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.
I have Crohn’s disease…multiple surgeries with bowel resection…2 reversals, no more bags. I am afraid of potassium citrate because of 3rd stage kidney disease that I have. I have to drink 10 ml three times a day. my specialist feels the liquid form mixed with water will be more beneficial than a pill. Question: Is the potassium bad for my kidneys? Are protein, salt and sugar bad for m kidneys at this stage? I form alot of oxalate and calcium stones because of the Crohn’s disease and past surgeries. In remission now, with a subtotal colectomy and ileo sigmoid anastamosis. I get small bowel obstructions periodically. Thank You
Hi Jane, Stage 3 CKD poses no real problems for potassium citrate in most people. Often, diarrhea from bowel disease causes enough sodium loss one can use plain sodium bicarbonate that is far more tolerable. The main issues with small bowel obstruction are low urine volume from diarrhea, high urine oxalate, and sometimes low urine pH. The former often responds to beverages with glucose in them that are absorbed well in the jejunum – ask your GI specialist. The high oxalate can respond to extra calcium with your main meals, or may require oxalate binders. Because the underlying disease is complex how to use these will also be complex and I can make only general comments. Regards, Fred Coe
I was just prescribed Potassium Citrate HR. I have Humana (Part D) coverage. This is listed Tier 3 and the cost for 90 day supply is 406.49. Needless to say I will not be taking it. Thank you for an alternative!
I was just prescribed Potassium Citrate HR. I have Humana (Part D) coverage. This is listed Tier 3 and the cost for 90 day supply is 406.49. Needless to say I will not be taking it. Thank you for an alternative!
Great article. But I would like to note that plain potassium citrate crystals USP (food grade) are available online from most bulk supplement and chemical suppliers at about fifteen bucks a pound — check Amazon, or Post Apple Scientific (I have no affiliation with any commercial website). I have used them myself to make healthier versions of commercial electrolyte replenishing drinks.
I also put some in capsules for a friend who temporarily lost her insurance and couldn’t afford her prescription (which she was taking for high blood pressure that failed to respond to more typical meds) The commercial version is the same stuff, apparently, adulterated with simple wax to make it time-release (really, they should cost no more than salt tablets!)
There might be a method to create a time-released version at home but most of us don’t have the means to measure absorption. Easier to just convert me/q to mg and mix your daily potassium dose into two or more liters of water or other beverage that you consume or cook with each day.
(I’d be cautious about putting it in gelatin capsules unless your potassium levels are closely monitored — too many mg in too short a time span could trigger a potentially life-threatening electrolyte imbalance.
As for Crystal Light: while I love Crystal Light, it contains quite a bit of artificial sweetener, which is not advisable for some people with kidney stones. (For example, people like me, who also have the genetic disorder PKD).
Hi Amy, ALtogether right as far as I know. My only addition to all patients – you seem particularly adroit – is to engage their physicians to be sure this is safe for them. POtassium can be dangerous, not everyone has a proper scale to measure out the powder, some people have kidney disease and could die. If the physician feels it is safe, this approach is a fine way around the price gouging we encounter with this material. Regards, Fred Coe
Great article. But I would like to note that plain potassium citrate crystals USP (food grade) are available online from most bulk supplement and chemical suppliers at about fifteen bucks a pound — check Amazon, or Post Apple Scientific (I have no affiliation with any commercial website). I have used them myself to make healthier versions of commercial electrolyte replenishing drinks.
I also put some in capsules for a friend who temporarily lost her insurance and couldn’t afford her prescription (which she was taking for high blood pressure that failed to respond to more typical meds) The commercial version is the same stuff, apparently, adulterated with simple wax to make it time-release (really, they should cost no more than salt tablets!)
There might be a method to create a time-released version at home but most of us don’t have the means to measure absorption. Easier to just convert me/q to mg and mix your daily potassium dose into two or more liters of water or other beverage that you consume or cook with each day.
(I’d be cautious about putting it in gelatin capsules unless your potassium levels are closely monitored — too many mg in too short a time span could trigger a potentially life-threatening electrolyte imbalance.
As for Crystal Light: while I love Crystal Light, it contains quite a bit of artificial sweetener, which is not advisable for some people with kidney stones. (For example, people like me, who also have the genetic disorder PKD).
