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 been taking potassium citrate for about 3 years. I have produced in my life time about 14 kidney stones. As a heads up the other day I noticed a potassium tablet 1 gram floating amongst my stool. Put on a latex glove and retrieved the tablet, it was very crumbly and broke apart very easily but not dissolved. I wonder how pills I had flushed down the drain along with $$$$$. Everyone should be observing their stool for the same issue, I am sure I am not the only one flushing money away.
Hi Tom, You are not wasting your money. The wax matrix is lost in the stool, the potassium citrate leaches out into the GI tract and is absorbed. Yours is a well known discovery. I hope you have been stone free the three years. Your 24 hour urines during treatment will show the expected rise in urine pH and potassium, and fall in urine ammonia – ask your physician. Regards, Fred Coe
I have been taking potassium citrate for about 3 years. I have produced in my life time about 14 kidney stones. As a heads up the other day I noticed a potassium tablet 1 gram floating amongst my stool. Put on a latex glove and retrieved the tablet, it was very crumbly and broke apart very easily but not dissolved. I wonder how pills I had flushed down the drain along with $$$$$. Everyone should be observing their stool for the same issue, I am sure I am not the only one flushing money away.
Hi Tom, You are not wasting your money. The wax matrix is lost in the stool, the potassium citrate leaches out into the GI tract and is absorbed. Yours is a well known discovery. I hope you have been stone free the three years. Your 24 hour urines during treatment will show the expected rise in urine pH and potassium, and fall in urine ammonia – ask your physician. Regards, Fred Coe
Dr. Coe, this site is very beneficial, thanks much to you. I recently had another bout of gout, and in working with my urologist have discovered I average a urine ph of 5.1, and am supersaturated with Uric Acid. The possibility of stones got my attention! Currently I am slamming Crystal Light Lemonade, made with alkaline water, along with some 275mg pills and herbal Uric Acid reducer, while measuring my ph 3-4 times a day to calibrate things. I am most acid the first of every morning, will try a lemonade at bedtime to see how that affects things. Question: Is this likely to be a permanent situation? If so, drinking lemonade daily is not a major burden!
Hi Brett, indeed the low urine pH causes uric acid crystallization, and raising urine pH is the correct answer. Here is something about the mechanisms involved. Here is a more clinical review of uric acid stone prevention. Given no stones as yet, what you are doing is not unreasonable. If they form it means your approach lacks vigor and you will need potassium citrate and 24 hour urine monitoring to assure an average pH above 6. Regards, Fred Coe
Dr. Coe, this site is very beneficial, thanks much to you. I recently had another bout of gout, and in working with my urologist have discovered I average a urine ph of 5.1, and am supersaturated with Uric Acid. The possibility of stones got my attention! Currently I am slamming Crystal Light Lemonade, made with alkaline water, along with some 275mg pills and herbal Uric Acid reducer, while measuring my ph 3-4 times a day to calibrate things. I am most acid the first of every morning, will try a lemonade at bedtime to see how that affects things. Question: Is this likely to be a permanent situation? If so, drinking lemonade daily is not a major burden!
I have had kidney stones 5 times. The analysis came back 80% magnesium ammonium phosphate- struvite, 20% calcium phosphate hydroxy- and carbonate- apatite. I also have been diagnosed with diabetes type 2 managed with diet and exercise last A1C 6.1. I’m taking one over the counter potassium citrate supplement pill per day (99 mg). I am trying to eat food with less oscillates, combine food with foods with calcium, and limit protein. Any suggestions? Thanks.
Hi Mark,
Good job on all the healthy changes you have made. Don’t forget to get enough calcium by food (for men this is 1,000mg/day) and drink enough fluids to produce at least 2.5 liters of urine per day. Seems like you are doing everything you need to do, but remember to do an annual urine collection to make sure these changes are having the desired effect!
Very best, Jill
I’ve been making ‘lemonade’ from lemons (probably not the cheapest way to go), stevia, and potassium bicarbonate. I had the potassium bicarbonate already since I was trying to replicate a commercial alkaline water. The alkaline water, surprisingly enough, seemed to help with sciatica pain – but I did not like paying so much for water and using all those plastic bottles.
Potassium bicarbonate + citric acid should make potassium citrate, right?
~
A possible low cost option –
Potassium citrate can be purchased on Amazon as a bulk powder supplement for 0.02 per gram for 1 kg. A digital pocket gram scale can be purchased for $12.
~
Interesting side effect – I’ve noticed since I started drinking the ‘lemonade’ that my skin has been lightening; I found this on glutatione and citrate (people use glutathione injections for skin lightening):
https://www.ncbi.nlm.nih.gov/pubmed/15643280
Hi Rhyothemis, I gather that your physicians recommended potassium citrate for stone prevention you have employed some workarounds. You can purchase potassium citrate as a food product. I always suggest people clear the use of it with their physicians. You need to parcel it out into 1080 mg tronches, and some people have problems with potassium handling so an error could be dangerous. The same for potassium bicarbonate and citric acid. LIkewise, be sure you need supplemental citrate – urine pH or citrate are too low. Regards, Fred Coe
Dr. Coe,
I am a calcium oxalate stone sufferer. I just completed a 24 hour urine collection, which showed i am low in citrate and magnesium. My nephrologist prescribed potassium citrate 10 mEq twice daily. I took it for the first time this morning and have had severe diarrhea all day long, as well as abdominal burning and gas. I can’t take this again, and will be calling his office about alternatives. What would you recommend as an alternative to K-cit? I also drink 3 liters of water daily at a minimum.
Thank you, Matt
Hi Matt, Sorry! That is a terrible response. Perhaps you might modify your diet to 5 servings of fruits and veggies/day, and that will give you about 100 mEq of potassium as citrate equivalent anions. The article also lists suitable beverages. Regards, Fred Coe
I passed 165 calcium oxalate stones 2 years ago , 372 last year and 123 so far this year. I finally saw a nephrologist and am taking 15 meq Potassium Citrate X4 and it appears to have slowed them down. I’m not sure how many are currently in my kidneys or if the medication is preventing new stones.
Thanks for the article and research it will be very helpful in reducing the cost of my medication. I have back problems also which makes it difficult to distinguish back pain from kidney pain. I only mention this because stones can cause infection and sepsis which I have had 3 times since 2014. Again thank you for the info
Hi Stephen, Accelerated stones like yours are special indeed. The 24 hour urine findings are often sparse, but if treatment is pushed so as to lower supersaturations well below their starting values stone rates fall remarkably. Sorry I never wrote a special article on this but the link has the best from my prior research. Regards, Fred Coe
Looking at some past posts there has been a difference of opinion on how to convert the OTC 99 mg tablets of potassium citrate to mEq. I did a search and on Drugs.com it said to convert mg to mEq to divide 99mg by the atomic weight of potassium which is 39.0983 which comes out to be 2.53mEq. Using that figure 10 mEq would be 3.95 tablets(4 99 mg tablets). that would be for the element Potassium.
