swanson (mail order, recommended to me by a Health Food store locally) 3 times a day–yes, that is a lot of pills, but the capsules are small and easy to swallow. I am happy to report that, after a follow up with my Nephrologist and a full 24 hour urine test and blood panel, that my reports show that my Pot. Cit. levels are now at 700! This is only after 2 months of the OTC pills. The better news that each 120 capsule bottle is about $2.49–I just bought a bunch on sale at $1.86 during Swanson’s Black Friday sale. With free shipping, that is less than $8.00 a month compared to $350.00 for 3 months via prescription. I am pleased and so is my Nephrologist..he told me to “keep on keeping on” and we will run tests again in 6 months.
Kathleen Stokes here. Thank you so much for posting this about the Swanson Potassium Citrate. I’m chronic stone former and should be on PC, but it’s been too blooming expensive. This news may make a huge difference for me.
Hello.
I am curious, how much lemonade did you drink before? Also, did you switch to PC tabs or added to lemonade drinking? I am asking because the lemonade has about 20,5 mEq of potassium citrate per quart, so 1,5 quarts should make the same dose as 3 daily X 4pcs of OTC potassium citrate pills).
I’d like to add (assuming dr Coe won’t mind) a small correction: I’d say that “a little less than 4 pills” is more exact than “just over 3,5”. 99mg of potassium = 2,53 mEq, so 4 pills = 10,12 mEq. Also, there is no “potassium citrate” in urine, just “citrate” (in solution, citrate anion won’t bind to potassium).
PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.
Regards
Luke
Luke–I was drinking approx 2 liters of the Crystal Light. That alone brought my Potassium level to only the low 200’s. I did not get the results from just the drink alone. I continue to drink it–along with another liter of water/lemon water or other beverages throughout the day. The addition of the PC capsules over the last couple of months has brought me up to 700. I assure you, I am in no way affiliated with Swanson’s..just trying to share “real life” results after clinical testing from before and after. We are all looking for a more reasonable alternative to the highway robbery of Urocit-K and the likes. My Dr. actually puffed himself up claiming the “miracle” that his prescribing UK to me and how it worked. I shut him down real quick with the bottle of the capsules I have been taking. I am sure he is disappointed that his kick back won’t be coming. I hope other can have the same success
“PS. While I can understand enthusiasm of someone who found much cheaper alternative to ridiculously overpriced medicine (the price of prescription PC is close to crime… OK, I can see that the purity in prescribed medicines has to be much higher than in food supplements – but this is still way overpriced) , your post looks heavily like an ad for Swanson’s. I understand that it is unintentional of course.”
IF I promoted a product and that is not allowed, I apologize, I just thought I would give the name of the product that worked FOR ME. Since we are correcting details, I think that you using the term “lemonade” is deceiving to the general reader. Lemonade is NOT Crystal Light and that is the product that is being touted for it’s PC usefulness.
Well, I didn’t want to offend you in any way, or suggest that you’re affiliated with any company. Also, mentioning a product is allowed and encouraged, as far as I know – and if it is not, only Dr Harris and Dr Coe can decide. I just wanted to point that posts like yours can be received as advertisements for some products (double mentioning the brand, emphasising on the price, saying ‘I am so happy now’ etc.).
I did not meant *you* are doing it and I apologize if you did take it this way.
So I understand you have added PC pills and still are drinking the Crystal Light? That explains my doubts – the dose of alkali increased nearly twice; could you post full results of 24h urine test before and after?…
By the way is it urinary *potassium* or *citrate* in your results?
Hi, I do not think anyone is promoting products. I would not permit that. Once we get into alternatives to prescription medications naming of products is inevitable, and sometimes can seem like promotion when it is simply identification. Regards, Fred
Looks like compulsory early posting is my habit… I will write in Notepad from now.
I guess your doctor is more proud than disappointed – prescribed medicine did work perfectly, you only have used a substitute. Much cheaper to be exact.
Also, I am not familliar with US regulations; possibly he was playing on the safe side – prescribe a controlled pill instead of advising cheaper but not so controlled alternative. So please don’t blame him for it.
Regards
Luke
Regards
Luke
US regulations permit physicians to use OTC materials. Use of bulk food products as an alternative to prescription grade is not common, and I have not been enthusiastic because of possible harm from measurement errors when it comes to potassium. Regards, Fred Coe
Dr. Cole, Thank you for your kidney stone information site which i came across when i was researching Potassium Citrate, which my Kidney doctor has prescribed in order to raise urine citrate levels, so to resist additional Calcium Oxalate stone formation. I have decreased kidney function due to the functional loss of the left side of my horseshoe shaped kidney because of a (painless, unknown) stone blockage in 2006. He categorizes me as a moderate stage chronic kidney disease.
My most recent blood analysis showed an abnormal high level of blood potassium, 5.6 and then 5.9. this is considered a problem.
My question regards your article on the substitution of Crystal Light Lemonade Mix for the 10Meq Potassium Citrate Pills. My research seems to indicate there is minimal or zero potassium in lemons, and in the Crystal Light. Therefore, If I drink the lemoande mix, instead of taking the two daily pills, will i continue to benefit from the increased Citrate, while losing the harmful (for me now) effect of the increased Potassium?
I have been doing the 24 hour urine collection periodically, and the Litholink reports show good improvement in all areas, except for the citrate category, and increasing the dosage of Potassium Citrate is problematic with my decreased kidney function, and the elevated levels of blood potassium. I wonder if the substitution of lemonade mix for the pills will work as i explained above and would sincerely appreciate any comments you may have.
Best regards,
Tom
Hi Tom, Thanks for your important questions. The measurements do indeed show high potassium levels but not in a dangerous range. There is citrate in lemons and potassium is present in almost all fruits. Lemons are in the reasonable amount per portion category with less than 200 mg (5 mEq) per 1/2 cup serving. Crystal litht contains a lot of citrate, and 62 mg (1.5 mEq) in a 2 gm serving which is one drink equivalent. So it is a potassium source if used in large amounts. Your two pills have 20 mEq.
The real issue for you is in fact none of these matters. Your urine citrate did not seem to rise with the potassium and is probably low because of your kidney disease. I am not so sure you should be on potassium at all, and I would discuss this with my physician if I were you. If your stones are uric acid and you need alkali, perhaps alternative sources are better. If you have had calcium stones, do you still form them or is it that you did once do so? Do your urine chemistries still show any stone risk – often risk vanishes as kidney function falls. In short I would not take potassium in your situation unless your physicians have very significant reasons for needing to use it. Regards, Fred Coe
Dr Coe, Thank you so much for your reply. I wonder if you have any idea how much good you are doing through this website.
I have had the same thoughts regarding the use of potassium citrate and your comments are most helpful. I think the initial idea of the Potassium Citrate and other dietary changes was to guard against another serious calcium oxalate stone blockage that caused the failure of the left side of my horseshoe kidney. There was a similar incident some 20 years before, caused by a very large stone that was surgically removed and a temporary stint placed, and the left side kidney function was restored, until the 2006 incident. Because both of my two known stone incidents were serious enough to cause kidney failure and i now have only one kidney, it was felt that i could not afford even one more stone. My 24 hour urine chemistries through Litholink, several between 2011 and 2015, have shown substantial risk reduction, except for citrate, which remains in the higher risk range. So your comments, including the fact that high urine citrate is less likely in kidney compromised patients, and patients with decreased kidney function are less likely to develop stones, leads me to rethink this plan, and i will review with my Kidney Doctor here in Indianapolis soon.