My wife, who carries our insurance through work, is retiring and we will be on Medicaid, no plan C. I have a one month supply of potassium citrate, just prescribed, haven’t taken any yet. I can get a refill before the insurance ends. Is there any benefit to taking the medicine short term, while correcting diet? Any disadvantage to starting but then stopping?
Hi Ed, No and no; take what you can tolerate buying, stop whenever with no disadvantage, and change diet. Note the many comments on this article offering workarounds the terrible price gouging. Regards, Fred Coe
My wife, who carries our insurance through work, is retiring and we will be on Medicaid, no plan C. I have a one month supply of potassium citrate, just prescribed, haven’t taken any yet. I can get a refill before the insurance ends. Is there any benefit to taking the medicine short term, while correcting diet? Any disadvantage to starting but then stopping?
Hi Ed, No and no; take what you can tolerate buying, stop whenever with no disadvantage, and change diet. Note the many comments on this article offering workarounds the terrible price gouging. Regards, Fred Coe
Great article! I just have one question. Is there any reason why over-the-counter potassium citrate (99mg) could not be used? I realize it’s a lot of pills, but would still be less than 1/2 the cost of the 10 mEq pills I’m currently taking.
Hi Frank, no reason. Its just a lot of pills! Potassium citrate is a simple salt, and the pricing is just ridiculous. Regards, Fred Coe
Great article! I just have one question. Is there any reason why over-the-counter potassium citrate (99mg) could not be used? I realize it’s a lot of pills, but would still be less than 1/2 the cost of the 10 mEq pills I’m currently taking.
Hi Frank, no reason. Its just a lot of pills! Potassium citrate is a simple salt, and the pricing is just ridiculous. Regards, Fred Coe
I am on Potassium Citrate ER 10 MEQ TB. I take 2 tablets in the morning and 2 tablets in the evening (after meals). We have a CVS drug plan. I went to pick up my my scrip last night (120 pills) and the requested amount was $70. (it is usually $5 or so) . . . Apparently we have fallen into the “donut hole” . . . Yes, we can afford this but so many can not !!
Hi Robert, it is really a horror. Lots of people on the site have added useful comments about how to get around the high prices. Take a look at older ones. Regards, Fred Coe
I take a form called Potassium Citrate ER 10 MEQ TB (2 in the morning and 2 in the evening). We also have SilverScript from CVS which is $29.40 a month for 2 of us.
I had been paying $12 month for 120 tablets. Last week it shot up to $72. It took 2 hours on the phone with the Silverscript people to get everything resolved. I needed to have the doctor specify that I must have this form. There are others. The whole thing has to be renegotiated every year ^^%$#@^&*(*) On the other hand, my yearly cost is now $144 rather than $864 🙂
On the other hand, not every patient is prepared to argue this out. Especially folks who may be poorer or whose first language is not english etc.
At first the Silverscript folks try to tell you that they are not CVS and that this is not THEIR problem. That’s a lie. Silverscript is a CVS company. Period.
Hi Robert, this whole gauging about potassium citrate is disgusting. Many comments on this page concern alternatives, although your present price is pretty good. Regards, Fred Coe
I take a form called Potassium Citrate ER 10 MEQ TB (2 in the morning and 2 in the evening). We also have SilverScript from CVS which is $29.40 a month for 2 of us.
I had been paying $12 month for 120 tablets. Last week it shot up to $72. It took 2 hours on the phone with the Silverscript people to get everything resolved. I needed to have the doctor specify that I must have this form. There are others. The whole thing has to be renegotiated every year ^^%$#@^&*(*) On the other hand, my yearly cost is now $144 rather than $864 🙂
On the other hand, not every patient is prepared to argue this out. Especially folks who may be poorer or whose first language is not english etc.
At first the Silverscript folks try to tell you that they are not CVS and that this is not THEIR problem. That’s a lie. Silverscript is a CVS company. Period.
Hi Robert, this whole gauging about potassium citrate is disgusting. Many comments on this page concern alternatives, although your present price is pretty good. Regards, Fred Coe
What about magnesium citrate? is that an option?
Hi David, No; poorly absorbed and likely to cause diarrhea in high dose. Regards, Fred Coe
What about magnesium citrate? is that an option?
Dr. Coe,
I’ve been drinking a liter of Crystal Light a day for a year and it’s worked wonders for bringing down my urine calcium. However, the aspartame aspect continues to be worrisome. If I can tolerate lemon juice added to my daily water intake, how much lemon juice would I need to drink daily to get the equivalent of 20 mEq of potassium citrate? Thank you for your insight.