Urocit-K in the 10mEq tablet has 1080mg of potassium citrate correct, so using that figure , 1080 divided by 99 equals 10.909 round that off to 11 (99 mg tablets).
Now the Potassium Citrate is a compound and as such the amount of potassium should be proportional to the citrate.
I asked the question to 2 pharmacists one came up with the 4 tablets and the other came up with the 11 tablets. so which is correct?
Hi Larry, We did this calculation elsewhere. Every citrate binds 3 atoms of potassium. So 9 mmol of potassium as citrate salt will have 1 mmol of citric acid. Because citric acid has three proton binding sites, this will give 9 mmol of bicarbonate equivalent. If one adjusts up to 10 mmol of potassium and factors the MW of citrate you come to 1080 mg of the total salt. Since your pills are about 2.5 mmol of potassium, you will need 4 to match one 10 mEq potassium citrate. Note mEq and mmol of potassium are the same as potassium has only one positive charge. Regards, Fred Coe
To be perfectly clear one can take FOUR, 99 mg capsules of potassium citrate to replace one of the Urocit-K 10mEq tablets or one of the single serving crystal lite lemonade pouches.
Hi Larry, It depends on what the 99 refers to. If the labels says 99 mg of potassium as the potassium citrate salt, then there are 99/39 or 2.5 mEq of potassium as the citrate salt. Therefore 4 of the tablets will equal one 10 mEq tablet of potassium citrate. If it refers to 99 mg of the potassium citrate salt, then you would need 1080/99 or 11 to make up a 10 mEq of potassium as the citrate salt. Check the label. Regards, Fred Coe
To make it perfectly clear. Four 99mg tablets of the OTC potassium citrate would be the equivalent of one 10mEq Urocit-k or one Crystal light lemonade single serving (16oz) on the go packets.
Hi Larry, It depends on what the 99 refers to. If the labels says 99 mg of potassium as the potassium citrate salt, then there are 99/39 or 2.5 mEq of potassium as the citrate salt. Therefore, four will equal one 10 mEq tablet. If it refers to 99 mg of the potassium citrate salt, then you would need 1080/99 or 11 to make up a 10 mEq of potassium as the citrate salt. Check the label. Regards, Fred Coe
Dr Coe, Thanks for this information and being sensitive to the cost of Potassium Citrate. I have been on Potassium Citrate (10 meq/day) for 3 years since my surgery. I do 24 hr urine monitoring and at the beginning of this year my doctor suggested we may need to increase the dosage. However she gave me the option of trying LithoLyte (Citrate + Bicarbonate, over the counter 10 meq, $0.44/day). I discussed it with my GP and he was OK with it since the sodium was 2% of FDA recommended daily allowances. After 4 months, 24 urine and blood work tests look good. Do you have any experience or opinions on this product? I haven’t been able to find much info on it.
Hi Tom, I have no experience with it. I looked at the package, a model of deceptive verbiage. It contains 3.97 mEq of potassium for 10 mEq of base, so presumably each dose contains 6 mEq of sodium, presumably as the bicarbonate salt. A reasonable dose of 40 mEq of base/d would then give 24 mEq of sodium and 16 mEq of potassium. I cannot tell the percentages of citrate vs bicarbonate. Do I worry about the extra sodium? No, too little. How about bicarbonate instead of citrate? No evidence. So why not use it, so long as everyone agrees we have no trial evidence that it does anything for stones. It is not potassium citrate. Regards, Fred Coe
LithoLyte contains:
5 meq potassium citrate
2.5 meq magnesium citrate
2.5 meq sodium bicarbonate
For a total of 10 meq of alkali. Fred, you and I discussed this weekend at the AUA. Will you update this reply?
Thank you
Ryan
Hi Ryan, Thanks for the update. I could not figure the composition out from the web pictures, but glad to have the details on the site for everyone who might want an alternative citrate. Regards, Fred
Dr. Coe I checked with a Swansons tech guy and their 99mg Potassium Citrate capsules are 99mg of potassium so 4 of their capsules would be 10mEq of potassium citrate. Swansons sell a bottle of 120 capsules for $2.99 which would be the same as buying 3 of the boxes of the single serving on the go foil pouches of crystal light lemonade. That’s about 1/3 the price of the crystal light single serving. so for those who want to reduce their intake of artificial sweetener this would be a good option.
I fortunately live where Swansons headquarters is located and they have a retail store so shipping costs is not a factor.
Hi Larry, you are great. If it is potassium then 4 will do in place of one over priced 10 mEq tablet. As for Crystal LIght, it is not very expensive, so the pills or the beverage are both bargains. Thanks, Fred
How much citric acid is in a 1620mg 15meq potassium citrate pill. Has anyone had success with Dr. Clarke store citric acid pills?
Hi Vincent, there are 15 mEq of citrate as the potassium salt meaning that when metabolized it will produce 15 mEq of base – what is desired to raise urine citrate. There is no citric acid per se in the product as all of the citrate species are as the citrate anion, whereas citric acid has protons on its available anionic sites. Dr Clark is selling citric acid per se, which cannot be metabolized to produce alkali. It has no role or purpose in stone prevention. Here is how citrate tablets work. Regards, Fred Coe
Thanks. I stopped taking potassium citrate 1620mg (15 MEQ), 6 per day because of cost. Replaced it with 590mg citric acid 3 times daily because of cost. 24 hour urine sample revealed citric acid level of 120, too low. Now taking 6 citric acid pills daily and will do another 24 hour urine test and a KUB xray. Stones (60% calcium and 40% oxilate) have not grown since taking potassium citrate pills. Are you telling me that the citric acid pills don’t work and I should go back to potassium citrate pills? Thank you
Hi Vincent, I am. Citric acid will be eliminated in the urine as such. Worse, it is an acid load. Citrate is metabolized as citric acid and so takes up a proton producing alkali and thence raising urine citrate. Citric acid will be metabolized as is – no alkali formed – and what the cells do not want will be lost in the urine. Regards, Fred Coe
Dear Dr. Coe,
Recently I was prescribed two 1620mg ER Potassium Citrate tablets per day.
If I were to dissolve 3240mg pharmaceutical grade Potassium Citrate in 2 liters of water and then drink this over the course of the day would this be equivalent to taking the pills as prescribed?
At age 73 I had my first and only stone removed. That was an experience that I am hoping never to repeat. Thank you very much for all that you do to keep people like myself well informed and especially for this very well organized and well written website.
