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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. James Tetazoo

    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.

    • Fredric L Coe

      Hi James, they are, and so is the predatory pricing of a simple potassium salt. Regards, Fred

  2. Barb Hoffman

    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?

    • Fredric L Coe

      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

  3. Steve Grunlan

    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.

    • Fredric L Coe

      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

  4. D Rosser

    $445 for 400 pills at Kaiser, with insurance.
    Took home 100 of them at $115. Only enough for 25 days.

    • Fredric L Coe

      Hi D Rosser, the price of this stuff is abusive. We need a few political activists! Mere physicians like me are ineffective. Fred

  5. Scott

    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!

    • Fredric L Coe

      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

  6. Beth Sickles

    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.

    • Fredric L Coe

      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

  7. Michael Babb

    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.

    • Fredric L Coe

      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

      • Carol Imes

        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.

        • Fredric L Coe

          Hi Carol, 1080 mg of potassium citrate is 10 mEq, so 1 mEq is 108 mg of potassium citrate. Regards, Fred Coe

          • Brett Flournoy

            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.

            • Fredric L Coe

              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

    • Brett Flournoy

      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.


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