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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.


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.


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.


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.


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.


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.


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.


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 citrate in beverageswater 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.


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.


  1. Robert Moore

    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.

    • Fredric Coe, MD

      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

  2. Robert Moore

    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 !!

    • Fredric Coe, MD

      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

  3. Frank Cobis

    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.

  4. Ed Humpal

    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?

    • Fredric Coe, MD

      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

  5. Amy Pagnozzi

    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).

    • Fredric Coe, MD

      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

  6. Jane Dunn

    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!

  7. Jane Wardle

    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

    • Fredric Coe, MD

      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

  8. James Miles

    I was diabetic for 13 years and was taking metformin 1000 mg twice daily. Last A1C was 15. My symptoms have always been stomach and bowels. I am a 54 year old male. the metformin wasn’t really working so this year, our family doctor started me on Natural Herbal Gardens Diabetes Disease Herbal mixture, With the help of Natural Herbal Garden natural herbs I have been able to reverse my symptoms using herbs, my symptoms totally declined over a 7 weeks use of the Natural Herbal Gardens Diabetes disease natural herbal formula. My diabetes is totally reversed!

    • Fredric Coe, MD

      Hi James, I am happy for you, but would not personally support the use of this preparation in someone with so high an A1C as yours. Be sure and keep your care at least partly with a reliable endocrinologist who specializes in diabetes and the disease can have terrible long term consequences. Regards, Fred Coe

  9. Randy Morris

    Dr. Coe
    I was perfectly happy drinking Crystal Light. however, there has been much recent data that artificial sweeteners may increase the risk for Type 2 diabetes as much as actual sugar. Alas, I starting drinking water spiked with ReaLemon juice instead. Since the goal as I understand it is to alkalanize the urine, I wondered if you had any opinion on the pH of water. Bottled water pH runs anywhere from 3-9 depending on the brand. Would you hypothesize that there is benefit to drinking a more alakline water? (Which I am guessing getts that way by the bottler adding hCO3)


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