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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Citric Acid Monohydrate, Dextrose Monohydrate, And Trisodium Citrate Dihydrate
Brand Name
Acd
Generic Name
Citric Acid Monohydrate, Dextrose Monohydrate, And Trisodium Citrate Dihydrate
Active Ingredient
Citric AcidCategory
Standardized Insect Venom Allergenic Extract [EPC]
Salt Form
Monohydrate
Variants
2
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Acd, you must consult a qualified healthcare professional.
Detailed information about Acd
Citric Acid is a tricarboxylic acid used clinically as a urinary alkalizing agent, a component in diagnostic tests, and a pharmaceutical buffer. It plays a vital role in metabolic processes and the prevention of certain types of kidney stones.
Dosage of Citric Acid and its conjugate salts is highly individualized based on the patient's acid-base status and the specific condition being treated.
Citric Acid is used in children, but dosing must be calculated carefully, usually based on body weight or surface area.
In patients with significant renal impairment (GFR < 30 mL/min), Citric Acid combinations containing potassium must be used with extreme caution to avoid hyperkalemia (high potassium). Conversely, sodium-containing versions may contribute to fluid retention and should be avoided in patients with renal failure or congestive heart failure.
Since the liver is the primary site for the conversion of citrate to bicarbonate, patients with severe hepatic insufficiency may have a reduced alkalizing response. Monitoring of systemic pH is essential.
Elderly patients are more likely to have reduced renal function and may be taking other medications (like ACE inhibitors) that affect potassium levels. Dose selection should be cautious, usually starting at the lower end of the dosing range.
If you miss a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double the dose to catch up, as this can lead to acute electrolyte imbalances or metabolic alkalosis.
Signs of Citric Acid overdose (specifically when taken with salts) include:
In case of suspected overdose, contact a poison control center or seek emergency medical attention immediately. Treatment usually involves correcting electrolyte imbalances and, in severe cases, dialysis.
> Important: Follow your healthcare provider's dosing instructions exactly. Do not adjust your dose or stop the medication without medical guidance, as this can cause your urinary pH to drop and increase the risk of stone formation.
Gastrointestinal symptoms are the most frequently reported side effects of Citric Acid therapy, particularly when using oral solutions. These include:
Citric Acid therapy is generally safe when used as directed, but it carries significant risks if the patient has underlying conditions that affect electrolyte or acid-base regulation. The most critical safety point is the requirement for dilution. Citric acid is a caustic substance in concentrated form; failure to dilute it properly can lead to esophageal injury or severe gastric irritation.
No FDA black box warnings for Citric Acid.
While Citric Acid is a natural substance, pharmaceutical preparations often contain dyes (like FD&C Yellow No. 5), flavorings, and preservatives (like sodium benzoate). Patients with known sensitivities to these additives should review the full ingredient list with their pharmacist.
Citric Acid combinations must NEVER be used in the following circumstances:
FDA Pregnancy Category C. There are no adequate and well-controlled studies of Citric Acid in pregnant women. It is not known whether Citric Acid can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. However, maintaining acid-base balance is critical during pregnancy. Citric Acid should be given to a pregnant woman only if clearly needed and under strict medical supervision. Monitoring for fluid retention (edema) is particularly important in the third trimester to avoid complications like preeclampsia.
Citric acid is a normal constituent of human milk. When taken at therapeutic doses, it is unlikely to significantly alter the citrate content of breast milk or affect the nursing infant. However, because the medication is often taken as a salt (sodium or potassium), the mother's electrolyte balance should be monitored. Always consult a healthcare provider before breastfeeding while on chronic therapy.
Citric Acid is approved for use in children for the treatment of metabolic acidosis and certain renal conditions. It is particularly useful in pediatric distal renal tubular acidosis (dRTA). However, long-term safety data regarding bone growth and dental health are limited. Dosing must be precisely adjusted by a pediatric nephrologist. It is NOT approved for use in infants without specialist oversight due to the risk of immature renal handling of large acid/base loads.
Citric Acid (C6H8O7) is a weak organic acid. In the body, its primary role is as a metabolic intermediate. When administered orally as an alkalizing agent, the citrate anion is absorbed and oxidized in the liver to form three molecules of bicarbonate (HCO3-). This bicarbonate then enters the systemic circulation, raising the blood pH.