Melissa Howard
Dr. Coe,
I’ve been drinking a liter of Crystal Light a day for a year and it’s worked wonders for bringing down my urine calcium. However, the aspartame aspect continues to be worrisome. If I can tolerate lemon juice added to my daily water intake, how much lemon juice would I need to drink daily to get the equivalent of 20 mEq of potassium citrate? Thank you for your insight.
Melissa Howard
Hi Melissa, I detest the lemon idea – bad for tooth enamel, and silly. How about this: the ideal US diet included 5 servings of fruit and veggies. That provides about 100 mEq of potassium mostly as alkali. Try it for a while and get a 24 hour urine test. See if your urine citrate is not normal – without the Crystal light. If not, perhaps it will be higher than before and you can use less of the CL or even take some potassium citrate as pills. Let me know, Regards, Fred Coe
I presented the following information to my PCP. He has given me the go ahead to try this out. I would take potassium citrate powder dissolved in something like crystal lite, or packaged in capsule form. I would be responsible for weighing, and packaging the potassium citrate myself, so a scientific scale capable of measuring to 0.01g I would appreciate feedback!
Here is what we talked about:
Potassium Citrate
Current Cost: $10.00 for 90 days. $40.00 per year.
New Cost: $135.00 for 90 days. $540.00 per year.
Current Prescription: Potassium Citrate ER 15 MEQ. It provides 15 mEq per tablet. I take 2 tablets per day, or 30 mEq each day.
An alternative approach is to purchase potassium citrate in a 1 Kg carton, and create comparable mEq doses.
• 100mg powdered potassium citrate = 2.56 mEq
• (15mEq/2.56mEq) x 100 = 586 mg powder are needed to replace each tablet of the current prescription.
• 2 doses daily = 1,172mg or about 1.172 g per day of powder are needed.
• 1 Kg = 1000g
• 1000g/1.172g = about 853 daily doses
• 1 Kg potassium citrate = $18.01 (Amazon) or about 2.3 years of doses.
• Scientific Scale with reference weights (3000g x 0.01g) = $67.80 (Amazon)
Hi Charles, 1080 mg potassium citrate pills each provide 10 mEq of potassium citrate, so I am not so sure of your initial estimate for 100 mg of the powdered product. Check it with the manufacturer. Otherwise, using bulk material with a scale and your physician as the responsible adult in the room makes a lot of sense – trade off some nuisance for a lot of financial savings. Regards, Fred Coe
Join the discussion…
I presented the following information to my PCP. He has given me the go ahead to try this out. I would take potassium citrate powder dissolved in something like crystal lite, or packaged in capsule form. I would be responsible for weighing, and packaging the potassium citrate myself, so a scientific scale capable of measuring to 0.01g I would appreciate feedback!
Here is what we talked about:
Potassium Citrate
Current Cost: $10.00 for 90 days. $40.00 per year.
New Cost: $135.00 for 90 days. $540.00 per year.
Current Prescription: Potassium Citrate ER 15 MEQ. It provides 15 mEq per tablet. I take 2 tablets per day, or 30 mEq each day.
An alternative approach is to purchase potassium citrate in a 1 Kg carton, and create comparable mEq doses.
• 100mg powdered potassium citrate = 2.56 mEq
• (15mEq/2.56mEq) x 100 = 586 mg powder are needed to replace each tablet of the current prescription.
• 2 doses daily = 1,172mg or about 1.172 g per day of powder are needed.
• 1 Kg = 1000g
• 1000g/1.172g = about 853 daily doses
• 1 Kg potassium citrate = $18.01 (Amazon) or about 2.3 years of doses.
• Scientific Scale with reference weights (3000g x 0.01g) = $67.80 (Amazon)
Hi Charles, 1080 mg potassium citrate pills each provide 10 mEq of potassium citrate, so I am not so sure of your initial estimate for 100 mg of the powdered product. Check it with the manufacturer. Otherwise, using bulk material with a scale and your physician as the responsible adult in the room makes a lot of sense – trade off some nuisance for a lot of financial savings. Regards, Fred Coe
Join the discussion…
What if you mixed 1/2 cup of RealLemon with the 1 liter of diet 7 up? Do you have any info on the amount in True Lemon lemonade packages?