Thank you again for your kind and good work.
Best regards
Tom
Hi Tom, I am glad the site is helpful. Take a look at the supersaturations, which usually fall a lot with reduced kidney function. Also your stone analyses. Be sure the SS that corresponds to the crystals in stones are not very high – review with your physician. Citrate dosing raises urine pH and urine citrate – more variably, so CaP SS rises and uric acid SS falls below 1. A risk in chronic kidney disease is uric acid stones so be very careful about urine pH – needs to be about 6. There is a syndrome of high serum potassium, low urine pH and low urine ammonia – called Type 4 renal tubular acidosis to which you may be prone. Regards, Fred Coe
Dr. Coe, thank you so much for your site and information concerning potassium citrate. I have been on Urocit-K since 1988 taking 2- 10 Meq tablets at night. Paying for them all these years hasn’t been an issue as insurance paid all except $10 after becoming generic. I will be retiring in a couple of years and cost will be an issue. I have looked into the below reference to Swanson Potassium Citrate 99mg capsules and had a couple of questions concerning any potassium citrate. When I looked at the supplement facts on one 99mg tablet, I saw the following; Supplemental Facts: “% Daily Value 3% Potassium(from potassium citrate) Other ingredients: Rice flour, gelatin, may contain one or both of the following: magnesium stearate, silica.Suggested Use: As a dietary supplement, take one capsule per day with food and water.” It states Daily Value at 3% Potassium Citrate. Is this not stating a single tablet is composed of 3% potassium citrate and the remaining 97% composed of the rest of the ingredients? If this is so then how much does one have to take of this to equal the Urocit-k tablet? I have never seen anything stated on the Urocit-K to indicate how much of it’s composition is Potassium Citrate. I’m assuming it is 100% Potassium Citrate unless someone can provide the composition listing on it. The other question concerns the fact the Swanson is a capsule. The advantage of the tablet is it is slow releasing, but if potassium citrate is also available in liquid then then the capsule may not be an issue in an overnight dosage?
Best regards, Don
Hi Don, After much study of the label it seems they mean each tablet contains 99 mg of potassium, which is about 2.5 mmol of potassium. Standard potassium citrate capsules contain 10 mmol of potassium as the citrate salt. So 4 of the small pills will match 1 of the prescription pills you have been taking. The 3 percent comes from comparing the 99 mg of potassium to the recommended amount of diet potassium which is a bit above 4000 mg. Regards,m Fred Coe
Thank you so much Dr. Coe for your response. I do have another question concerning the following from your site. “I did find on inspection of the Medicare lists of drug prices by insurance plan that some plans appear to include potassium citrate pills in their formularies at a preferred level and charge as little as $10 for what appears to be 90 pills. Others do not do this and publish higher prices, often as percentages of the retail cash price. Once again, I hope those of you with experiences in
purchasing the drug will share what you know.” I will be leaving the workforce in a couple of years and will be investigating Medicare supplement insurance. Do you by any chance remember what publication that you reviewed the Medicare list of drug prices by insurance plans? I know United Healthcare maybe one such insurance and my company provides for a limited time an opportunity to continue my healthcare plan after retirement but the cost for such a “Cadillac” plan is expensive and the retirement offer only pays a percentage leaving me to pay well over 50% of the plan besides the deductible. Making me think why spend over half of my pension for a supplement plan, still pay a large deductible and then contend with the high cost of medications for me and my wife. The other thing I’ve learned is Veterinarians offer Potassium Citrate pills for cats and dogs for the same reason as for humans and the cost for them is as expensive. Gee you would think after all these years the cost would come down. Is it really that expensive a process or chemically difficult to make such a medication? Doesn’t appear to have any ingredients outside of what you would find in a high school lab.
Hi Don, I am afraid all I know is in the article. Frankly the comments are better than what I wrote! All the best, Fred
Hi Dr. Coe,
I’ve heard that instead of Potassium Citrate, a small amount of sodium bicarb in water can be an effective way of neutralizing the acidity of urine to help decrease the risk of calcium oxalate stone formation. If your blood pressure is under control, is this an alternative method to citrate? Thanks!
Hi Lisa, No. Sodium alkali will raise urine calcium – because of the sodium, and that will offset the benefits of the alkali which lower urine calcium and perhaps raise urine citrate. In your case, be sure you are acting with informed intent. Have you been fully evaluated? Do you know your stone composition is calcium oxalate? Here is a good plan, check it out. The pH of normal urine is about 6 and one does not want to raise it because higher pH can convert calcium oxalate stones into calcium phosphate stones – in principle. Calcium oxalate stones themselves are independent of pH altogether. Warm regards, Fred Coe
Hi Dr. Coe,
I’ve heard that instead of Potassium Citrate, a small amount of sodium bicarb in water can be an effective way of neutralizing the acidity of urine to help decrease the risk of calcium oxalate stone formation. If your blood pressure is under control, is this an alternative method to citrate? Thanks!
Hi Lisa, No. Sodium alkali will raise urine calcium – because of the sodium, and that will offset the benefits of the alkali which lower urine calcium and perhaps raise urine citrate. In your case, be sure you are acting with informed intent. Have you been fully evaluated? Do you know your stone composition is calcium oxalate? Here is a good plan, check it out. The pH of normal urine is about 6 and one does not want to raise it because higher pH can convert calcium oxalate stones into calcium phosphate stones – in principle. Calcium oxalate stones themselves are independent of pH altogether. Warm regards, Fred Coe
I’ve made my own 1000 milligram postassium citrate gel caps w/o any real challenges. Problem is that after 1 month of taking these in place of the 1080mEq tablets the urine Ph had dropped from about 6 to about 5. This urine test was from a sample taken about 8 hours after taking 2 of the prescribed 4 – 1000 milligram doses. Question is how quickly does the Ph respond to the ingested dose and how quickly is most of the dose excreted through urine or other body functions? ie. has anyone done studies on Ph vs time after dosing? Urologist has suggested spreading the 4 gel-caps more evenly over the day. I did experiment with the dissolution time of the gel-caps versus the tablets. Gel caps were fully dissolved in 100 F water in ~ 8 minutes. Tablets were unchanged in form but easily penetrated by a fork after 1 hour. After 5 hours I gave up and could easily crush the tablet between 2 fingers which released some granular material which quickly dissolved and left behind a small amount of what I presume was a binder material. I suspect the granular postassium citrate was slowly dissolving out of a platform of the binder material.
