시트르산염 (시트르산 칼륨, 시트르산 나트륨, 시트르산)

용도

• Adjunctive therapy to inhibit calcium oxalate formation
• Decrease possibility of calcium oxalate stone formation (Nutrived Potassium Citrate Granules)
• Adjunctive therapy to inhibit calcium oxalate formation
• Adjunctive therapy of chronic renal failure as a potassium supplement and alkalinizing agent
• Significantly acidemic chronic renal failure
• Hypokalemic chronic renal failure
• Adjunctive therapy to inhibit calcium oxalate crystal formation (hypocitraturia)
• Adjunctive therapy to inhibit calcium oxalate crystal formation
• Decrease possibility of calcium oxalate stone formation (Nutrived Potassium Citrate Granules)
• Persistent calcium oxalate crystalluria/uroliths (after diet and hydrochlorothiazide)
• Adjunctive therapy of chronic renal failure as a potassium supplement and alkalinizing agent

투여 방법

가능한 부작용

• Gastrointestinal distress (nausea, vomiting, diarrhea)
• Hyperkalemia (specifically with potassium citrate)
• Fluid retention (specifically with sodium citrate)
• Metabolic alkalosis (rare)

주의사항 및 금기

• Heart failure
• Severe renal impairment (with azotemia or oliguria)
• Urinary tract infections (UTI) associated with calcium or struvite stones
• Aluminum toxicity
• Hyperkalemia or conditions predisposing to it (adrenal insufficiency, acute dehydration, uncontrolled diabetes mellitus) - for potassium citrate
• Peptic ulcer disease
• Delayed gastric emptying, esophageal compression, or intestinal obstruction (specifically for tablet formulations)
• Use with caution (weigh risks vs. benefits) in severe renal tubular acidosis or chronic diarrheal syndromes as they may be ineffective. Sodium citrate products should be used with caution in patients with congestive heart disease due to sodium load. Monitor serum potassium levels closely when using potassium citrate, especially in patients with renal insufficiency.

약물 상호작용

• Amphetamines: Alkalinized urine can decrease excretion, potentially increasing toxicity.
• Pseudoephedrine / Ephedrine: Alkalinized urine can decrease excretion.
• Antacids: May cause systemic alkalosis. Aluminum-containing antacids may cause aluminum toxicity, especially in renal insufficiency. Sodium bicarbonate combinations may cause hypernatremia.
• Aspirin (Salicylates): Alkalinized urine can increase the excretion of salicylates, decreasing their efficacy.
• Fluoroquinolones (e.g., ciprofloxacin, enrofloxacin): Solubility is decreased in an alkaline environment; monitor for signs of crystalluria.
• Lithium: Alkalinized urine can decrease excretion.
• Methenamine: Concurrent use is not recommended as methenamine requires an acidic urine for efficacy.
• Quinidine: Alkalinized urine can decrease excretion.
• Tetracyclines: Alkalinized urine can decrease excretion.
• ACE Inhibitors (e.g., enalapril, lisinopril): May lead to increases in serum potassium levels (hyperkalemia) when used with potassium citrate.

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