Hi April, RealLemon can damage your tooth enamel and is not a good idea. If you need supplemental potassium citrate the better idea is to get as much as possible from diet – five servings of fruits and veggies are recommended per day for all people in the US. Given that, if your urine citrate remains low then how about Crystal Light – it has more potassium citrate than diet 7 up. If you do this, you need to use 24 hour urines to know if you have achieved your goals. Regards, Fred Coe
What if you mixed 1/2 cup of RealLemon with the 1 liter of diet 7 up? Do you have any info on the amount in True Lemon lemonade packages?
Hi April, RealLemon can damage your tooth enamel and is not a good idea. If you need supplemental potassium citrate the better idea is to get as much as possible from diet – five servings of fruits and veggies are recommended per day for all people in the US. Given that, if your urine citrate remains low then how about Crystal Light – it has more potassium citrate than diet 7 up. If you do this, you need to use 24 hour urines to know if you have achieved your goals. Regards, Fred Coe
Hi Doc,
I have uric acid stone in left kidney 1,5 x 2.0 cm. On the other side I have diabetes, A1c 9ish that is contraindication for Urocit K. Is Crystal light ok in this case or the source of citrate is same? Even with max dose of U-K of 60 mEq a day according to manufacturer, PH will rise only 0.7 and that will not make any difference when I start with 5.5
I did dissolve stone of a similar size on the same place couple years ago, but that was requiring much more baking soda ,15-20 grams a day and PH of 7.5-8, off course, not for all 24 hours a day, and it took almost 6 months.
Previous attempt to dissolve it took 6 months with ph 6,5-7 and did not ing to stone. That amount of sodium now rise my BP. How should I organize my intake of alkaly to reach PH 7.5-8 under these circumstances.
p.s. Of course, I am on allopurinol 300 x 1 and eating 5 or more fruits a day.
Hi Velimir, It is not true that diabetes contraindicated potassium citrate; it may or may not depending on the level of kidney function. Crystal light contains alkali as the potassium salt, and so do fruits and veggies. If your physician believes you cannot take potassium citrate, use sodium citrate or sodium bicarbonate, and ask your physician to consider temporary urine of a thiazide diuretic to cope with the extra sodium. You do not need a pH over 7, incidentally, 6.5 should be sufficient. Regards, Fred Coe
Hi Doc,
I have uric acid stone in left kidney 1,5 x 2.0 cm. On the other side I have diabetes, A1c 9ish that is contraindication for Urocit K. Is Crystal light ok in this case or the source of citrate is same? Even with max dose of U-K of 60 mEq a day according to manufacturer, PH will rise only 0.7 and that will not make any difference when I start with 5.5
I did dissolve stone of a similar size on the same place couple years ago, but that was requiring much more baking soda ,15-20 grams a day and PH of 7.5-8, off course, not for all 24 hours a day, and it took almost 6 months.
Previous attempt to dissolve it took 6 months with ph 6,5-7 and did not ing to stone. That amount of sodium now rise my BP. How should I organize my intake of alkaly to reach PH 7.5-8 under these circumstances.
p.s. Of course, I am on allopurinol 300 x 1 and eating 5 or more fruits a day.
It is safe for a pregnant women
Hi Leah, It is not generally used during pregnancy. Regards, Fred Coe
It is safe for a pregnant women
Hi Leah, It is not generally used during pregnancy. Regards, Fred Coe
My grocery store pharmacy wanted $600 for 120 pills–with my insurance, I was able to purchase the same amount for $20..
Hi Kathy, I am glad for you. Price gouging for this medication has been terrible for everyone. Regards, Fred Coe
Where please?
I have high uric acid stones, along with high blood pressure requiring Lisinopril. The Lisinopril, when taken with potassium citrate raises my potassium to levels that are too high for my PCP. There don’t appear to be too many alternatives for people like me. I have read about using citric acid to raise urine pH. What are your thoughts on this situation?
Hi Robert, You can use sodium alkali for the uric acid stones, and if the blood pressure rises from the sodium a low dose of chlorthalidone to balance it. ALternatively you can use potassium citrate with chlorthalidone to remove potassium. Ask your physician which s/he prefers. Regards, Fred Coe
I have high uric acid stones, along with high blood pressure requiring Lisinopril. The Lisinopril, when taken with potassium citrate raises my potassium to levels that are too high for my PCP. There don’t appear to be too many alternatives for people like me. I have read about using citric acid to raise urine pH. What are your thoughts on this situation?