Hi Nate, Yes it would indeed. The flavor might be a bit off, but it should be fine. Just be sure your physician knows what you are doing and approves. Potassium is a hazardous material in some people, and likewise making up your own meds. Regards, Fred Coe
I just tried to fill a prescription for Potassium Citrate 1080MG at a Walmart in Asheville, NC. Price quoted was $800.00. Not sure of the quantity, guessing it was 120 tabs.
Hi Paul, How disgusting. This post has many alternatives listed, use one or another and just drop the pills as having a criminally inflated price. Fred
I had 2 Echograms lately, & the technician found very small stones in the bladder area. I don’t have a regular Dr. yet (still waiting after nearly 2 years now); Hull, QC Canada lacks doctors in their hospital for some time now & cut back which is a nightmare at “Emergency”.
The only night Dr. available told me that these little stones in my bladder were permanent & have been there for some time; not to worry about them & continue without meds or diet plan.
I read that Potassium Citrate mixed with water; Also cranberry juice & watermelon seeds can help get rid of them. IS THIS A KNOWN FACT OR NOT?
Hi Dianne, I gather that you had a reason for the studies, and perhaps these stones are causing symptoms. Without a physician I would not try things – if we do not know anything about a matter, better not try to treat it. As for no doctors, here in US Canada is used as the very model of perfect health care. I cannot imagine not having any physician at all. Specifically, the juices have no role. Potassium citrate has some trials but I cannot tell what you really have, and hate to say to use something for it. Sorry indeed, Fred Coe
I have found Now brand Potassium Citrate capsules in 99mg strength on Amazon Canada for $16.99 Canadian. Would this be an acceptable type of Potassium Citrate?
Hi Kathy, Many have discovered these pills. They are very small. A standard dose of potassium citrate is 1080 mg of the salt, and if the 99 mg is of the potassium citrate that would need 10 to make one full dose. But I suspect it is 99 mg of potassium. A full dose of 10 mEq of potassium citrate contains 10 mEq of potassium or 400 mg, so it may be 4 to one. Check the label. Regards, Fred Coe
I get 90 pills from Humana RX and my copays is $131.00. My Dr. thinks this is still too high.
I agree with your physician. The prices are outrageous. Fred
Hello , is there anything to make potassium citrate oral solutions taste better or make it easier on the stomach if that’s the cause . I’m taking 15 ml per dose three times a day . I use to take the pills but they think it irritated my stomach years ago . In the past I have had calcium oxalate stones and calcium phosphate stones . Now I’m having uric acid stones . All my levels are out of wack . I also have a citrate deficiency. I’m also mitigare and Allopurinol because my joints were giving me lots of problems and my rheumatologist thought it would help . I’m also a fast grower of stones and both sides of my family have stones . Also I have Primary Ciliary Dyskinesia do you know if that plays anything into kidney stone formation?
Hi Ben, As for your PCD, I know of no link to stones. From your kidney stone reports you must have changed your urine composition over time as calcium phosphate uric acid stones are not very compatible the one requiring a very acid urine the other an alkaline one. The low citrate is not specific. Your description of urine chemistries is not very detailed but if you want to post them I could try to help. As for potassium citrates, do you need them? If you presently have uric acid stones, you do, but perhaps you could use alternatives. For example Crystal Light has a lot of potassium citrate in it. Regards, Fred Coe
Thank you for your response. They think that my calcium phosphate stones were caused by a medication topamax I was taking for migraines at the time . The last stones I have passed we’re uric acid . My nephrologist said that the most recent 24 hour test my citrate was still low even after taking potassium citrate. Also my calcium and sodium was high . I have been going low salt but he said there are a lot of hidden foods with salt . Or it could of been anomaly since I was in recent vacation and had more salt then usual . Also my rheumatologist discovered recently that I had high uric acid in 2011 of 8.5 but no one said anything. Which probably explains my joint pain over time . He diagnosed me with unusual type of idiopathic migrating gout. He said I don’t fit the normal patterns. My uric acid blood levels have dropped to 5.4 . He still wants lower . Allopurinol and mitigare have helped .
I have some years of 24 hour tests it would be hard to post them all . They were also afraid that I had a salt wasting disorder . But the nepherologist felt at the time that the urologist had me do the 24 hour test to soon after my lithotripsy.
Hi Ben, if you were on fosamax you would indeed have reduced sodium conservation via impaired tubule bicarbonate reabsorption. It is true that SWL causes transient sodium losses from the treated kidney but the other kidney will compensate by reducing these so it is not a cause of abnormal sodium handling. What is relevant now is your present 24 hour urine findings. Regards, Fred Coe
Hi Ben, This helps a lot. Fosamax causes renal tubular acidosis with high urine pH and calcium phosphate stones. Stopped, it has left you where you naturally reside, with acid urine and uric acid stones. These stones are treated by raising urine pH with potassium citrate. This always works, if pursued as uric acid will not form when urine pH is above 6 on average throughout the day. The level of urine uric acid excretion is of little importance for the stones. Regards, Fred Coe
This was my first kidney stone : Carbonate Apatite (Dahllite) 90%
Calcium Oxalate Dihydrate (Weddellite) 10%
Hi Ben, A calcium phosphate stone, apt to form in alkaline urine, usually in people with high urine calcium. Here is a nice article about calcium phosphate stone formers. In your case I think the Topamax did it. Regards, Fred Coe
I am curious if Crystal Light Pink Lemonade has been compared to regular Lemonade. The Pink Lemonade does not have sodium citrate, only potassium, which is good if you are avoiding sodium. But does it have the same large meq of citrate? It has a tiny amount of soy lethicin, but I doubt it has much oxylate. Any info?
Hi Brad, We have only measured the standard lemonade do I do not know. I expect no oxalate, and potassium is always preferable to sodium. You can get another 24 hour urine to see if the potassium and citrate are at the level desired. Regards, Fred Coe
Thanks for this information. I have a degree in chemical engineering, and even I have trouble figuring out mEq related to mg of potassium and citrate. Apparently citrate in solution has a number of possible valences (charges). I recently did a 24 hr. urine test, and my nephrologist (kidney doctor) prescribed 2 pills (1080mg each), twice per day, 4 pills total. I thought that was a lot, but reading your article it appears not, so thanks. Unfortunately I have one kidney that is blocked and now is not functioning, and so we are aiming to keep the other functioning. A CT scan showed 3 smaller stones in the “good” kidney, so I am hoping this pill regimen works to prevent further stones from forming. Will the pill regimen help the non-functioning kidney at all? It apparently was blocked at the ureter tube. I like the idea of drinking Crystal Lite and/or diet 7-UP. but right now I can fortunately afford the price of pills. That could change. On my health plan I paid $40 for 1 month supply (120 pills) at Costco. I was previously taking potassium chloride, and that prescription was only $3 for 90 days!