Hi Stanley, the fall in pH makes one wonder if the material is being absorbed. The eight hours should be enough. If the tablets you make are a proper substitute the correct approach is to substitute them for the Rx version at the same presumed dose and timing, and get the pH of a 24 hour urine collection for comparison. All else is subject to timing issues that confuse matters. Regards, Fred Coe
I’ve made my own 1000 milligram postassium citrate gel caps w/o any real challenges. Problem is that after 1 month of taking these in place of the 1080mEq tablets the urine Ph had dropped from about 6 to about 5. This urine test was from a sample taken about 8 hours after taking 2 of the prescribed 4 – 1000 milligram doses. Question is how quickly does the Ph respond to the ingested dose and how quickly is most of the dose excreted through urine or other body functions? ie. has anyone done studies on Ph vs time after dosing? Urologist has suggested spreading the 4 gel-caps more evenly over the day. I did experiment with the dissolution time of the gel-caps versus the tablets. Gel caps were fully dissolved in 100 F water in ~ 8 minutes. Tablets were unchanged in form but easily penetrated by a fork after 1 hour. After 5 hours I gave up and could easily crush the tablet between 2 fingers which released some granular material which quickly dissolved and left behind a small amount of what I presume was a binder material. I suspect the granular postassium citrate was slowly dissolving out of a platform of the binder material.
Hi Stanley, the fall in pH makes one wonder if the material is being absorbed. The eight hours should be enough. If the tablets you make are a proper substitute the correct approach is to substitute them for the Rx version at the same presumed dose and timing, and get the pH of a 24 hour urine collection for comparison. All else is subject to timing issues that confuse matters. Regards, Fred Coe
Hi Stanley, the fall in pH makes one wonder if the material is being absorbed. The eight hours should be enough. If the tablets you make are a proper substitute the correct approach is to substitute them for the Rx version at the same presumed dose and timing, and get the pH of a 24 hour urine collection for comparison. All else is subject to timing issues that confuse matters. Regards, Fred Coe
BTW
Blood tests done at the same time as the urine test showed potassium levels were right in the middle of the desired range. Can’t get to the actual data right now because med center servers are down for maintenance.
Hi Stanley, I would expect the blood potassium to be normal as it is regulated powerfully by the kidneys and the body cell mass. Regards, Fred Coe
BTW
Blood tests done at the same time as the urine test showed potassium levels were right in the middle of the desired range. Can’t get to the actual data right now because med center servers are down for maintenance.
Hi Stanley, I would expect the blood potassium to be normal as it is regulated powerfully by the kidneys and the body cell mass. Regards, Fred Coe
As a stone former and physician drug developer sensitive to pricing and public health, I was shocked to learn my 3 month supply of potassium citrate would cost me over $1000 at a retail pharmacy, whereas I paid much less than this last year under a different pharmacy benefits manager. On the other hand, I was so grateful for Dr. Coe’s writing on this issue and for the community of stone formers who are struggling to secure their necessary preventative treatments.
Given all of the above, I am endeavoring to understand the extent and basis for the apparent price increase, perhaps somehow to improve this unfortunate trend. I would be pleased if this would be an appropriate forum to exchange more specific facts regarding recent prices trends of prescription potassium citrate, and possible recent changes in market dynamics, such as with the various manufacturers, pharmacies, or pharmacy benefits managers.
Thanks to all who may have constructive input or who may be interested in joining me in additional due diligence.
Joshua
Hi Joshua, this is an open forum for all interested and good intentioned people, and certainly for an expert like yourself. COnsider it your forum. The price increase is indeed shocking and seems like mere greed. But perhaps you have a more nuanced view which I would want to understand. Warm regards, Fred
I’m so glad we will be able to bring our collective influence to bear on the problem of PC pricing. Although Dr. Coe indicated he is not particularly political, he rightly noted that the solution will involve activism. I’m hoping to play some part in this, and will rely on support of those on this blog and others. I am fortunate to be under treatment by a nephrolithiasis expert at the University of Pennsylvania, who mentioned on my last visit that if he learns about increasingly concerning price issues, he would himself take this to Washington!
While I’m not yet able to conclude the price driver is “pure greed” I will not be surprised to learn something similar is at play. What will be helpful now are more detailed facts about actual prices paid/charged in the past 1-2 years for prescription PC, including the manufacturer of the dispensed product, the pharmacy, and the pharmacy benefits manager or insurance plan.
To facilitate, I have created a dedicated email account: potassiumcitratepricing@gmail.com
Please send all specific facts of interest to that account and I will update the forum as I learn more.
This won’t be easy, and I don’t know the probability of success, but I hope to find out! At a minimum, armed with facts and the testimonies on this forum alone, I expect we can attract media interest and additional expert input.
It is very clear to me that the PC pricing case is a specific and clear example of unjustified price hikes on a simple, off-patent, molecule which addresses a medical need of a relatively small, but captive clinical population.
I am not a doctor. I’ve been on this computer hoping to find out why my potassium citrate 1080mg prescription went from a tier 2 to a tier 4 drug this year! I don’t have a kidney stone issue. I take a “cocktail” of drugs to stave off osteoporosis (also OTC calcium, Vitamin D and hydrochlorothiazide). I screamed when the pharmacy aide told me I would have to fork out over $160 for a one-month supply of this medication! But now I see you have found much higher pricing, depending, I guess, on the prescription plan. Who manufacturers this medication? What did they pay for R&D? Is there a patent on it? It’s potassium, for God’s sake, not an invention! I would like to see an investigation and new media coverage, but, alas, this is not a life-saving drug, for the most part. It’s not an EpiPen. President Trump wants to replace the ACA with something more affordable. I hope that drug pricing is on his list. I hope you will put me on your email list.
We are lucky that we have AARP Supplement OptumRX, we pay a premium for both my husband and myself. This medication costs $65.00 for us as a co-payment, but actual price would be $160.00. So we’re saving $95.00, but if you take into account the premiums we have to pay the savings are lower. I don’t know why the cost of this medication is so high, but I have noticed that many medications have gone into higher tiers of drugs. So then the prices go up.
Fred,
Would an meq of potassium bicarbonate be just as effective as an meq of potassium citrate for urinary alkalinization and raising urinary citrate levels?
Thanks!
Hi John, In a way yes: alkali is alkali. Possibly no in that citrate has to be metabolized to bicarbonate and that spreads the effect out. Said better, it has to be absorbed and metabolized as citric acid, taking up a proton in the process which proton, being consumed, is replaced by loss of a proton from carbonic acid in blood thereby producing bicarbonate. The longer time span – it real – is an advantage. I have happily used both for years and cannot tell them apart. I know of no trials even in relation to urine pH although perhaps I have not looked well enough. Thanks for the great comment – Fred
Fred,
Thank you for the follow up. I asked because:
1. If the alkali effect of 1 meq of both substances is equal, would the potassium bicarb be useful/not as useful because the bicarb version would have less potassium?
2. I am not a chemist but wondered if the citrate version had more alkali effect due to having three proton binding sites rather than one.
Once again thank you for all that you do.
John
Hi John, In mEq units of the potassium salt, the two are equal if equal. The mass of material for 10 mEq of the one is not the same as for the other. mEq is the product of gm moles of the material times the available binding sites. Regards, Fred
Fred,
Would an meq of potassium bicarbonate be just as effective as an meq of potassium citrate for urinary alkalinization and raising urinary citrate levels?
Thanks!