In the kidneys, the increased bicarbonate load leads to an increase in urinary pH. Furthermore, the presence of citrate in the renal tubules provides a dual benefit:
The onset of action for urinary alkalization is relatively rapid, with changes in urinary pH typically observed within 1 to 2 hours after a dose. The duration of effect is short (4 to 6 hours), which is why multiple daily doses are required to maintain a consistent urinary pH. There is no evidence of tolerance development; the body's response to Citric Acid remains consistent over long-term therapy provided renal and hepatic functions are stable.
Common questions about Acd
Citric Acid is primarily used in medicine as a urinary alkalizer to prevent the formation of kidney stones and to treat metabolic acidosis. It works by being converted into bicarbonate in the body, which raises the pH of both the blood and the urine. Additionally, it is used in diagnostic tests for H. pylori and as a stabilizing buffer in various other medications. Some formulations are also used to manage low citrate levels in the urine, a common cause of calcium stones. It is always used under medical supervision for these clinical purposes.
The most common side effects are gastrointestinal in nature, including stomach pain, nausea, vomiting, and diarrhea. These symptoms occur because the concentrated solution can be irritating to the lining of the stomach and intestines. To minimize these effects, the medication must be properly diluted in water or juice and taken after meals. Most patients find that these side effects are mild and decrease as their body adjusts to the medication. If side effects become severe or include bloody stools, you should contact your doctor immediately.
You should use caution when consuming alcohol while taking Citric Acid. Alcohol can lead to dehydration, which increases the risk of kidney stone formation and may counteract the benefits of the medication. Furthermore, alcohol can increase stomach acid production, which may worsen the gastrointestinal irritation caused by Citric Acid. It is best to discuss your alcohol consumption with your healthcare provider to ensure it does not interfere with your treatment goals. Staying well-hydrated with water is the priority during therapy.
Citric Acid is classified as FDA Pregnancy Category C, meaning its safety has not been fully established through large-scale human trials. While citric acid is naturally present in the body, the high doses used for medical treatment could potentially affect electrolyte balance. It should only be used during pregnancy if a doctor determines that the benefits outweigh the potential risks to the fetus. Pregnant women taking this medication require close monitoring for fluid retention and blood pressure changes. Always inform your obstetrician if you are prescribed this medication.
For its effect on urinary pH, Citric Acid begins working quite quickly, often within 1 to 2 hours after the first dose. However, its effects are temporary, typically lasting only 4 to 6 hours, which is why it must be taken multiple times throughout the day. If you are taking it to dissolve existing stones, it may take weeks or months of consistent therapy to see results on imaging tests. Regular monitoring of your urine pH is the best way to confirm the medication is working as intended. Your doctor will guide you on how to track these results.
You should not stop taking Citric Acid suddenly without consulting your doctor, especially if you are taking it to prevent recurrent kidney stones or manage chronic acidosis. Stopping the medication abruptly can cause your urine to become more acidic very quickly, which may trigger the rapid formation of new stones. If you need to discontinue the drug, your doctor will likely monitor your blood and urine chemistry to ensure your body remains stable. Always ensure you have enough refills to avoid missing doses unexpectedly. Sudden changes in therapy can reverse the progress made in stone prevention.
If you miss a dose, take it as soon as you remember, provided it is not almost time for your next scheduled dose. If it is nearly time for the next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one, as this can cause a sudden spike in potassium or sodium levels and lead to stomach upset. Consistency is key for maintaining the correct urinary pH. If you find yourself missing doses frequently, talk to your doctor about strategies to help you remember.
Citric Acid itself does not cause fat-based weight gain, but sodium-based formulations (like sodium citrate/citric acid) can cause the body to retain water. This water retention may lead to a slight increase in scale weight and visible swelling in the ankles or hands. If you notice rapid weight gain (more than 2-3 pounds in a day) or significant swelling, contact your doctor, as this may indicate a strain on your heart or kidneys. Potassium-based versions are less likely to cause this effect. Maintaining a low-sodium diet can help minimize fluid retention during treatment.
Citric Acid has several significant drug interactions, most notably with aluminum-containing antacids, which can lead to toxicity. It also interacts with blood pressure medications like ACE inhibitors and certain diuretics that affect potassium levels. Because it changes the pH of your urine, it can also speed up or slow down the removal of other drugs from your body, such as aspirin or amphetamines. You must provide your doctor with a complete list of all medications and supplements you are taking. Never start a new over-the-counter medication without checking with your pharmacist first.