Thanks again for all the information. Jeff
Hi Jeff, it is indeed a bother to figure out the mg in a 10 mEq potassium citrate tablet! You present two problems. One is the lost kidney, a terrible loss presumably from obstruction. Be sure there is no potential for reversal of obstruction restoring some function – your physicians presumably did this. Given one kidney, a problem is reduction of risk that it will be lost over time because of compensatory increase of filtration per nephron and acid retention. The latter could be a reason your nephrologist suggests potassium citrate. Another reason would be conventional stone prevention in the remaining kidney. It is a reasonable alternative if urine citrate is below risk level (400 mg/d) or urine pH is low enough to raise risk of uric acid stones. I presume you and your nephrologist have reviewed your 24 hour urine studies and have concluded it is the best approach. It will not affect the damaged kidney. Here is one of my favorite articles on stone prevention, that integrates diet and meds. You do need to make your diet as ideal as possible given both lost kidney and stone prevention. Regards, Fred Coe
Thanks Dr. Coe. I am encouraged by your statement about potential for reversal of obstruction. My GP said it was just dumb luck! The nephrologist has not been too forthcoming when asked about restoring some function, so I am going to see my urologist. He had performed lithotripsy on previous stones about 20 years ago, and seemed to take a more proactive approach. Now it seems there is laser destruction of stones, which was not available 20 years ago. At any rate, yes, the goal is to be super “good” on diet and keep the remaining functioning kidney up to snuff. I am a bit concerned about the potassium citrate raising my BP, as it seems to have risen about 10 points since starting potassium citrate and stopping potassium chloride, but perhaps my diet I has not been as well as it should. The potassium citrate is supposed to be taken with food, so its difficult to reduce weight gain. If you know of any studies on restoring some kidney function I would be interested to know. I am otherwise quite healthy, not obese, do not drink but 1 beer per week, non-smoker. Thanks for your insights!
Hi Jeff, I hope there is potential; your urologist will be able to determine this. Potassium citrate is not known to raise blood pressure. In fact potassium loads tend to lower it. There are no special tricks for restoring kidney function, it is just arresting loss. Regards, Fred Coe
Thanks again Dr. Coe.
Follow-up: I visited my urologist today, who I consider a very good urologist, and he said that despite the “total blockage” of the left kidney ureter and apparent total loss of function, he has been fooled in the past, and recommended sonic lithotripsy to remove the blockage (%80 success rate in removing the blockage) and then waiting 2-3 months to allow the kidney to decrease in size, and perhaps regain some function, maybe %20, which would be better than nothing. Then sonic lithotripsy of the largest of the stones in the right kidney.
I know this gets away from the original discussion on pot. citrate, but he did say taking it was a good thing. I did not ask him about pot. citrate and BP, but from what I have read on the Internet you are correct, potassium should lower it. I was wondering more about the high levels of K.
Anyway, hopefully I can report back positively in 2-3 months.
Jeff
Hi Jeff, I am glad your physician is planning to do what can be done about the obstruction. Likewise that you could confirm my comments about potassium and blood pressure from reading on the web. Rising serum potassium with one normal kidney is not an issue. Check it out. Regards, Fred Coe
Dear Dr Coe,
My name is Tony Polcari, and I am a urologist in St. Paul Minnesota. There is a supplement on the market called Theralith XR. Apparently there is “99mg” of potassium citrate in each tablet. Do you know what the conversion is to mEq?
Thanks,
Tony
Hi Dr Polcari, 10 mEq of potassium citrate is 1080 mg, so 99 mg is about 0.9 mEq. I do not much favor it as too low a dose for meaningful treatment. Regards, Fred
Hello Dr Coe, I started taking prescribed, five 10 meq potassium citrate tablets daily, after meals in 1987.
I have had calcium stones since age 37. In 2008 I developed a left bundle branch block,
no family history, My Cardiologist suggested I stop the potassium citrate as he felt strongly that it contributed significantly to my block. I got a second opinion at a nationally respected
clinic and surprisingly they concurred.
In 2012, I had a very painful diverticulitis attack and the ER doctor performed a cat scan and found unusually large diverticulae. A few months later, I had a colonoscopy at a renowned
hospital with extremely credible GI references. They found unusually large pockets in my sigmoid and beyond and recommended a sigmoid cholectomy in April 2013. A year later
the GI team seemed very interested in my history and strongly recommended that I stop potassium citrate completely even though I reduced it from 5 to 2 tablets at my cardiolgist recommendation. I am considering trying the crystal light because it is probably easier on the GI tract than tablets. I have no definitive clinical evidence to support this and would like your opinion. Thanks for your help, John C.
.
Hi John, A search of PubMed under ‘left bundle branch block AND Potassium supplements or potassium citrate’ yeilded no publications, so the medical opinion is probably based on experiences not as yet in the literature. Even so I would do what your physicians said to do. As for the sigmoid diverticula I doubt the potassium citrate cause them but possibly the pills themselves did so as physical objects. Be sure you need this agent. Check your evaluation data and ask if it is the best for you. Here is a nice article to look at. Regards, Fred Coe
Hello Dr. Coe, Thanks for your perspective on potassium citrate. My PCP has recommended crystal light to increase my citrate levels. Also, he indicated that
diet 7up and sprite zero could improve it enough without taking tablets.
I had my first stone in 1985 4mm. I passed it in the ER as it was stuck in the ureter. Since then, I was on a low oxalate, low calcium diet. In 1992, I was proactive and had a lithotrpsy of a 5mm stone. This failed and I had “wall of stones”, no stent and 6 days in hospital. 30 days later US showed a 3mm stone.
I learned from this experience and started going to an accredited teaching
hospital in the city. The difference in knowledge and care was significant.
I had a ureteroscopy in 2009 to remove a 1.1cm stone and a bilateral in2017 for numerous 2 and 3mm stones. My US last week was diagnosed by the radiologist
as an 8 mm stone, however my urologist said it was mostly Randals Plaque( and we both thank you for the outstanding article on this topic) and probably at most a 3 mm stone. Its confusing as the radiologist said he has 25 years of reading
US and that Randalls is impossible to detect. The urologist wants to do lithotripsy which scares me as I had poor results. He claims the procedure can break up some plaque and the small stone simultaneously. I appreciate your thoughts.
My family and co workers think I should get another opinion from a nationally
recognized stone clinic – with all my documentation. Is this overkill, as they say
that I need to travel outside the phila area…..