Hi John, In a way yes: alkali is alkali. Possibly no in that citrate has to be metabolized to bicarbonate and that spreads the effect out. Said better, it has to be absorbed and metabolized as citric acid, taking up a proton in the process which proton, being consumed, is replaced by loss of a proton from carbonic acid in blood thereby producing bicarbonate. The longer time span – it real – is an advantage. I have happily used both for years and cannot tell them apart. I know of no trials even in relation to urine pH although perhaps I have not looked well enough. Thanks for the great comment – Fred
Drug pricing is my specialty, I have worked years for the PBM which is now known as Caremark or CVS/Caremark. I also have owned and ran several pharmacies, this includes independents as well as Walmart’s and Costco’s. I would be glad to go over individual drug pricing trends, but for summary sake here is the issue. Generic (non patent holding) drugs are being pursued as commodities in the free market capitalist system. Companies or even huge investors with drug distribution ties are playing a supply and demand game. They corner the market on the supply and then demand you pay whatever price they determine. The supply takeover is really quite easy as there are usually very limited production sources of cheap raw materials in the global market place. This limitation of producers was market driven due to very low drug prices in the market for these long time off patent drugs. Now some great profit based minds decided hey since these materials are so inexpensive in daily drug price dollars, and couple that with the fact people are Forced to take this product or suffer the consequences, market takeovers are commonplace. As soon as a investor or generic manufacturing company (many of which are big drug company owned!), achieves market control on the supply, they can raise prices with reckless abandon! Who’s gonna stop them! There are no regulations against. The people are often oblivious especially if their insurance is paying the tab so there is minimal outcry if your only paying 10$ copay regardless. And the insurers or the PBMs responsible for paying the Bill! They get paid by the group plan they administer for and are indirectly rewarded for managing higher drug outlay. Not to mention that the pbms like Caremark/cvs are owned by drug wholesalers, manufacturers and insurers even! When prices are high in drug industry everyone wins except consumer who finances this bill. Drug price comparing sources like good Rx are a scam, look logically at why would they give a discount card for FREE and spend millions in ads as a for profit company??? Where does the money come from? I’d be glad to tell you in emails. Frustrated Pharmacist, and drug Managed care and pricing expert. Dennis clark.
Hi Dennis, I am amazed and appreciative! The latter to have you comment on this site – we have about 68,000 people on the site monthly, all because of kidney stones – I presume – and shocked about this one cheap now expensive mineral supplement. Dr Steinerman was right to post here and try to create a discussion forum. For a physician, there is only one question needed to have a moral compass: Is this the best I can do for my patient? It looks like for the drug industry the moral compass is also exacting: Is this the worst I can do for my patients? You imply there are no regulations because of the anaesthetic effects of insurance companies that themselves are happy to simply pass on costs to the plans who then pass it on the – did I say? – patients. If the plans evaporated and people had to buy the stuff prices would fall like a lead plummet into the ocean and all would be well. Thank you so much for helping us understand our local plight in a larger context. Is it possible you would write a guest article on this site concerning exactly what is in your comment? This site, as you can see, is run by me for my university and free from all commercial content and bias. I would be thrilled to host the article and feature it. Let me know – email is on the site. Obviously, because of our specific issue, it would be ideal to focus on potassium citrate as an example of the much more vast issue in your comment. Warm regards, Fred
Dr Coe,
Dear sir, sorry I’m just seeing this. Would love to re-write for your audience. Pricing in the drug world has got to change. Individuals make more selling a bottle of pills that you would be paid for an entire surgical procedure.
Will send this via email as well with my personal contact info.
Hi Dennis, That would be great. Best for the text would be as a Word or perhaps Google Doc for the text. Likewise, I would like to post a standard head shot if you have one convenient. I do this for all posts when possible. Please feel free to expand on the theme, articles can run to over 8,000 words which means essentially no limit. I think many would love to know more. If there are links to news articles, or other sources, let me have them and I can put them in. If you do it as a Google Doc the links stay in when I import.
I will feature your article on all the pages and I assure you thousands will read it.
Fred
Drug pricing is my specialty, I have worked years for the PBM which is now known as Caremark or CVS/Caremark. I also have owned and ran several pharmacies, this includes independents as well as Walmart’s and Costco’s. I would be glad to go over individual drug pricing trends, but for summary sake here is the issue. Generic (non patent holding) drugs are being pursued as commodities in the free market capitalist system. Companies or even huge investors with drug distribution ties are playing a supply and demand game. They corner the market on the supply and then demand you pay whatever price they determine. The supply takeover is really quite easy as there are usually very limited production sources of cheap raw materials in the global market place. This limitation of producers was market driven due to very low drug prices in the market for these long time off patent drugs. Now some great profit based minds decided hey since these materials are so inexpensive in daily drug price dollars, and couple that with the fact people are Forced to take this product or suffer the consequences, market takeovers are commonplace. As soon as a investor or generic manufacturing company (many of which are big drug company owned!), achieves market control on the supply, they can raise prices with reckless abandon! Who’s gonna stop them! There are no regulations against. The people are often oblivious especially if their insurance is paying the tab so there is minimal outcry if your only paying 10$ copay regardless. And the insurers or the PBMs responsible for paying the Bill! They get paid by the group plan they administer for and are indirectly rewarded for managing higher drug outlay. Not to mention that the pbms like Caremark/cvs are owned by drug wholesalers, manufacturers and insurers even! When prices are high in drug industry everyone wins except consumer who finances this bill. Drug price comparing sources like good Rx are a scam, look logically at why would they give a discount card for FREE and spend millions in ads as a for profit company??? Where does the money come from? I’d be glad to tell you in emails. Frustrated Pharmacist, and drug Managed care and pricing expert. Dennis clark.
Hi Dennis, I am amazed and appreciative! The latter to have you comment on this site – we have about 68,000 people on the site monthly, all because of kidney stones – I presume – and shocked about this one cheap now expensive mineral supplement. Dr Steinerman was right to post here and try to create a discussion forum. For a physician, there is only one question needed to have a moral compass: Is this the best I can do for my patient? It looks like for the drug industry the moral compass is also exacting: Is this the worst I can do for my patients? You imply there are no regulations because of the anaesthetic effects of insurance companies that themselves are happy to simply pass on costs to the plans who then pass it on the – did I say? – patients. If the plans evaporated and people had to buy the stuff prices would fall like a lead plummet into the ocean and all would be well. Thank you so much for helping us understand our local plight in a larger context. Is it possible you would write a guest article on this site concerning exactly what is in your comment? This site, as you can see, is run by me for my university and free from all commercial content and bias. I would be thrilled to host the article and feature it. Let me know – email is on the site. Obviously, because of our specific issue, it would be ideal to focus on potassium citrate as an example of the much more vast issue in your comment. Warm regards, Fred
Dr Coe,
Dear sir, sorry I’m just seeing this. Would love to re-write for your audience. Pricing in the drug world has got to change. Individuals make more selling a bottle of pills that you would be paid for an entire surgical procedure.
Will send this via email as well with my personal contact info.