Yes, Citric Acid in combination with sodium or potassium citrate is widely available as a generic medication. Generic versions are typically much more affordable than brand-name products and are required by the FDA to be bioequivalent, meaning they work the same way in the body. You may find it as a liquid concentrate, powder, or tablet. When switching between brands or generics, always check the label to ensure the concentration and the type of salt (sodium vs. potassium) are the same. Your pharmacist can help you identify the most cost-effective generic option.
Other drugs with the same active ingredient (Citric Acid)
> Warning: Stop taking Citric Acid and call your doctor immediately if you experience any of the following:
Prolonged use of Citric Acid for urinary alkalization requires ongoing monitoring. Long-term effects can include:
There are currently no FDA black box warnings for Citric Acid or its common combinations (such as Shohl's solution). However, this does not imply the medication is without risk; it must be used strictly under medical supervision, especially in patients with heart or kidney disease.
Report any unusual symptoms to your healthcare provider. You may also report side effects to the FDA at 1-800-FDA-1088.
Patients on long-term Citric Acid therapy must undergo regular laboratory testing. This includes:
Citric Acid does not typically cause drowsiness or cognitive impairment. However, if a patient experiences lightheadedness due to electrolyte shifts or alkalosis, they should avoid driving until the symptoms resolve.
Alcohol should be used with caution. Alcohol can contribute to dehydration and metabolic changes that may counteract the benefits of Citric Acid in preventing kidney stones. Additionally, alcohol can increase the risk of gastric irritation when taken alongside Citric Acid.
Do not stop taking Citric Acid suddenly if you are being treated for chronic metabolic acidosis or recurrent kidney stones. Abrupt discontinuation can lead to a rapid drop in urinary pH, potentially triggering the formation of new stones. If the medication must be stopped, your doctor will likely monitor your blood and urine chemistry closely during the transition.
> Important: Discuss all your medical conditions, especially heart disease, kidney disease, or high blood pressure, with your healthcare provider before starting Citric Acid.
Citric Acid therapy can affect several laboratory results:
Mechanism of Interactions: Most interactions are either pharmacodynamic (additive effects on potassium/sodium levels) or related to urinary pH changes (altering the ionization and excretion of other drugs). The aluminum interaction is a unique absorption-based interaction where citrate chelates aluminum, making it more soluble and easily absorbed.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking. Carry a list of your medications at all times.
These conditions require a careful risk-benefit analysis by a physician:
Patients who have had a severe allergic reaction to any citrate salt (sodium, potassium, or calcium citrate) should avoid Citric Acid formulations. While Citric Acid itself is rarely the allergen, the complex formulations often share similar excipients, such as benzoate preservatives or specific citrus flavorings, which can trigger cross-reactions.
> Important: Your healthcare provider will evaluate your complete medical history, including your latest blood work, before prescribing Citric Acid.
Older adults are at a significantly higher risk for side effects.
In patients with mild to moderate renal impairment, Citric Acid can be used but requires frequent monitoring. In severe renal impairment (GFR < 30), the risk of metabolic alkalosis and hyperkalemia/hypernatremia is extremely high. Sodium citrate/citric acid is often preferred over potassium versions in these patients, provided they can tolerate the sodium load.
Patients with cirrhosis or severe liver failure may have impaired metabolism of citrate to bicarbonate. This can lead to a 'citrate gap' where the alkalizing effect is delayed or diminished. These patients also often have complex fluid balance issues (ascites), making the choice of sodium vs. potassium salts critical.
> Important: Special populations require individualized medical assessment and more frequent laboratory monitoring.
| Parameter | Value |
|---|---|
| Bioavailability | >95% (as citrate) |
| Protein Binding | Low (<5%) |
| Half-life | ~0.5 to 1.5 hours (plasma citrate) |
| Tmax | 0.5 to 1.0 hours |
| Metabolism | Hepatic (Krebs Cycle) |
| Excretion | Renal (<5% unchanged), Lungs (as CO2) |
Citric Acid is classified as a Urinary Alkalinizer and a Systemic Alkalinizer. It is often grouped with other electrolyte replenishers and buffering agents. In the context of H. pylori diagnostics, it is considered a Diagnostic Acidifying Agent.