Thanks again for your help, John
Hi John, It is rather hard for me to see plaque on even a CT, but I have no personal experience in visualizing plaque with ultrasound. Of course you should get another opinion. I generally favor URS over SWL, but of course I have not seen your images and know nothing exact about your situation. One detail I do note is the amount of stone surgery despite energetic diet changes. The low calcium diet is not a good idea and has proven ineffective as opposed to other options. For surgery, I know Dr Brian Matlaga at Hopkins as extraordinary. Of course U Penn is a famous institution and I can certainly imagine you getting fine care there, as well. Regards, Fred Coe
Bulk Supplements sells Potassium Citrate in bulk. 1kg costs only $18.96 so that’s only about 2¢ per 10 mEq – about $7 per quarter for 40 mEq per day. Very economical. If one has Amazon Prime, it can be purchased there with free shipping and speedy fulfillment.
Hi Michael, You are right, and the price of the pills is an outrage. Just be sure you can measure out the dosage accurately and that your physician knows what you are doing. Some people are not tolerant of high potassium loads, and some cannot measure out potassium citrate accurately. I suspect you have neither issue but let your physician know and he/she can help you decide. Regards, Fred Coe
In response to Michael Babb, is a mEq = to 1 mg with the bulk Potassium Citrate? If not, he is using the wrong dosage I think. Thank you for your very informative article.
Hi Carol, 1080 mg of potassium citrate is 10 mEq, so 1 mEq is 108 mg of potassium citrate. Regards, Fred Coe
Hi Dr. Coe, Michael, Carol, I followed Michael’s plan and after doing all the math, and buying a gram scale, I came up with this: 3/4 teaspoon of bulk Potassium Citrate = 40 mEq. (or about 4.3-4.4 grams). Now, the “pills” are extended release, I assume to smooth the impact to urine ph over the day; the bulk is immediate. Thus, I mix a daily batch in a cup, and “sip” on it through the day, backed up by strip testing. Hassle? Maybe. Impact to cost? Reduced to insignificant. So the secret sauce is 3/4 teaspoon for 40 mEq, Michael could you please verify my math.
Hi Brett, using bulk K citrate is indeed rational. It takes 1080 mg of K citrate to give 10 mEq, so your math is fine. Just be sure your physician knows what you are doing. Are you safe taking potassium? She/he is responsible for your case. Regards, Fred Coe
Bulk Supplements is an excellent solution price wise, and my calculations come to 3/4 teaspoon = 40 mEq. However, the pills are extended release whereas the bulk product is of immediate impact. I dissolve the 3/4 teaspoon in a cup of water and sip on it throughout the day, backed by urine strip testing to calibrate the process. So far so good.
This year my potassium citrate was $982 for a 90 day supply because we had not met our deductible. I was shocked. It is now $197 for a 90 day supply which is still ridiculous.
I agree Beth, it is ridiculous. But many have written lots of good ways around that price in their comments on this article. Take a look at them all. They are better than the article. Regards, Fred Coe
Dr. Coe, Thank you so much for your incredibly informative website! I’m 63, have had 3 major stone passing episodes, and a few smaller, less painful, episodes. I was able to retrieve a stone from the last major event; it was calcium oxalate. My urologist has only done a dipstick test and my urine PH was 5. He said he wanted to do some imaging (x-ray) to see what we were dealing with, but that never got scheduled. I take tamsulosin because of an enlarged prostate. Although I’ve had an afib ablation I have no heart disease and no blood pressure issues. Some questions:
1. I have a sensitive stomach so I thought maybe I’d put a third of a teaspoon of baking soda into 12 oz of Crystal Light to temper it a bit and get the benefits of both. I thought it improved the flavor and added some fizz, which I assume is perhaps negating its ability to increase urine PH? Do you think I’m doing more harm than good?
2. I passed a small stone recently. Symptoms started occurring shortly after several days of very bumpy jet-skiing. Link? Along those lines, what thoughts do you have concerning the “hop and drop” method of passing kidney stones?
3. If potassium citrate has the potential to dissolve stones(?), might it make sense to make Crystal Light your last drink of the day so that it lingers longer in your kidneys?
4. Magnesium supplements?
5. Can you recommend a urologist in Spokane?
Thank you!
Hi Scott, You are forming calcium oxalate stones, and need prevention, which is a process. I would advise you not try remedies but rather get testing – blood and 24 hour urine – and treat what is wrong. Here is my favorite article. Here is a less complex one. Treatment without knowledge of cause can worsen things. Regards, Fred Coe
$445 for 400 pills at Kaiser, with insurance.
Took home 100 of them at $115. Only enough for 25 days.
Hi D Rosser, the price of this stuff is abusive. We need a few political activists! Mere physicians like me are ineffective. Fred
4oz of pure organic lemon juice has 40mEq of potassium citrate, so just 2 oz in the morning and 2oz in the evening gets you a clinical dose of 40mEq.
Hi Steve, not so simple. It contains perhaps that much total combined citric acid and citrate, but the amount of citrate base depends on the pH. We found lemon juice had only modest amounts of citrate – see the table in this article. Citric acid is absorbed and excreted unchanged. So no, the juice is not a good remedy. If you mean instead of actual lemon juice one or another preparation of lemonade, they can contain as much as 20 mEq/liter of citrate. As there are 33.8 ounces in a liter, 4 liters will have very little citrate indeed. Regards, Fred
Just read your great article about the price of potassium citrate. After having a 9mm calcium oxalate stone removed in the summer, blood work and a 24 hour urinalysis, my urologist prescribed potassium citrate 15 meq twice a day plus a diuretic. I have no prescription insurance. I was astounded when I had the prescription filled. $118 for a 30 day supply. After doing some research I found the GoodRx app, transferred my prescription to Wal-Mart and it brought down the price which was $158 for 60 pills down to $51, a savings of over $100! I am thinking of cutting down to one pill per day, drinking a liter of Crystal Light lemonade and a diet 7 up daily. My doctor did mention the Crystal Light at the time, but I was hesitant with my GERD diagnosis. I think it is worth a try, do you?
Hi Barb, Everyone has their own way around what amounts to scandalous overpricing of this mundane potassium salt. Some have bought bulk potassium citrate and weigh out the needed doses – see the other comments on this article. But whatever you do, be sure your physician knows and approves. He/she is responsible for your safety and care. Diet 7 up is not like Crystal Light in having a lot less potassium citrate. Regards, Fred Coe
I have more of a question then a comment. I can not swallow the potassium citrate pills so Chrystal Light was recommended to me by my urologist. However I also have a personal issue with aspartame. Can I drink Chrystal Light made with Stevia and achieve the same results?