Hi Robert, You can use sodium alkali for the uric acid stones, and if the blood pressure rises from the sodium a low dose of chlorthalidone to balance it. ALternatively you can use potassium citrate with chlorthalidone to remove potassium. Ask your physician which s/he prefers. Regards, Fred Coe
2 “Alka-Seltzer Gold” tablets =1000mg Citric Acid, 1000mg Potassium Bicarbonate, 1050mg Sodium Bicarbonate. The tablets are dropped into water and the components react, releasing carbon dioxide. I believe Potassium Citrate and Sodium Citrate are formed in the reaction. How would this work as a source of alkali? (This website seems to have some of the best kidney stone information available. Thank you!)
Hi Daniel, I have never thought about this OTC favorite. Certainly the bicarbonate will react with the citric acid to yield a mix of sodium and potassium citrate. Reduced to their molar amounts per pill these come to 12.5 mEq sodium bicarbonate, 10 mEq of potassium bicarbonate, and 15 mEq of acid from the 5 mmol of citric acid and the fact that this acid has three protons. The net is about 22.5 mEq of sodium and potassium (the latter being 10 of the 22.5) with about 15 mEq of citrate and 7 mEq of leftover bicarbonate. A very potent mix. Frankly if my math is right – I am not a compounding chemist!! – that is a lot of alkali. Regards, Fred Coe
2 “Alka-Seltzer Gold” tablets =1000mg Citric Acid, 1000mg Potassium Bicarbonate, 1050mg Sodium Bicarbonate. The tablets are dropped into water and the components react, releasing carbon dioxide. I believe Potassium Citrate and Sodium Citrate are formed in the reaction. How would this work as a source of alkali? (This website seems to have some of the best kidney stone information available. Thank you!)
Hi Daniel, I have never thought about this OTC favorite. Certainly the bicarbonate will react with the citric acid to yield a mix of sodium and potassium citrate. Reduced to their molar amounts per pill these come to 12.5 mEq sodium bicarbonate, 10 mEq of potassium bicarbonate, and 15 mEq of acid from the 5 mmol of citric acid and the fact that this acid has three protons. The net is about 22.5 mEq of sodium and potassium (the latter being 10 of the 22.5) with about 15 mEq of citrate and 7 mEq of leftover bicarbonate. A very potent mix. Frankly if my math is right – I am not a compounding chemist!! – that is a lot of alkali. Regards, Fred Coe
I have passed some 27 kidney stones and the last 5 (3 yr span) had to be surgically removed. Finally I was given Potassium Citrate and now I haven’t passed a stone in almost 2 yrs. My insurance moved it from tier 2 to tier 4 which now I have to pay half instead of $10. Insurance said it wasn’t medically necessary. I’m on Medicare and Cigna Healthspring is the part D. I’m fighting it.
Hi Janice, Horrible stuff. Read the many workarounds patients have contributed on this article – check out the older postings as well. Lots of ways to save money. Regards, Fred Coe
I won, the insurance must have felt my pain and approved my request. Not only approved it but moved the med to a $4 tier. Just had a CT and still no stones. Potassium Citrate is wonderful!!
I have passed some 27 kidney stones and the last 5 (3 yr span) had to be surgically removed. Finally I was given Potassium Citrate and now I haven’t passed a stone in almost 2 yrs. My insurance moved it from tier 2 to tier 4 which now I have to pay half instead of $10. Insurance said it wasn’t medically necessary. I’m on Medicare and Cigna Healthspring is the part D. I’m fighting it.
For people that can accurately measure out 1.1 grams (or multiples thereof) of USP grade (food grade) potassium citrate (Urocit K pills are 1.08 grams), the cost is about 2 cents, compared to a dollar or more for a single Urocit K pill. For example, 1000 g of USP K-citrate can be found on Amazon for $19. This is enough to make 910 standard doses: at the bench mark of 4 per day (120 for 3 months) the cost would be $2.50. I would think the K-citrate powder could be mixed with almost any liquid you drink ( and you should drink lots), or 4.4 grams could be mixed in a 1 liter water bottle, and consumed to completion each day, either by sipping through the day, or mixing with other things you drink.
