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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. Ric

    Hi Dr Coe,

    How effective is magnesium citrate compared to potassium citrate at increasing urinary citrate and Ph? Thanks

    • Fredric L Coe, MD

      Hi Ric, Very limited because it affects bowel function. Fred

  2. Melissa Howard

    Dr. Coe,
    I’ve been a member of Jill’s group for almost 4 years. In that amount of time I’ve followed the diet, added a few supplements suggested by the nephrologist (mg, K2, D3, B complex) and I’ve also added 1 liter of Crystal Light to my daily water to substitute the 10mEq of potassium citrate the nephrologist also recommended. I’ve remained stone-free all this time. My question is, my 24 hour urines prior to starting the added citrate showed my citrate levels to be adequate and in the 600s, but the nephrologist still prescribed potassium citrate as an additional strategy to lower my urine calcium. While my urine calcium’s have lowered significantly from mid 400s to 230ish, my citrate levels have risen into the 900s. I’m trying to figure out if there’s a sweet spot so I don’t overdo a good thing. Would it be smart to cut back on the Crystal Light perhaps to 1/2L? Or is my 4 year track record a good indicator I’m where I need to be? I also worry about the aspartame. Should I be?
    Thank you so much for your consideration.

    • Fredric L Coe, MD

      Hi Melissa, Aspartame does not scare me – most sugar substitute scares have arisen from Big Sugar paying scientists to find a problem, any problem, with them. The extra citrate does not scare me, and using K citrate to lower urine calcium a bit is not at all irrational. I presume your stones were not calcium phosphate as urine pH will be increased. No stones for 4 years, incidentally, sounds good, so perhaps things are about the best they need to be for you. Regards, Fred Coe

      • Melissa Howard

        Dr. Coe,
        Your input is reassuring. Thank you so very much.

        Melissa Howard

        • John

          Have heard or suggested Ortholyte? It looks to be a combination of pot citrate, mag citrate and sodium bicarbonate.

          • Fredric L Coe, MD

            John, Even at page 10 on Google I cannot find ortholyte apart from shoes. Can you post a link to it??? Fred

  3. Nancy

    Thank you for providing such detailed scientific information for everyone. In this article, you mentioned that potassium citrate may be harmful for some types of stone formers. I was a little confused as I understood from your article entitled CITRATE TO PREVENT CALCIUM AND URIC ACID STONES that potassium citrate is beneficial for calcium oxalate stones, uric acid stones, and possibly beneficial for calcium phosphate stones. Could you kindly clarify in which circumstances potassium citrate would be harmful? Thank you so much.

    • Fredric L Coe, MD

      Hi Nancy, Careful reader – I should write up to your thoughtful level. Calcium phosphate crystals form when urine is more alkaline – what happens when you take K citrate – but the drug can raise urine citrate that lowers calcium crystal formation. SO there is a kind of tension between the benefits of the citrate and the risks from more alkaline urine raising calcium phosphate crystallization. No trial has concerned calcium phosphate stone formers as a specific group – they are just a minority of ‘calcium’ stone formers studied. So, no one knows if k citrate is good, bad, or indifferent for calcium phosphate stones. I have asked my friends to do a trial, but no one thinks it worthwhile. Thanks for reading to well. Fred

      • Laura

        Hi Dr. Coe.
        Thank you for all your thorough info. I was just prescribed Potassium Citrate due to my Calcium Oxolate stones. The Rx for 180 pills is $120 at Walmart. I stumbled across your article and had a question about the benefits of Potassium Citrate for Calcium Oxolate stones or is it just for uric acid stones? It was my family physician that prescribed it and not the Urologist. I’m just wondering if I should check with the Urologist before starting the Rx, especially if it won’t help my kind of stones? Thank you in advance for your help!

  4. Harvey Bushell

    Oops. Pls feel free to edit Meq to mEq in my previous comment. Tnks 🙂

  5. Harvey Bushell

    Hi.. I just found out that an independent nearby pharmacy here in Toronto can order bottles of 100 potassium citrate pills for $5 each. They are from a company called Atoma Assurance who sell various supplements and OTC pharmaceuticals. The label/info on the bottle only says each pill is 99mg but my pharmacist did a bit of research and found they are 2.53Meq each. So doing the math 4 pills or 10.1Meq works out to be 20 cents. This is their parent company’s web site:

    • Fredric L Coe, MD

      Hi Harvey, he and you are right, others have found the same. If you need this drug, 4 pills are about 1 normal pill, so a common starting dose would be 4 pills 2 times a day. But are you sure it is the right drug? Is your urine citrate low?? Is is because urine pH is low?? It will do nothing unless it is bringing something abnormal into a more normal range. Regards, Fred Coe

      • Harvey Bushell

        Yes, I’ve discussed this a number of times with my urologist. I’ve had/passed 15 kidney stones over the last 25 years. We’ve tested a number of them and they were all 100% uric acid stones. They are usually between 3mm and 6mm. Since I started taking potassium citrate (20mEq/day) 4 years ago (and regularly test the pH of my urine) I have not passed any stones.