Hi Mary K, used as a commercial sweetener stevia is synthetic and devoid of oxalate. Regards, Fred Coe
I never noticed the cost until I was on a high deductible health plan. $120 for 30 day supply (90 pills of 15mEq). Before, I just paid a copay which was just a fraction of that. High deductible plans are a growing trend these days and that might be a reason for the perception of increased prices.
Hi James, they are, and so is the predatory pricing of a simple potassium salt. Regards, Fred
SIR, I AM STILL CONFUSED !! DO YOU AGREE THAT 1/2 TSP. OF POTASSIUM CITRATE POWDER EQUALS 3 10mEQ TABLETS. AND 3/4 TSP. OF POTASSIUM CITRATE POWDER EQUALS 4 10mEQ TABLETS ?? THE PURE POTASSIUM CITRATE POWDER IS FROM MICROINGREDIENTS BOUGHT ON AMAZON. THE SERVING SIZE (1/8TH TSP) IS ONE SCOOP EQUALS 275 MGS…..JAKE
Hi Jerry, 1080 mg of potassium citrate crystals as powder is 10 mEq. Therefore 275 mg will be 10 x 275/1080 or 2.54 mEq. If 275 mg is 1/8 teaspoon – your number, then 1/2 teaspoon is 4 times higher or 4 x 2.54 = 10.018 mEq. Fred
Hi Dr.
I am on medication currently( Potassium Citrate tablets ) after discovering 8mm stone in the left kidney.
How can I get rid of this stone without surgery ?
Thanks
Ahmed
Hi Ahmed, Unless your stones are made of uric acid, potassium citrate cannot dissolve them, but only prevent more. Regards, Fred Coe
Thankfully my insurance covers it so I only pay $5 for 60 doses. Do you have any concerns about the aspartame?
Hi Anette, I was not aware that potassium citrate tablets contain aspartame. Do they? Regards, Fred Coe
Hi again, I’m sorry my question wasn’t clear. I meant the aspartame in Crystal Light. I looked at Crystal Light Pure, which is sweetened with stevia, but it does not contain potassium citrate
Hi Anette, Aspartame has no oxalate. I hope that is the answer you are asking for. Fred
I used potassium citrate (10Meq/3xday) for years per my doctors orders. The price over that time nearly tripled since the drug was reclassified as a tier 4 drug!! Really?! Tier 4? Why, besides greed?! As a guy who went to college to be an organic chemist I KNOW pot/cit is simple to make and potassium is an abundant and inexpensive element. A tier 4 drug allows drug companies to rape the system needlessly. I switched to sodium bicarbonate tablets (650 mg tab/3x day) and have been completely stone (oxalate) free for YEARS after suffering with numerous operations to remove or breakup stones. I also take Hydrochlorothiazide (diuretic) and have a doctor approved blood pressure that averages 85/60. Not bad for a 67 year old male. Sodium bicarbonate works great for me and saves me nearly $1000/year over pot/citrate. Talk to your doctor and see if you too can quit the potassium citrate rip-off.
Hi Hunter, Of course any alkali will do the same as potassium citrate in terms of acid base chemistry and increase of urine citrate, a protection against stones. Sodium loading does raise blood pressure, but you are on a diuretic that helps dispose of that sodium. Sodium loads raise urine calcium and stone risk but your thiazide lowers urine calcium, so that is presumably alright. The sodium load can promote potassium loss because of your thiazide and I am sure your physician monitors that. So your advice is not generalizable except to people taking thiazide. As for profiteering, I think it is shameful and disgusting, and unfortunately not rare in the US right now. Regards, Fred Coe
You can buy food-grade powdered potassium citrate in bulk on Amazon for about $10/kg, which works out to about one cent per gram which I think is about 10 meq. Is there any reason not to use that mixed with the beverage of choice a couple of times per day rather than any of the very expensive extended release potassium citrate powder. Seems this is the least expensive approach but are there any drawbacks to using the potassium citrate powder.
Hi John, You are part of a crowd that has discovered food grade potassium citrate. A gram is indeed about 10 mEq, and I am sure you can weigh it out and also sure that this simple compound will work to raise urine pH and, to the extent possible given your metabolic situation, urine citrate. But I ask you let your physician know. Some people have limited renal capacity to remove potassium from blood, and physicians are paid to know who they are and protect them from potential harm from rising blood potassium. I say this because home weight measurements can vary. Do it at home but let your physician know and approve. Regards, Fred Coe
Thank you for this website.
I have recently had surgery for bladder stones (uric acid stones).To prevent recurrence I started taking potassium citrate twice a day 10mEq ,plus Tamsulosin .4mg and Finestaride 5MG .I have also increased my water intake.
With my Medicare insurance Potassium citrate is costing me $100 a month which is a big rip off. I spoke to my doctor and to cut costs he said that I can take EFFER-K potassium bicarbonate tablets which would cost me $33 a month.
I do not see you mention of EFFER-K potassium bicarbonate tablets. I see only sodium bicarbonate .
Do you have any opinion on taking EFFER-K potassium bicarbonate tablets.
Hi henry r, Alkali are all effective, and potassium bicarbonate will work if dosed sufficiently. Unlike citrates that are metabolized, the bicarbonate comes as alkali causing spikes of high pH and troughs of low pH. I would advise working with your physicians to time the material for good averaging. I believe these tablets dissolve in water, and if so the best course is spreading the drug out over the day and especially leaving some for just before bed. I rarely bother with pH test strips but you might want to use some with each voiding for a while to be sure about constancy of high urine pH. Uric acid must dissolve at pH 6 or higher. Regards, Fred Coe
Dr Coe,can you recommend reliable easy to read urine PH test strips.Reviews on Amazon show that most strips colors are hard to read, figure out.
Hi Henry, I am color blind myself so they all look odd. But if it is very low pH you want to avoid – 4.5 – 5.5, the color change is usually rather good – to those who can see it. Regards, Fred Coe
Potassium Citrate is available as a powder, fairly cheap. Search on Amazon for many choices.
Hi David, Many have found this, and some plan to use it instead of pills. As I say to all, this simple compound is the same in pills and from Amazon, at least chemically, but if you plan to use bulk K Citrate for your treatment be sure your physician knows and approves. Potassium has its hazards, home weights are not always exact, and some people are not as good as others in tolerating potassium loads. If your physician is happy with using bulk powders, that is fine. Regards, Fred Coe
Thank you for continuing to monitor and respond on this page. You mention 5 servings of fruits and vegetables per day providing enough potassium alkali. Does it matter whether raw or cooked?
My pcp wants me to eat more meat and veggies to battle my early stage diabetes, so I make lots of soup, mostly chicken, with lots of raw celery, carrots, radishes and onions plus frozen mixed vegetables in it.