Also, if you don’t have the capability to measure accurately at the gram level, you could measure out 1.5 oz (42.5 g) on a kitchen scale and dissolve in 30 oz water, then use 3 oz/day (dilute further or add to other drinks) – a 10 day supply, with very simple kitchen mixing chemistry.
Does this seem reasonable?
For people that can accurately measure out 1.1 grams (or multiples thereof) of USP grade (food grade) potassium citrate (Urocit K pills are 1.08 grams), the cost is about 2 cents, compared to a dollar or more for a single Urocit K pill. For example, 1000 g of USP K-citrate can be found on Amazon for $19. This is enough to make 910 standard doses: at the bench mark of 4 per day (120 for 3 months) the cost would be $2.50. I would think the K-citrate powder could be mixed with almost any liquid you drink ( and you should drink lots), or 4.4 grams could be mixed in a 1 liter water bottle, and consumed to completion each day, either by sipping through the day, or mixing with other things you drink.
Also, if you don’t have the capability to measure accurately at the gram level, you could measure out 1.5 oz (42.5 g) on a kitchen scale and dissolve in 30 oz water, then use 3 oz/day (dilute further or add to other drinks) – a 10 day supply, with very simple kitchen mixing chemistry.
Does this seem reasonable?
Hi Bruce, Many have suggested as you have, but some time ago and their posts are in the older cadre. It is a reasonable approach except I always urge people to be sure their physicians know what they are doing and approve. Physicians are responsible for outcomes, and some people may be specially sensitive to potassium dose and therefore need special care. Regards, Fred Coe
Hello, Doctor…I just had emergency surgery to remove a stuck kidney stone in my right kidney. I only have one functional kidney as my left never developed. My urologist tells me that my left is packed with stones. He wants me to drink a quart of water a day for the rest of my life with 2oz of lemon juice in it. I can’t get it down. Can I use Crystal Light instead and does it have to be every day forever?
Hi Abby, Given you have only one functioning kidney (right one), prevention is of very high importance and I am not in favor of must water and lemon juice. I would strongly recommend 24 hour urine and serum testing to find out why you form stones and aggressive efforts to prevent more. Here is a good opening review on the site. Please read it, and get fully tested, and treated accordingly. Regards, Fred Coe
Hello, Doctor…I just had emergency surgery to remove a stuck kidney stone in my right kidney. I only have one functional kidney as my left never developed. My urologist tells me that my left is packed with stones. He wants me to drink a quart of water a day for the rest of my life with 2oz of lemon juice in it. I can’t get it down. Can I use Crystal Light instead and does it have to be every day forever?
Hi Abby, Given you have only one functioning kidney (right one), prevention is of very high importance and I am not in favor of must water and lemon juice. I would strongly recommend 24 hour urine and serum testing to find out why you form stones and aggressive efforts to prevent more. Here is a good opening review on the site. Please read it, and get fully tested, and treated accordingly. Regards, Fred Coe
You can buy one kilogram of potassium citrate powder from amazon for $19
You can buy one kilogram of potassium citrate powder from amazon for $19
Hi Mike, You are right, and many others find this and agree with your point. Just be sure your physician knows you are using it, because some people do not handle potassium well. Likewise, you need to measure out each dose, so you do not get an excess. Potassium can be dangerous. Your physician needs to be in the loop. Regards, Fred Coe
I can testify to the horrible cost of Potassium Citrate 10/1080. I have taken this for last 4 years 3/day for Uric Acid Stones. Thank god this has worked for me so far. Even or maybe because of my health care plan this medication has run from $175 to $523 for 90 days. The highest price has something to do with my meeting my deductible. I thank you for your detailed analysis and insight. I had turned to purchasing my Potassium Citrate from India at a cost of $48 for 270 tablets. Turns out to be the same pharmaceutical brand as that my mail order pharmacy utilizes.
Can you tell us more about the Potassium Citrate from India?
I can testify to the horrible cost of Potassium Citrate 10/1080. I have taken this for last 4 years 3/day for Uric Acid Stones. Thank god this has worked for me so far. Even or maybe because of my health care plan this medication has run from $175 to $523 for 90 days. The highest price has something to do with my meeting my deductible. I thank you for your detailed analysis and insight. I had turned to purchasing my Potassium Citrate from India at a cost of $48 for 270 tablets. Turns out to be the same pharmaceutical brand as that my mail order pharmacy utilizes.
Can you tell us more about the Potassium Citrate from India?
I would like to know about the Indian company selling potassium citrate.