Hi Dennis, That would be great. Best for the text would be as a Word or perhaps Google Doc for the text. Likewise, I would like to post a standard head shot if you have one convenient. I do this for all posts when possible. Please feel free to expand on the theme, articles can run to over 8,000 words which means essentially no limit. I think many would love to know more. If there are links to news articles, or other sources, let me have them and I can put them in. If you do it as a Google Doc the links stay in when I import.
I will feature your article on all the pages and I assure you thousands will read it.
Fred
Dr. Coe- I was taking 4 Potassium Citrate tablets ER (15MEQ) per day, but going on Medicare has made those steep price rises a factor now. My doctor recommended Klor-con EF (25MEQ) 3X’s a day as a cheaper alternative–but every pharmacist I speak to says Klor-con is not indicated for uric acid in the bladder, which is my particular condition. I feel caught in the middle–do you have any thoughts on this? Thanks in advance. James Roberts
Hi James, Klor-con is potassium chloride which will not help you. Klor-con/EF is potassium citrate bicarbonate which will raise urine pH and help prevent uric acid stones. THe confusion is about the ‘EF’. Regards, Fred Coe
Dr. Coe- I was taking 4 Potassium Citrate tablets ER (15MEQ) per day, but going on Medicare has made those steep price rises a factor now. My doctor recommended Klor-con EF (25MEQ) 3X’s a day as a cheaper alternative–but every pharmacist I speak to says Klor-con is not indicated for uric acid in the bladder, which is my particular condition. I feel caught in the middle–do you have any thoughts on this? Thanks in advance. James Roberts
Hi James, Klor-con is potassium chloride which will not help you. Klor-con/EF is potassium citrate bicarbonate which will raise urine pH and help prevent uric acid stones. THe confusion is about the ‘EF’. Regards, Fred Coe
You can also buy bulk potassium citrate powder on amazon. $14 for 250gm or $30 for one kg.
Be careful taking potassium citrate powder, because that is a huge quick dose, compared to the pop and lemonade that are drank a little at a time thru out the day, or the prescription potassium citrate that is in a wax base to allow it to be released much more gradually than plain pot cit powder. Also, the prescription pot cit has cautions for it, like it can burn a hole in your intestine, so I suppose the powder is much more dangerous. So you’ll have to dilute it and take it like the lemonade in a dilute concentration thru out the day. I suggest reading -googling potassium citrate FDA insert to see the side effects /dangers of it to help you be careful with using a concentrated powder.
Hi Joseph, I like both of your comments, and I agree with them. If anyone is buying the food grade potassium citrate and weighing out doses, diluting the powder in some beverage and drinking it over some hours – that is a good idea.
I also have to say that I cannot endorse this whole practice unless everyone who practices home measurement of potassium citrate does it in consultation with their physicians who can assure things are being done correctly. Potassium salts are dangerous, some people have diseases that make sudden doses of potassium especially dangerous. I regret the profiteering of the drug maker(s) who have so scandalously inflated the price of this simple supplement but I fear someone will injure himself/herself for lack of skill in measuring, for taking in potassium too rapidly, or by having a condition that affects potassium handling. Please, everyone who reads this, involve your physician if you intend to do your own potassium citrate preparation – your physician has scientific training and medical training and can keep you safe. So I agree with Joseph but also worry. Regards, Fred Coe
Hi, I was wondering if it sounds reasonable, that if one was prescribed a specific dose by a doctor, and the patient used a quality scientific scale to accurately weigh bulk potassium citrate to the amounts specified by the doctor, wouldn’t this be a great way to avert the industry’s cost increases? Assuming the citrate was diluted in sufficient liquid, so as to avoid contact with the pure powder? In our world today we really give away a huge amount of trust in ourselves to the very lobbyists that want to make it so we cannot be self sufficient, and need to buy expensive products. This seems like a great opportunity to step up our intelligence level as citizens and learn more about treating our illnesses with open source knowledge, instead of having to pay premiums for proprietary health services, when the solution is a rather simple chemical that just has to be properly weighed and prepared. People have the ability to have utilize more intelligence and independence from corporate entities in their health practices (such as learning to weigh potassium citrate after receiving a dose recommendation from a doctor) just like any other way one can avoid corporate dominance.
Hi Milo, Many of those who commented suggested or are doing what you propose. I must warn caution – be sure you know how to weigh out one gram of the potassium citrate salt, and be sure your personal physician knows what you are doing and is in accord and willing to supervise. Potassium salts can kill people if not used correctly. Your physician needs to be responsible for how you take them. Regards, Fred Coe
I am on potassium citrate for my stones and would rather drink crystal light but am deterred by the aspartame. A beverage called Tru Lemon is sweetened by Stevia which seems to be healthier than aspartame. Would you happen to know if this Tru Lemon contains the same ability to help with stones as Crystal Light? Thank you
Hi Bill, No evidence supports a danger from aspartame. The sugar lobby has spread unfounded fears. I do not know what is in the lemon beverage as we did not test it. Regards, Fred Coe
I have a similar question to Bill that may interest Bill as well. Crystal Light Pure is another product sold in the exact manner as its original except made with Stevia instead of Aspartame. I too came here to ask if Crystal Light Pure had been tested as I do prefer Stevia over Aspartame. Aspartame & Sucralose has been shown to change gut flora which in turn is related to the onset of diabetes. Here’s an article about it in the NY Times: https://well.blogs.nytimes.com/2014/09/17/artificial-sweeteners-may-disrupt-bodys-blood-sugar-controls/?action=click&contentCollection=Europe&module=MostEmailed&version=Full®ion=Marginalia&src=me&pgtype=article&_r=0
Would you or anyone out there be willing to test Crystal Light Pure for Alkali content? If anyone out there must ingest Aspartame or Sucralose I recommend taking something to rectify your gut flora daily such as the probiotic “Kefir”. There are many brands of Kefir in the milk refrigerator at your local grocers.
Ps. Crystal Light Pure does not taste as acidic & its ingredients differ in many ways other than just its sweetener.
Hi Sheldon, The person who did the work is Dr John Asplin at Litholink. I do not know if he is willing to do this kind of testing again. I read the NYT review of the work, in rats with inadequate human work – too small. I am unimpressed because the sugar institute has long financed research designed to cast doubt on the safety of sugar substitutes and found willing scientists to find this or that problem. Sans a real human study – large enough and convincing – I am totally not convinced. But, if you are concerned, I understand. Beverages with sugar in them are a known health problem because sugar is 1/2 fructose and fructose is established as a serious health hazard – that is why the sugar industry keeps trying. Regards, Fred Coe
Here’s a quote from another part of this site, regarding sweeteners: “Please note that Stevia is very high at 42 mg for one tsp so be careful.” It’s on the page entitled How to Eat a Low Oxalate Diet.
Hi David, Purified chemical Stevia is without oxalate. Stevia leaf is high in oxalate. Regards, Fred Coe
I have taken a supplement of Magnesium Citrate in the form of Natural Calm http://naturalvitality.com/natural-calm/ in the past for the magnesium. I have sent them an inquiry to see how much citrate is in each dose. Can you speak to the efficacy of taking citrate in this form for kidney stones?