Will the alkali survive the cooking?
Thanks, Bill
Hi Bill, in a word, yes. But are you a stone former? If you are, and need potassium citrate – for uric acid stones as an example – diet alone will not be enough. If you form calcium stones, diet may be enough. If you form no stones, then certainly diet is enough. Without knowing more, I cannot add more. Regards, Fred Coe
I have passed several uric acid stones over the past year with several ER visits! I still have a 15mm stone in my left kidney which I have been taking potassium citrate pills for trying to dissolve it. My stone analysis said my last stone was 80% uric acid and 20% calcium. I am not tolerating the potassium citrate pills ( 2 in the morning and 2 at night) and stopped taking them after 2 weeks because my legs felt weak, I was nauseated and having diarrhea. My serum potassium was normal but I just don’t feel well when I take the pills. I take Nexium for heartburn so I have issues with a lot of citrus beverages. What would be a good regimen for me as an alternative to the pills? I’m not fond of plain water, but would like to get enough citrate in me to avoid taking these pills at all. Please help! I’m hoping to dissolve this last stone and prevent more! Thanks so much in advance!
Hi Debby, sodium bicarbonate pills, 10 grain, 2 three times a day will generally work. Ask your physician if she/he agrees/ Regards, Fred Coe
Thank you, Dr. Coe, for this article! On 7/15/2019, my prescription of Potassium Citrate ER 1620 MG (15MEQ) 3-month supply increased in “retail price” to $1,630.59 from around $400 the previous year. I’m a 48-year-old Cistinuria patient. I have no idea why the cost went up so high and so fast, but it’s rather alarming! I’m losing my good insurance (I still get the prescription for just the $45 copay), and it makes me nervous. The stuff really works.
Hi Anna, Raising urine pH does help and there are endless substitutes for the overpriced K citrate. Check out the hundreds of comments, old and new, for practical suggestions. Regards, Fred Coe
Two stones,two lithotripsy procedures in a year. The pills are over $100 for 30 days with my Medicare plus prescription plan. I can’t afford that.
Hi Eileen, These pills are certainly overpriced. But do you need them? Take a look at a reasonable approach to stone prevention and be sure you have been evaluated properly and indeed need the medication. You will find in the article that one adds potassium citrate when diet has been optimized against stones and urine citrate is low enough to raise stone risk. Otherwise there is scant reason to use it. Regards, Fred Coe
I was taking Potassium Citrate pills, my end of a month’s supply of which (90 pills) cost $3 under my old insurance. I switched over to my wife’s insurance, which will not cover a penny of it until we’ve hit the $3,000 family deductible. And it turns out that the at the current price (and at multiple pharmacies) that would run to over $170 a month. Which seems insane. So I ordered these pills on Amazon: https://www.amazon.com/gp/product/B01JN8WWMI/ Do you see any obvious red flags why this was a bad idea?
Hi Jeremy, these pills contain about 100 mg of potassium citrate, a prescribed pill contains 1080 mg, so you would need 10 of the pills for one of the other. If you do not mind swallowing so many I see no problem. Regards, Fred Coe
No need to publish this, but thank you Dr. Coe.
I can no longer take extended release potassium citrate tablets (slowed digestive system due to Chemo). Any issue with buying potassium citrate powder and mixing with a water or juice, and drinking the appropriate MEQ during the day. I can buy 300 grams of pure power from a US manufacturer for 9 dollars (Amazon). I had been taking about 3 grams per day of the ER tablets. This would be about 10 cents per day for the powder. Am I missing something?
Hi Doug, the powder is fine, just be sure about hour you weight it out, and let your physician know that you are doing this. Regards, Fred Coe
Hi. I use the potassium citrate (10Meq/2xday) along with Hydroclorothyazide (50mg) to block stones. I’ve been having some massive GRED issues lately and the large pills are not helping at all. If I was to switch to food grade powdered will that do the same thing. I dont really want all the chemicals in Crystal Lite, and I eat sugar.
Thanks for your help.
Hi Cori, Food grade potassium citrate can be used. You need an accurate balance to weigh out the usual one gram dose – the amount in one standard potassium citrate pill. Please consult with your physician before switching and assure that she/he agrees and is fully satisfied with what you are doing. Regards, Fred Coe
I read your article about potassium citrate. I had a hard time finding the pill form but believe it or not, I found a 90 capsule bottle at Bed, Bath & Beyond for a little under $5.00. What a deal!!!
Hi Kathy, I think you will find that the capsules contain about 100 mg of the potassium citrate vs. 1080 mg in a single Rx pill. If so it means you will have to take 10 of them to match one prescribed one. Read the label and check. If you are not sure, have your physician confirm for you. Regards, Fred Coe
Hello Dr. Fredric,
I was diagnosed with around 2mm kidney stones and I also have higher than normal uric acid in blood. My doctor prescribed me to take 1 pill [40mg] Febuxostat per day and 3 pills [15mEq each] Potassium Citrate per day. After 2 weeks of medication my urine ph is now at 8.0 from the previous 5.5. I thought he would lower the dosage of my medicine because my research shows ph level needs to be at 6.0-7.0 to dissolve stone but he said it is okay. Am i at risk of forming a calcium stones for this? I will be taking this medication for 3 months and I am worried.
Hi Al, I presume you have uric acid stones, but that is not clear. If none have been analysed, your physician can measure the density of your stones on CT and make a good guess. If the stones are not uric acid, alkali will not necessarily help. As for high pH causing calcium phosphate stones, that is true. The usual approach is to measure 24 hour urine stone risk factors at the start before treatment and treat what is abnormal, then do followup measurements to be sure the treatment has not made things worse. Regards, Fred Coe
Dr. Coe,
At the age of 50 I unfortunately classify myself as a chronic kidney stone maker (calcium oxalate). I have tried Potassium Citrate (along with other medications) several time throughout the years and I am unable to tolerate it, Recently Lytholyte was suggested by a urologist. Have you found this form of citrate to beneficial with patients? Also, shortly after starting the Lytholyte I had 5 stones (averaging 2-3 mm) that became stuck in my left ureter which required surgery three days ago. I am hoping it was a coincidence, however is there any correlation to citrate leading to stones leaving the kidneys?
