Sodium Bicarbonate/ Citric Acid

South African indications:

• Urine hyperacidity

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Contraindications

• Hypersensitivity to the active ingredient or any of the excipients in this combination product
• Should not be given with urinary antiseptics which require an acid urine, such as methenamine mandelate and methenamine hippurate
• Where sodium (salt) intake has been limited under medical advice

Cautions

Caution in the following patient groups

• Pregnancy
• Breastfeeding
• Hepatic impairment

Renal insufficiency

• Use with care in patients suffering from renal insufficiency
• Coadministration with antacids in patients with compromised renal function may result in the absorption of dangerously high amounts of aluminium

Presence of bacteriuria

• Alkalinising agents do not eradicate bacteriuria although they may temporarily relieve lower urinary tract symptoms

Sodium bicarbonate precautions

• Should be administered extremely cautiously to patients with congestive heart failure, cirrhosis of the liver, or hypertension and to patients receiving corticosteroids

Forms avail. in SA and covered in this monograph: gra

Urine hyperacidity

Sodium Bicarbonate/ Citric Acid
2.550/0.823 (g/5g)

• Oral (gra): 5-10g, 8hrly

To be administered in half a glass of cold water (after effervescence) before or after meals

Paed. forms avail. in SA and covered in this monograph: gra

Urine hyperacidity

Sodium Bicarbonate/ Citric Acid
2.550/0.823 (g/5g)

• Younger than 6 years: Not established for use
• Between 6-12 years: Oral (gra): 5g, 8hrly
• Older than 12 years: See adult dosage

To be administered in half a glass of cold water (after effervescence) before or after meals

Recommendations for this combination product as per highest risk category when comparing individual active ingredients

Pregnancy

• Caution (Sodium bicarbonate, Citric acid)
• The safety of sodium bicarbonate during pregnancy has not been established, but its use during these periods is not considered to constitute a hazard. Antacids containing sodium bicarbonate should not be used during pregnancy due to their potential to cause metabolic alkalosis and fluid overload
• Caution with toxaemia of pregnancy

Breastfeeding

• Caution; no information available (Citric acid)
• The safety of sodium bicarbonate during breastfeeding has not been established, but its use during these periods is not considered to constitute a hazard
• Safety of citric acid in breastfeeding has not been established

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended (Sodium bicarbonate, Citric acid)

Elderly

• No dose adjustment recommended (Sodium bicarbonate, Citric acid)

Porphyria Information

• Not yet classified (NC) (Citric acid)

Drugs in Sport

• Permitted - No warnings

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Sodium bicarbonate
Gastrointestinal Disorders

• Stomach cramps
• Belching
• Flatulence

Endocrine and Metabolic Disorders

• Metabolic alkalosis
• Hypokalaemia

Citric acid
Central Nervous System Disorders

• Tetany

Gastrointestinal Disorders

• Diarrhoea
• Nausea and vomiting

Endocrine and Metabolic Disorders

• Metabolic acidosis

Combination products may have additional pharmacological effects not accounted for by the action of the individual ingredients

Sodium Bicarbonate/ Citric Acid

• Urinary antiseptics which require an acid urine
• Methenamine mandelate
• Methanamine hippurate

Sodium bicarbonate

• Angiotensin-converting enzyme inhibitors
• Analgesics
• Antibacterial agents
• Antiepileptic agents
• Antifungal agents
• Antihistamines
• Antimalarial agents
• Antipsychotic agents
• Antiviral agents
• Bisphosphonates
• Digoxin
• Corticosteroids
• Cytotoxic agents
• Dipyridamole
• Lithium
• Penicillinamine
• Levothyroxine
• Lansoprazole

Citric acid

• Aluminium hydroxide

None routine. Specific cases may require

• Renal function
• Hepatic function
• Electrolytes

Sodium bicarbonate
Sodium bicarbonate has antacid properties and neutralises gastric acid with the production of carbon dioxide.

Citric acid
Citric acid is metabolised to sodium bicarbonate and acts as a systemic alkaliser.

Sodium Bicarbonate/ Citric Acid is available in several formulations. Please note the list below gives examples of products which are available and is not necessarily comprehensive. The listing of a product does not constitute endorsement of the product by EMGuidance; likewise, failure to list a product does not imply that EMGuidance disapproves of the product. This information is put together on the basis of the National Government's Medicines Price Registry at the time of publication

COMBINATION PREPARATIONS

Sodium bicarbonate/ Citric acid

Granules (per 5g) 2.45/0.865g

• Effersol (Pharmacare)