Hi Kim, A lot depends on what kind of stones you form and what is wrong with you that promotes stones. CHeck out this summary and see where you might fit. The trials have been potassium citrate or potassium magnesium citrate, so I cannot comment on this product. But effective citrate doses for those who benefit from citrate range between 20 and 40 mEq /day – roughly 2-4 grams of potassium citrate or 80 to 160 mg of potassium. Regards, Fred Coe
I have taken a supplement of Magnesium Citrate in the form of Natural Calm http://naturalvitality.com/natural-calm/ in the past for the magnesium. I have sent them an inquiry to see how much citrate is in each dose. Can you speak to the efficacy of taking citrate in this form for kidney stones?
Hi Kim, A lot depends on what kind of stones you form and what is wrong with you that promotes stones. CHeck out this summary and see where you might fit. The trials have been potassium citrate or potassium magnesium citrate, so I cannot comment on this product. But effective citrate doses for those who benefit from citrate range between 20 and 40 mEq /day – roughly 2-4 grams of potassium citrate or 80 to 160 mg of potassium. Regards, Fred Coe
Can you help me understand the difference between citrate and citric acid? As I understand, citrate is a derivative of citric acid. So if you increase citric acid in the diet, do you automatically increase citrate and thereby increase urinary citrate excretion? Thank you!
Hi Marilyn, I can. Citric acid is an acid and if metabolized by the liver does not produce alkali for the body. Citrate is the same acid minus its proton – here is a treatment of protons and stones. When citrate is metabolized it is metabolized as citric acid which means it takes up a proton – removing acid from the blood. This is identical to adding alkali to the blood. Regards, Fred Coe
Can you help me understand the difference between citrate and citric acid? As I understand, citrate is a derivative of citric acid. So if you increase citric acid in the diet, do you automatically increase citrate and thereby increase urinary citrate excretion? Thank you!
I am going to chime in on the cost. My doctor prescribed potassium citrate tablets and they were so large I was unable to swallow them. The capsule got caught in my throat and burned as it dissolved there. The tablets were $95 for a 1-month supply. Now he has prescribed a liquid form of it costing $82.43 for a 1-month supply. I just picked it up at the pharmacy tonight. I was told that Medicare will not cover this medication. This is expensive but if it will help I am willing to try. My stones were 80% urticaria acid and 20% calcium oxalate. My doctor wants me to eat a low oxalate diet in addition to taking the medication.
The instructions for the liquid say to put 10mL of it into a glass of water. Can I put it into something other than water like lemonade or orange juice to help cover the taste?
I just noticed that auto correct changed a word in my post. My stones are 20% uric acid and 80% oxalate.
That is 80% uric acid and 20% oxalate.
Hi Kate, Indeed the pricing is horrid and due to selfish and basically immoral behavior by a few companies – or perhaps only one. You can dissolve the material in a flavored beverage as potassium citrate is basically a simple chemical. Low oxalate diet seems not unreasonable but probably incomplete as a prevention measure. For the uric acid alkali is a cure. For the oxalate portion, here is a decent approach to prevention. Regards, Fred Coe
Thank you for your response. The information I get from you and this website is incredibly helpful.
I am going to chime in on the cost. My doctor prescribed potassium citrate tablets and they were so large I was unable to swallow them. The capsule got caught in my throat and burned as it dissolved there. The tablets were $95 for a 1-month supply. Now he has prescribed a liquid form of it costing $82.43 for a 1-month supply. I just picked it up at the pharmacy tonight. I was told that Medicare will not cover this medication. This is expensive but if it will help I am willing to try. My stones were 80% urticaria acid and 20% calcium oxalate. My doctor wants me to eat a low oxalate diet in addition to taking the medication.
The instructions for the liquid say to put 10mL of it into a glass of water. Can I put it into something other than water like lemonade or orange juice to help cover the taste?
I just noticed that auto correct changed a word in my post. My stones are 20% uric acid and 80% oxalate.
That is 80% uric acid and 20% oxalate.
Kate, I guess it must be 80% uric acid? Regards, Fred
Hi Kate, Indeed the pricing is horrid and due to selfish and basically immoral behavior by a few companies – or perhaps only one. You can dissolve the material in a flavored beverage as potassium citrate is basically a simple chemical. Low oxalate diet seems not unreasonable but probably incomplete as a prevention measure. For the uric acid alkali is a cure. For the oxalate portion, here is a decent approach to prevention. Regards, Fred Coe
Thank you for your response. The information I get from you and this website is incredibly helpful.
I have been taking potassium citrate for a little over a week. I had blood work done before going on a trip to make sure my potassium level is okay. In addition I have developed a uti and had a urine culture done, My doctor called last night. I do have a uti and am now on Cipro. My potassium level is fine but he is concerned about my creative level. It measured 1.7 (up from 1.2 about 6 weeks ago). He wants me to keep taking the potassium citrate while we are away but to have the blood work repeated when we return from our trip in 3 weeks. If the level is still high he will order another ultrasound. The last one done about 6 weeks ago indicated a couple of non-obstructive stones in my left kidney. He said if the level is still high he may take me off if the potassium citrate to see if that is the cause of the rise.
Is there something I can do in the meantime to try to lower the level myself? When asked what causes creative levels to rise he said it could be any number of things. I Googled it and saw that eating large amounts of meat can raise it and the night before the test I had a large portion of pot roast at a late dinner. Could that have had an effect? I am so nervous about all of this with my leaving the country for three weeks.
Hi Kate, a rise in serum creatinine from 1.2 to 1.7 is very concerning. Potassium citrate will not raise urine creatinine nor will dinner. Have it checked fasting and if it is still so high an ultrasound is needed right away – as I think your physicians already concluded. No one can take care of their own serum creatinine – it indicates a serious fall in kidney function and of the causes obstruction is paramount. Another cause is NSAIDS – any brand. This is a matter of immediate concern for your physicians to deal with. I would not be traveling and let this slide. Regards, Fred Coe
Just as a follow-up my creatinine level has gone back down. The tests indicate that my kidneys are functioning fine. The ultrasound did show two small stones in my left kidney that the doctor was unable to remove during the last lithotripsy but they are non-obstructing. The doctor does not know why the level jumped as it did but is happy it has dropped. I am continuing taking potassium citrate and am on a low oxalate diet due to having combination stones. I am feeling fine.
Hi Kate, I am happy your serum creatinine came down but the reason matters because it reflected kidney injury that could recur. Drugs are most worrisome – not potassium citrate. Obstruction was obviously not the issue. Be wary of any medications even OTC. Regards, Fred Coe
I have been taking potassium citrate for a little over a week. I had blood work done before going on a trip to make sure my potassium level is okay. In addition I have developed a uti and had a urine culture done, My doctor called last night. I do have a uti and am now on Cipro. My potassium level is fine but he is concerned about my creative level. It measured 1.7 (up from 1.2 about 6 weeks ago). He wants me to keep taking the potassium citrate while we are away but to have the blood work repeated when we return from our trip in 3 weeks. If the level is still high he will order another ultrasound. The last one done about 6 weeks ago indicated a couple of non-obstructive stones in my left kidney. He said if the level is still high he may take me off if the potassium citrate to see if that is the cause of the rise.