Thank you,
Andrea
Hi Andrea, Litholyte is a mixture of sodium bicarbonate, potassium citrate. It should not cause stones. Possibly you have idiopathic hypercalciuria and raising your urine pH with the sodium bicarbonate caused calcium phosphate stones. It is therefore crucial that you have the new stones analysed. Otherwise, you simply have not as yet aimed prevention treatment at the causes of your stones, and perhaps you might want to do that. Regards, Fred Coe
Thank you for your reply. Upon reviewing the stone analysis from my recent surgery it indicates the following:
Calcium Oxalate Dihydrate (Weddellite) 60%
Calcium Oxalate Monohydrate (Whewellite) 20%
Carbonate Apatite (Dahllite) 20%
It appears only one stone was analyzed. However the same results were reported from a stone analysis in 2019.
Hi Andrea, the stone is calcium oxalate and not due to increased urine pH from the potassium citrate. What is not clear is why you made these stones. Have you had proper serum and urine testing? Surely the urine or blood contain clues. Regards, Fred Coe
A while back when I got my last prescription filled for an astronomic price I scrolled through a year of posts and figured out the 15 MEQ to grams conversion. I bought powder off Amazon and a scale. Now, three months later, I’m ready to use it, can’t find my spreadsheet. Doctor knows I’m switching, but office wasn’t much help with a translation of MEQ to Grams. Can you help convert 15 MEQ to grams?
Hi Jim, 10 mEq of potassium citrate crystals is 1080 mg (1.080 gm). From that you can calculate the 15. Be sure your scale is accurate and that your physician is in accord with your plan. Regards, Fred Coe
I was recently diagnosed with a GFRe of 53. I am a 68 yo male in good health. I used to get calcium oxalate stones when I was younger. Probably 20 or so from 25-50 years old. A chronic dehydrated lifestyle working in construction. When I started drinking more water they stopped until I had one removed last year through lithotripsy. A 6mm. Because of the 53 GFR my Nephrologist put me on 1080 mg PC twice a day. I now drink over 100-120 oz of water daily. I am low sodium and low protein less than 60g most days. I have adapted to living vegan on most days. Should I still take the PC in your opinion? I haven’t started it yet due to what I would suspect will be side effects. I was thinking of starting on a half dose twice daily by cutting the pill in half to see how it feels. Thanks in advance for your thoughts.
Hi Greg, the potassium citrate is not a necessary problem for your kidneys but what is the reason for it? Is your urine citrate low? Was your new stone uric acid? Be sure and get evaluated for the cause of stones, and see what needs fixing. As for the reduced eGFR, your physicians need to figure that out, too. Is it high blood pressure, prior damage from stones, something else? Regards, Fred Coe
Hi Dr. Coe! I’m fascinated with nutrition and i’ve recently been testing my urine ph each morning directly after waking (digital tester, routinely calibrated). I consistently get a result between 5.2 and 5.3 pH (a level of acidity which, i understand, increases the risk of kidney stones). I’ve come across a couple of interesting studies identifying lemon juice and malic acid as effective solutions for both increasing urine ph and citrate excretion (which, i’ve learned from your site, are critical elements in stone prevention). I would love to hear your thoughts on whether these could be effective supplements!
Thanks!
Lemon Juice: https://www.ncbi.nlm.nih.gov/pubmed/18946667
Malic Acid: https://www.liebertpub.com/doi/abs/10.1089/end.2013.0477?journalCode=end
Hi Pete, Do you have kidney stones? If not, is there any reason to bother yourself about the urine pH? Scattered urine pH values are not enough to cause uric acid stones, one needs a 24 hour average below 5.5 otherwise the crystals will not be stable enough to matter clinically. A normal diet including five servings of fruits and veggies will generally create a urine pH of 6 on a 24 hour average. Malate is just like citrate, metabolized with a proton and thereby producing bicarbonate. Lemons, if not too acid, also have citrate. Regards, Fred Coe
Ah thanks, good to know re: the 24 hour sample! I don’t have stones thankfully, however my glomerular filtration rate is down at 75 (at age 33), and creatinine at 1.28, which i know are only slightly in the abnormal ranges, but I would still like to ensure my kidneys have a healthy environment to function in as they’re not running at “full capacity” so to speak. Plus, it’s been pretty interesting to track how different foods are affecting my urine pH!
Hi Pete, Given your youth and creatinine, I am not sure what the situation is. Serum creatinine varies with muscle mass and inversely with kidney function. So if you are muscular your actual renal filtration may be very high. If indeed you have reduced renal function, low urine pH is a known consequence. At age 33 reduced renal function always has a cause and one of considerable importance – diabetes, hypertension, or some primary renal damage. I would clarify matters by getting a 24 hour urine and calculating creatinine clearance – in the link above- to see if there is a problem. As well one might want to measure the protein loss in that collection. Regards, Fred Coe
I would consider myself moderately muscular. I’ll have to get my 24-hour urine tested by my doctor once the COVID precautions have been lifted. In the meantime, I tested my 24-hour urine (using my own ph meter) and my ph was down at 5.3. This is where i usually fall with my morning urine ph tests (per this study, it seems there is strong correlation between morning fasting tests and 24-hour tests https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4104426/). Interestingly, testing it again on a day where I took roughly 2g of malic acid throughout the day, my 24-hour urine ph jumped to 6.4. I tried this on two more separate days and saw similar results (along with increased urine output and an atypical thirst, nay, appreciation for water). I understand that malic acid breaks down to bicarbonate, which would understandably increase my urine ph. However, this study concludes that the body loses potassium in processing bicarbonate (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3770998/), which seems like it would hinder my efforts in increasing urine ph in the long run. Using malic acid has eliminated heel pain i’ve struggled with over the last year (which makes me think it has something to do with uric acid buildup). I plan to continue using small doses of malic acid to alleviate the heel pain, thus facilitating healthy exercise, and up my intake of bananas and sweet potatoes to ensure my potassium levels are not negatively impacted by the resulting potassium loss on bicarbonate breakdown. I’m also going to experiment with an alkaline low-PRAL diet while ensuring adequate nutrient intake using the Cronometer.com website (sweet potatoes and bananas have very high PRAL scores). My question for you is: if malic acid is indeed increasing excretion of citrate via urine, does that mean that i’m depleting my citrate stores? Is there a natural way to boost my supply of citrate naturally? Thanks in advance!
Hi Pete, You do not need to wait for urine testing. Commercial vendors send out home kits. Litholink is the best of them and your physician can order the testing anytime. Stone composition is crucial. As for malic acid, I imagine you are taking a malate salt, perhaps sodium or potassium malate. I cannot comment on doing that as opposed to using potassium citrate, because the latter is an approved treatment and malate is not. I know attempts have been made to extrapolate 24 hour results from spot samples, but never have been convinced that this is a good idea – same cost if you are getting a real panel, less information: seems silly. Spot urine pH testing and extrapolation to uric acid stone is also a bit of a stretch. I would think that commercial 24 hour urine testing combined with stone analysis is more ideal. Regards, Fred Coe