Is it possible to substitute magnesium citrate in place of potassium citrate?
Is it possible to substitute magnesium citrate in place of potassium citrate?
I have been told to keep to a lower oxylate diet and watch my choices but not to worry too much. He also suggested ( among other things) water with lemon juice or just lots of water. I have a question about the Crystal Light–does it have to be the lemonade flavor? I much prefer the grape and drink it a lot. I’m hoping it has the same amount of citrate, do you know?
Hi Cindyf, I do not know because we did not measure it. I hope your use of citrate is based on 24 hour testing that shows a low urine citrate, and of a low oxalate diet on testing that shows an elevated 24 hour urine oxalate. Without testing, treatment is random, and likely to cause more confusion than benefit. Regards, Fred Coe
I have been told to keep to a lower oxylate diet and watch my choices but not to worry too much. He also suggested ( among other things) water with lemon juice or just lots of water. I have a question about the Crystal Light–does it have to be the lemonade flavor? I much prefer the grape and drink it a lot. I’m hoping it has the same amount of citrate, do you know?
Love the article! Very informative, nice data and presentation.
I dread the first quarter of every year. To save money, we opt to pay a high deductible at the beginning of the year, instead of a co-payment throughout the year.
CVS typically charges us ~$300 for a 1 month supply of 15meq potassium citrate in January (Q1 because of our deductible). Today it was $1000.00 We rejected the prescription.
We transferred the prescription to Sam’s Club. (They quoted us a lower price over the phone.) Upon picking up the potassium citrate, the cost was $800.00.
My husband let the technician know we were quoted a much lower price. She asked if were PLUS members. We are. The new cost? $195.00
What was the difference? Teva Generics.
CVS was filling my prescription with a Biocomp pharma brand.
Here is the info needed to order Teva Generics:
AB Rated and bioequivalent to Urocit®-K Extended-release tablets
Product number
5meq = 00591-2682-01
10meq = 00591-2729-01
15meq = 00591-2742-01
They have many authorized pharmacy’s across the nation.
Hopefully this generic brand will be priced lower with various insurance plans.
Good luck everyone!
Hi Cj, Oh my! President Trump and legislators from both sides have vowed to control drug prices. Here is a good example of utter nonsense that is costing people a fortune for what amounts to a simple salt. I am so glad you found a workaround. Regards, Fred Coe
Hi Cj, can you tell me how to become PLUS member? thank you
Love the article! Very informative, nice data and presentation.
I dread the first quarter of every year. To save money, we opt to pay a high deductible at the beginning of the year, instead of a co-payment throughout the year.
CVS typically charges us ~$300 for a 1 month supply of 15meq potassium citrate in January (Q1 because of our deductible). Today it was $1000.00 We rejected the prescription.
We transferred the prescription to Sam’s Club. (They quoted us a lower price over the phone.) Upon picking up the potassium citrate, the cost was $800.00.
My husband let the technician know we were quoted a much lower price. She asked if were PLUS members. We are. The new cost? $195.00
What was the difference? Teva Generics.
CVS was filling my prescription with a Biocomp pharma brand.
Here is the info needed to order Teva Generics:
AB Rated and bioequivalent to Urocit®-K Extended-release tablets
Product number
5meq = 00591-2682-01
10meq = 00591-2729-01
15meq = 00591-2742-01
They have many authorized pharmacy’s across the nation.
Hopefully this generic brand will be priced lower with various insurance plans.
Good luck everyone!
Hi Cj, Oh my! President Trump and legislators from both sides have vowed to control drug prices. Here is a good example of utter nonsense that is costing people a fortune for what amounts to a simple salt. I am so glad you found a workaround. Regards, Fred Coe
Hi Cj, can you tell me how to become PLUS member? thank you
Hi. Thanks for the article. I’ve been drinking about a liter of crystal light a day and thankfully no issues. However this new study is a bit scary on artificial sweeteners? Do you still recommend crystal light in light of this new study?
https://www.google.com/amp/s/amp.cnn.com/cnn/2019/02/14/health/diet-soda-women-stroke-heart-attack/index.html
Hi Evan, The link in the article goes to a study about atrial fibrillation, so I cannot comment. But I will find the work on PubMed and see. Thanks for sending the link. Fred
Hi. Thanks for the article. I’ve been drinking about a liter of crystal light a day and thankfully no issues. However this new study is a bit scary on artificial sweeteners? Do you still recommend crystal light in light of this new study?
https://www.google.com/amp/s/amp.cnn.com/cnn/2019/02/14/health/diet-soda-women-stroke-heart-attack/index.html
Hi Evan, The link in the article goes to a study about atrial fibrillation, so I cannot comment. But I will find the work on PubMed and see. Thanks for sending the link. Fred
I’m wondering what the difference is between the prescription of potassium er 15 mEq and the over the counter potassium citrate 275 mg is? Do I have to pay for the prescription? Or can the OTC capsules work as well. Kroger wanted $108 for the prescription, so shopping around.