Is there something I can do in the meantime to try to lower the level myself? When asked what causes creative levels to rise he said it could be any number of things. I Googled it and saw that eating large amounts of meat can raise it and the night before the test I had a large portion of pot roast at a late dinner. Could that have had an effect? I am so nervous about all of this with my leaving the country for three weeks.
Hi Kate, a rise in serum creatinine from 1.2 to 1.7 is very concerning. Potassium citrate will not raise urine creatinine nor will dinner. Have it checked fasting and if it is still so high an ultrasound is needed right away – as I think your physicians already concluded. No one can take care of their own serum creatinine – it indicates a serious fall in kidney function and of the causes obstruction is paramount. Another cause is NSAIDS – any brand. This is a matter of immediate concern for your physicians to deal with. I would not be traveling and let this slide. Regards, Fred Coe
Just as a follow-up my creatinine level has gone back down. The tests indicate that my kidneys are functioning fine. The ultrasound did show two small stones in my left kidney that the doctor was unable to remove during the last lithotripsy but they are non-obstructing. The doctor does not know why the level jumped as it did but is happy it has dropped. I am continuing taking potassium citrate and am on a low oxalate diet due to having combination stones. I am feeling fine.
Hi Kate, I am happy your serum creatinine came down but the reason matters because it reflected kidney injury that could recur. Drugs are most worrisome – not potassium citrate. Obstruction was obviously not the issue. Be wary of any medications even OTC. Regards, Fred Coe
Got price reduced thru my rx plan provider. Have been on Potassium citrate er 15 meq aince 2014. Prior rx cost was $14.00 at walgreens for 120 tablets thru my medicare part d plan. Last refill jumped to $131.18. Shopped around and could not lower price. Call my part d plan provider to complain about price change. Tier level had changed from 2 to tier 4 50/50. They said I could apply for precertification exception to reduce tier level and price. They contacted my dr. and determined diagnosis, how long I had been on drug, had I tried any lower priced drugs (the 2 suggested I was already taking). My precertification was approved and the tier level was reset at tier 1. Picked up my new rx for potassium citrate er 15meq #120 at walgreens cost $4.00.
Hi Beverly, You are effective in a harsh world. The cost you mention is about fair for a commonplace mineral supplement. Regards, Fred Coe
Can calcium oxalate stones be controlled with a high alkaline diet and checking the urn with ph strips to keep the urn within the 6.5 range instead of using the Potassium Citrate (10 MEQ TB ). If not, can the prescribed 4 pills/day (2 in the am and 2 in the pm) be taken by starting with one pill for a couple of days and then increase the amount up to the 4 pills, over a week or two to minimize the side effects. And do they have to be taken two in the am and two in the pm or can they be taken throughout the day until the last one in the pm? Thank you, Matt Lovien
Hi Matt, Uric acid stones are cured by raising pH from below 5.3 to about 6. Calcium stones are not treated by raising pH, but because the alkali from citrate raises urine citrate, and citrate can retard crystal formation. The amount depends upon the treatment goals derived from your initial 24 hour urines, and then upon the response to treatment – again the 24 hour urines. No measurements of total citrate excretion, flying blind. If your stones are uric acid, then pH is the whole story so be sure you know what they are. Regards, Fred Coe
Can calcium oxalate stones be controlled with a high alkaline diet and checking the urn with ph strips to keep the urn within the 6.5 range instead of using the Potassium Citrate (10 MEQ TB ). If not, can the prescribed 4 pills/day (2 in the am and 2 in the pm) be taken by starting with one pill for a couple of days and then increase the amount up to the 4 pills, over a week or two to minimize the side effects. And do they have to be taken two in the am and two in the pm or can they be taken throughout the day until the last one in the pm? Thank you, Matt Lovien
Hi Matt, Uric acid stones are cured by raising pH from below 5.3 to about 6. Calcium stones are not treated by raising pH, but because the alkali from citrate raises urine citrate, and citrate can retard crystal formation. The amount depends upon the treatment goals derived from your initial 24 hour urines, and then upon the response to treatment – again the 24 hour urines. No measurements of total citrate excretion, flying blind. If your stones are uric acid, then pH is the whole story so be sure you know what they are. Regards, Fred Coe
I am 72 with a long history of kidney stones. Since I was put on 4 – Potassium Citrate 15meq pills daily, about 6 years ago, I have had no stones at all! BUT my drug plan – sponsored by a union – put me in a Medicare Part D plan and they require that I fill all my Rx’s thru “Express Scripps”. The cost of three bottles of 100 extended release, 15meq tabs is $585.00 !!! With Medicare Part D, once my annual expenditure for drugs reaches $3,700 I enter the “donut hole” and have to pay 100% of the cost of all my meds until I pay $4,950.00 out of pocket! Then I can start receiving a discount of between 25 and 40% off the cost of all meds until the end of calendar year, then it starts all over again! Jesse James should have robbed pharmacies instead of banks!
I am 72 with a long history of kidney stones. Since I was put on 4 – Potassium Citrate 15meq pills daily, about 6 years ago, I have had no stones at all! BUT my drug plan – sponsored by a union – put me in a Medicare Part D plan and they require that I fill all my Rx’s thru “Express Scripps”. The cost of three bottles of 100 extended release, 15meq tabs is $585.00 !!! With Medicare Part D, once my annual expenditure for drugs reaches $3,700 I enter the “donut hole” and have to pay 100% of the cost of all my meds until I pay $4,950.00 out of pocket! Then I can start receiving a discount of between 25 and 40% off the cost of all meds until the end of calendar year, then it starts all over again! Jesse James should have robbed pharmacies instead of banks!
Hi Paul, It is a shame on us all that companies can so raise the price of a trivial mineral and government takes no action. Other sources of potassium alkali are in the article, and the many commentators to the article have offered workarounds as well. I am truly disgusted with this drug’s makers that they would so behave. Regards, Fred Coe
Hi Dr Coe.
I too recently experienced increase in Potassium Citrate ER 15 meq #120 rx cost from $14 to $131.18 for 60 day supply. I have Medicare and Part D Rx plan. I tried shopping around to no avail. Call my Part D company and asked why the change from Tier 2 to Tier 4 50/50. No real answer other than prices went up.
Asked if I could appeal and they said I couple apply for a Precertification appeal since I have been taking RX since 2014. They would contact my prescribing physician and ask questions such as how long I have been on drug, have I tried any other lower cost medications, etc. I was already taking the other drugs recommended. My appeal was approved within a few days and I am happy to report that I just picked up my new Prescription for Potassium Citrate ER 15mep #120 and the charge was only $4.00. So I recommend that anyone with a prescription drug plan apply for precertification for this drug as well as any others that have gone up in price. Thanks for your great website.
Hi Beverly, You are enterprising and your advice seems important to everyone who can do what you did. Thanks. Regards, Fred Coe
That was a great idea. However, insurance companies have found the work around and now when you get an exception to the formulary they move it to tier 4 and do not allow a tier on anything that was added to the formulary. Keep checking and calling the pharmacies for pricing. Also it seems the 90 day supply is a small reduction in cost due to the increased tablets being purchased at once. 2019 there will be another huge increase, most are moving Potassium Citrate to tier 4 and raising the copay for tier 4 while lowering the other tier copay.