        Thanks for your help. It’s greatly appreciated.

  6. Nadim

    Hi Dr. Coe,
    I was wondering why there is no mention of simply using lemon juice as a source of citrate. According to the article linked below, “Approximately 85cc of lemon juice contains 60 mEq (4.2 gm) citrate.” Is there any reason to not add ~1 lemon worth of juice to water over the course of a day as an alternative to potassium citrate?

    • Fredric L Coe, MD

      Hi Nadim, Many have used it. If citrate is desired, the amount in a lemon will vary with the variety and ripeness. Crystal Light lemonade is cheap and one liter provides 20 mEq of potassium citrate. Are you sure you need potassium citrate? Do you have calcium stones and low urine citrate? Be sure you have been fully evaluated and need this remedy. Regards, Fred Coe

  7. Paul O

    Dr.Fredric Coe;
    After my 2nd kidney stone and my 3rd 24hr urine test analysis, ( previously was told to take potassium citrate pills but the cost was prohibateive) -my urologist recomended LithoLyte ( 1 packet in the morning and 1 packet in the evening ie 2 /day). With the auto ship program from the company the cost before tax would be $43.99/ month. This was a 50%+ savings over the Rx. After seeing your article, i could use Crystal Light (2 packets a day same as my doc’s recomemendation but the cost would be $14.88/month if this were the only usuage. i am thinking that a amajority of Crystal light with an occassional 1/3 teaspoon of sodium bicarbonate-trying to be “inanovative” as the article suggests. My 24 hr test show not enough urine output I thought it was 2liters but for some reason the lab recoreded the output as 1.5 liter. i pee all the time !! At any rate my 3 tests show a decrease from 2.0L to 1.66L and now 1.5L currently. Any suggestions about how i can get more urine output ( or possible problems causing output?). I had be switched from HTZ to Amlodipine 10mg for hypertension by my primary MD. I had notice a swelling of the ankles which the primary MD says is typical . I also take Atorvatin Calcium 40mg /day. Thanks for your insightful and thorough research and presenting this factor in an understanding way for the general population.

    • Fredric L Coe, MD

      Hi Paul, The urine volume is the excess of water intake over losses from sweating and respiration. This means you do not drink enough. Frequent urination in man often means prostate enlargement with a low capacity bladder. Stopping the CTZ was related to your BP, but was it also lowering your urine calcium as part of stone prevention? When you stop a diuretic there is transient sodium and water conservation – I hope you did not collect your 24 hour urine during that transient phase of about 2 weeks! Why are you taking citrate, is your urine citrate low, or is your urine too acid and you form uric acid stones? IN other words, what are the 24 hour urine abnormalities thought to cause your stones? Does the citrate correct them? As for your BP, if CTZ was not lowering it enough, it is usual to add a second drug to the first, to get synergy. Lacking direct knowledge of your situation, please consider these outsider remarks, as they may well be off the mark. Regards, Fred Coe

  8. Bella

    Potassium citrate is listed in diet lipton lemon iced tea mix,but I’m wondering how much. Is there any information on how much potassium citrate is in a prepared liter of this tea mixbor something similar?

    • Fredric L Coe, MD

      Hi Bella, Potassium citrate is common in food processing. The amounts will be medically unimportant if you actually need that material for stone prevention. Fred

  9. Frank Dimaggio

    Dr Coe- is crystal lite a safer substitute then potassium citrate for those of us who have CKD 3A?

    • Fredric L Coe, MD

      Hi Frank, If you need potassium citrate for stone prevention – usually uric acid stones in people with mild renal impairment – routine potassium citrate is safe. But I do not know your details, so this is mere commentary. Your physician is responsible for your safety. Regards, Fred Coe

  10. laura E-Mail oneal

    thank you I just got prescribed this medicine. when I went to pick it up today they wanted $235 for 90 day supply. WIth good RX it was $81 for 90 day supply. This is expensive so I am thinking I might try to stretch it further with substituting some days with the Crystal Light.


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