Indications
Citric acid is found in medicines mostly in combination with other ingredients:
- With Potassium Citrate or Sodium Citrate (oral solution): to make the urine less acidic, which helps prevent some kidney stones (uric acid and calcium stones) and eases the burning feeling of a mild bladder infection. It does not treat the infection itself.
- With Sodium Bicarbonate (effervescent powder or sachet): for quick relief of acidity, heartburn and indigestion.
- In oral rehydration salts (ORS): to help replace water and salts lost in diarrhoea.
- With Lactic Acid (vaginal gel): to keep the normal acidity of the vagina and reduce unpleasant odour or discharge, as advised by a doctor.
How It Works
Taken by mouth, citrate is changed in the body to bicarbonate, an alkali. This makes the urine less acidic and adds citrate to the urine, which stops stone-forming crystals from building up. In effervescent powders, citric acid reacts with bicarbonate in water to release gas, and the resulting citrate neutralises excess stomach acid. In vaginal gels it keeps the area mildly acidic, which supports the normal healthy bacteria.
Dosage and Administration
The dose depends on the product, so follow the pack label or the doctor’s advice.
- Oral solutions for the urine: mix the measured dose in a glass of water and take after meals, usually 2 or 3 times a day. Drink plenty of water during the day.
- Effervescent powders: dissolve one sachet or the measured dose fully in a glass of water and drink once the fizzing stops. Do not use regularly for more than 2 weeks without medical advice.
- ORS: dissolve in exactly the amount of clean water stated on the pack.
- Vaginal gel: insert with the applicator, usually at bedtime, for the number of days stated.
Children: only as advised by a doctor.
Interactions
- Products with potassium: Spironolactone, Amiloride, ACE inhibitors, ARBs and potassium supplements can raise blood potassium too high.
- Aluminium-containing antacids: citrate increases aluminium absorption; take them at least 2 hours apart.
- Making the urine alkaline can change how quickly some medicines, such as Methenamine, Lithium and Aspirin, leave the body.
Contraindications
Allergy to any ingredient. Products with potassium: severe kidney disease or high blood potassium. Products with sodium: people who must strictly limit salt, such as those with heart failure. Do not use urine-alkalinising products with an active urinary infection caused by stone-forming bacteria unless a doctor advises it.
Side Effects
Usually mild: stomach discomfort, nausea, diarrhoea and bloating. Frequent use of undiluted acid drinks can wear tooth enamel. The vaginal gel can cause mild burning or irritation.
Get urgent medical help for muscle weakness, tingling, a slow or irregular heartbeat or confusion (signs of high potassium), black or bloody stools, severe stomach pain, or swelling of the face, lips or throat.
Pregnancy and Lactation
Citric acid is a normal part of food and is not expected to cause harm. Combination products should be used in pregnancy or breastfeeding only on the advice of a doctor.
Precautions and Warnings
Use with care if you have kidney disease, heart disease or high blood pressure, or are on a low-salt or low-potassium diet. Always dilute oral products in water. See a doctor if urinary symptoms last more than 2 days, if you have fever or blood in the urine, or if indigestion keeps coming back.
Overdose
Too much may cause stomach upset and diarrhoea. With potassium or sodium products, large amounts can upset the body’s salt balance and affect the heart. Seek medical help.
Therapeutic Class
Urinary alkalinising agent; antacid component; vaginal pH regulator (used in combinations).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Keep sachets tightly closed to protect from moisture.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.