After reading your note, I contacted our insurance provider and an appealing the price change. If approved, it will go from a tier 4 to tier 1. Thanks for your advice.
Bulk pharmaceutical grade Potassium citrate powder = dirt cheap…LEARN how to use correctly. Ask a friendly pharmacist, Doctor, most chemists can show you, you get the idea. If the Pharmaceutical companies could charge 1 dollar for let’s say salt pills they would.
Hi Gideon, Others have put up the same comment over the past several years. You are right. I only urge people who do this inform their physicians and be sure they know how to measure accurately. Potassium can be dangerous, and some people have underlying diseases that make potassium supplements risky when not measured out precisely. Regards, Fred Coe
As a board-certified internist practicing internal medicine for 39 years, one must often come up with valuable and thrifty advice in the world of high deductibles and corrupt insurance cartels. Then of course we have the FDA fronting for proprietary products that should long have been declared generic. As someone who is fairly compulsive about measuring 24 hour urine’s in individuals even after a first kidney stone, I can tell you that one of the best solutions is 1-2 tabs of Alka-Seltzer (plain) daily. It is effectively a combination of potassium and sodium citrate. One can add a little extra sodium bicarbonate if you wish. I have also had a compounding pharmacy simply put together a solution of potassium citrate for far less than what the manufacturers are charging Canada or otherwise. Follow-up 24 hour urine studies along with some dietary diligence, vitamin D levels in the 60-70 range, a minimal sugar/paleocentric diet, and plenty of hydration invariably can prevent all future kidney stones from forming.
As a board-certified internist practicing internal medicine for 39 years, one must often come up with valuable and thrifty advice in the world of high deductibles and corrupt insurance cartels. Then of course we have the FDA fronting for proprietary products that should long have been declared generic. As someone who is fairly compulsive about measuring 24 hour urine’s in individuals even after a first kidney stone, I can tell you that one of the best solutions is 1-2 tabs of Alka-Seltzer (plain) daily. It is effectively a combination of potassium and sodium citrate. One can add a little extra sodium bicarbonate if you wish. I have also had a compounding pharmacy simply put together a solution of potassium citrate for far less than what the manufacturers are charging Canada or otherwise. Follow-up 24 hour urine studies along with some dietary diligence, vitamin D levels in the 60-70 range, a minimal sugar/paleocentric diet, and plenty of hydration invariably can prevent all future kidney stones from forming.
Hi Dr Foley, I appreciate your comments. I never have tried alka-seltzer. The sodium part may raise urine calcium, although that has not been proven – the data on calcium increase with sodium all concern sodium chloride. The compounding pharmacy is an excellent idea but perhaps hard to find these days. As for prevention working, I am glad to hear someone else say what I have been saying – they can indeed be prevented and you are a fine physician to do it for your patients. Warm regards, Fred
Sorry, first reported on wrong article. Do you have a new updated link?
“Potassium citrate lowers urine calcium excretion”
Sorry, but the page you were trying to view does not exist.
It looks like this was the result of either:
a mistyped address
an out-of-date link
OK I found the link in this article and I will fix it. But my prior answer is ideal for your question. Thanks again! Fred
Sorry, first reported on wrong article. Do you have a new updated link?
“Potassium citrate lowers urine calcium excretion”
Sorry, but the page you were trying to view does not exist.
It looks like this was the result of either:
a mistyped address
an out-of-date link
OK I found the link in this article and I will fix it. But my prior answer is ideal for your question. Thanks again! Fred
https://www.kidney.org/news/kidneyCare/spring10/DietSoda
to quote: At the start of the study, all the women had healthy kidney function, according to Julie Lin, MD, MPH, assistant professor of medicine at Harvard Medical School and a physician at Brigham and Women’s Hospital.
Drinking one diet soda daily did not decrease kidney function more than normal. Drinking TWO OR MORE diet sodas, though, appeared to cause problems.
ALSO: http://www.fitday.com/fitness-articles/nutrition/healthy-eating/diet-soda-kidney-damage-the-link.html
Hi Christine, I did indeed look at the article and I know the main author well. I did not know about this article and although he reads my site Gary did not mention the work to me. I presume the importance is because I have favored diet drinks as a source of citrate as against the expensive medicinal supplement. I will include this paper in the relevant articles and also write to Curhan about it. Once again, thanks. Fred
https://www.kidney.org/news/kidneyCare/spring10/DietSoda
to quote: At the start of the study, all the women had healthy kidney function, according to Julie Lin, MD, MPH, assistant professor of medicine at Harvard Medical School and a physician at Brigham and Women’s Hospital.
Drinking one diet soda daily did not decrease kidney function more than normal. Drinking TWO OR MORE diet sodas, though, appeared to cause problems.
ALSO: http://www.fitday.com/fitness-articles/nutrition/healthy-eating/diet-soda-kidney-damage-the-link.html
Hi Christine, I did indeed look at the article and I know the main author well. I did not know about this article and although he reads my site Gary did not mention the work to me. I presume the importance is because I have favored diet drinks as a source of citrate as against the expensive medicinal supplement. I will include this paper in the relevant articles and also write to Curhan about it. Once again, thanks. Fred
Fred
Any thoughts as to raising urinary citrate in patients with moderate kidney insufficiency? I worry about potassium and sodium levels in my dad.
A mixture of potassium alkali and sodium alkali perhaps? Crystal light?
Any tips are appreciated. Thanks!
Hi Jonathan, I guess you are thinking in terms of alkali to reduce progression of kidney disease, and that is certainly a thoughtful strategy. Sodium bicarbonate has been used in a trial. Thinking is that being poorly reabsorbed vs. chloride the bicarbonate salt causes less blood pressure rise. Not well tested. Most CKD patients do alright with potassium in doses of 10 to 20 mEq 2 to 3 times a day even if taking an ACE or ARB. But some diseases – diabetes, chronic obstruction – may not, so caution and followup. Crystal Light is nifty because cheap and not hard to take. Same dosage issues. I always try and recheck. Best, Fred
Oh if you don’t mind one more question:
What about magnesium citrate tablets (low dose of course, 2.5-5meq)for increasing urinary citrate, with people in mind once again who cannot tolerate a very high potassium load.
Below are two small studies which show it could raise the urinary citrate. I am thinking that even if 2.5-5meq of alkali could from from the magnesium salt; when combined with other alkali salts (sodium, potassium) etc, it may benefecial to stone patients like my dad. – thank you
See:
https://www.ncbi.nlm.nih.gov/pubmed/2299712
https://www.ncbi.nlm.nih.gov/pubmed/10424393
Hi Jonathan, Old and well known to me. If you take magnesium citrate it works better with meals because the magnesium will lower oxalate absorption. Frankly I am happier with beverages like Crystal Light that have a lot more citrate and taste pretty good, too. Best, Fred
I take potassium citrate prescription and at around 118.00 a month but now must get 90 day supply and the pharmacy and my plan want 537.00 for 3 months worth I would say that’s high! Now switching to TheraLith xr any advice as to this medicine vs potassium citrate?