Hi Jancie, the problem is only numbers of pills. Your 15 mEq pill has 1620 mg of potassium citrate vs 275 in the smaller cheaper tablets. So you would need about 6 (5.98) small tabs for each big ones. Check out how much you will save. Otherwise potassium citrate is potassium citrate. Regards, Fred Coe
Dear Dr Coe,
In 2014 I was prescribed potassium citrate and get it through a company called Theralogix. It’s called Theralith XR.
It’s extended release, it costs $50 for 360 tablets.
The formulation is:
Postassium citrate 99 mgs
Magnesium 180 mg (50% mag citrate & 50% mag oxide)
Vitamin B6 7.5 mg
It was explained that a Dr has to be affiliated with the prescription- gets some sort of credit. It is not covered by my insurance.
I’m just from my nephrology appt mandated to drink three liters- overwhelmed by loosing 3 xs the urine calcium than normal.
Over the years I’ve been told I have MSK- but not consistently- if that matters.
As a prolific stone maker (calcium oxalate) with 20+ large stones and “innumerable punctuate stones”.
I’ve been told this is quite serious and I’m 10 years away from CDC, if we don’t stop new stones from forming.
I’ve been advised to drink 3 liters of water which I struggle with. And take the Theralith- that’s it- which I’ve been taking for years.
The alarming part is, I don’t see how that mitigates the current state of my kidneys, which also have large cysts, UTIs and kidney pain. And the end result of CDC.
But reading all of the information you provide has been an excellent. I am so grateful for the work you do.
So I have you to thank for the notion to reduce salt intake and avoid oxalates in my diet.
Any other direction you can provide would be helpful.
Hi Laura, the product contains very little potassium citrate so you would need 10 of them to get 1080 mg of potassium citrate which is the size of a standard 10 mEq tablet. I gather your urine calcium is very high and assume it is from idiopathic hypercalciuria, not some other systemic cause – physicians see to this. Here is perhaps my best article for you as it outlines evaluation and treatment steps for who I think you are. Regards, Fred Coe
Dear Dr Coe,
In 2014 I was prescribed potassium citrate and get it through a company called Theralogix. It’s called Theralith XR.
It’s extended release, it costs $50 for 360 tablets.
The formulation is:
Postassium citrate 99 mgs
Magnesium 180 mg (50% mag citrate & 50% mag oxide)
Vitamin B6 7.5 mg
It was explained that a Dr has to be affiliated with the prescription- gets some sort of credit. It is not covered by my insurance.
I’m just from my nephrology appt mandated to drink three liters- overwhelmed by loosing 3 xs the urine calcium than normal.
Over the years I’ve been told I have MSK- but not consistently- if that matters.
As a prolific stone maker (calcium oxalate) with 20+ large stones and “innumerable punctuate stones”.
I’ve been told this is quite serious and I’m 10 years away from CDC, if we don’t stop new stones from forming.
I’ve been advised to drink 3 liters of water which I struggle with. And take the Theralith- that’s it- which I’ve been taking for years.
The alarming part is, I don’t see how that mitigates the current state of my kidneys, which also have large cysts, UTIs and kidney pain. And the end result of CDC.
But reading all of the information you provide has been an excellent. I am so grateful for the work you do.
So I have you to thank for the notion to reduce salt intake and avoid oxalates in my diet.
Any other direction you can provide would be helpful.
Hi Laura, the product contains very little potassium citrate so you would need 10 of them to get 1080 mg of potassium citrate which is the size of a standard 10 mEq tablet. I gather your urine calcium is very high and assume it is from idiopathic hypercalciuria, not some other systemic cause – physicians see to this. Here is perhaps my best article for you as it outlines evaluation and treatment steps for who I think you are. Regards, Fred Coe