level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.sotalolMonitor Closely (1)sodium citrate/citric acid decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.strontium ranelateMinor (1)sodium citrate/citric acid decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hr when possible.sulfasalazineMinor (1)sodium citrate/citric acid, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).tetracyclineSerious - Use Alternative (1)sodium citrate/citric acid decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.tiludronateMonitor Closely (1)sodium citrate/citric acid decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.timololMonitor Closely (1)sodium citrate/citric acid decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.tolbutamideMonitor Closely (1)sodium citrate/citric acid will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.trandolaprilMonitor Closely (1)sodium citrate/citric acid decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.ursodiolMonitor Closely (1)sodium citrate/citric acid decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.willow barkMinor (1)sodium citrate/citric acid, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).zoledronic acidMonitor Closely (1)sodium citrate/citric acid decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours. Frequency Not Defined Diarrhea Nausea Tetany Metabolic alkalosis Vomiting Stomach pain Fluid retention Contraindications Hypersensitivity to drug or component of the formulation Severe renal impairment, oliguria, anuria, azotemia, acute dehydration, untreated Addison disease, adynamia episodica hereditaria, heat cramp, hyperkalemia, severe myocardial damage, sodium-restricted diet Cautions Use with caution in toxemia of pregnancy Contains sodium; use caution in patients with peripheral or pulmonary edema, severe renal impairment, hypertension, or heart failure Conversion to bicarbonate may be impaired; use caution in shock, severely ill, or hepatic failure Do not dilute in tomato juice Pregnancy Category: C Lactation: consult physicianPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Alkalinizes urine; citrate binds with urinary calcium Pharmacokinetics Metabolism: Oxidized to sodium bicarbonate Excretion: Urine BRAND FORM. UNIT PRICE PILL IMAGE Oracit oral- 490-640 mg/5 mL solutionOracit oral- 490-640 mg/5 mL solutionOracit oral- 490-640 mg/5 mL solutionCytra-2 oral- 500-334 mg/5 mL solutionsodium citrate-citric acid oral- 500-334 mg/5 mL solutionsodium citrate-citric acid oral- 500-334 mg/5 mL solutionCopyright © 2010 First DataBank, Inc.Print Patient Educationsodium citrate-citric acid oral CITRIC ACID/SODIUM CITRATE - ORAL (SIT-rik AS-id/SOE-dee-um SI-trate) COMMON BRAND NAME(S): Bicitra, Cytra-2, Oracit, Shohl's USES: This medication is used to make the urine less acidic. Urine that is less acidic helps the kidneys get rid of uric acid, helping to prevent gout and certain types of kidney stones (urate). This medication can also prevent and treat certain metabolic problems (acidosis) caused by kidney disease.Citric acid and citrate salts (which contain potassium and sodium) belong to a class of drugs known as urinary alkalinizers. Because some conditions require you to limit your intake of potassium and sodium, your doctor's choice of product may depend on how much potassium and sodium you can take. HOW TO USE: Shake the container well before each dose. Take this medication by mouth as directed by your doctor, usually 4 times a day. To help prevent diarrhea and stomach upset, take each dose after a meal, and mix your prescribed dose of medication in a full glass (4 to 8 ounces or 120 to 240 milliliters) of cold water or juice just before taking, or take as directed by your doctor. Drink the entire mixture slowly. Ask your doctor or pharmacist for further instructions.The liquid form of this medication must be mixed with at least 4 ounces (120 milliliters) of water or juice before taking.Refrigerating the mixture before drinking may improve the taste. Drink more water or juice after taking this medication unless otherwise directed by your doctor.Dosage is based on your medical condition and response to treatment.Take this medication as prescribed. Do not increase your dose or take this more often without your doctor's approval. Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.While taking this medication, you may need to test the pH (acidity) of your urine using special paper. The pH will help determine the proper dose. Consult your doctor or pharmacist for more information. SIDE EFFECTS: Nausea, vomiting, diarrhea, and stomach pain may occur. Mixing the medication with water or juice, taking it after meals, and drinking more fluids will help prevent these side effects. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: swelling of the hands/ankles/feet, tingling/numbness of the hands/feet, weakness, fast/slow/irregular heartbeat, mental/mood changes (such as confusion, restlessness), muscle spasms, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. PRECAUTIONS: Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a sodium-restricted diet, mineral imbalance (such as high sodium or low calcium levels), extra fluid in the body (such as swelling of arms/legs, fluid in the lungs), high blood pressure, heart problems (such as irregular heartbeat, heart failure), kidney disease.Liquid forms of this product may contain sugar. Caution is advised if you have diabetes. Ask your doctor or pharmacist about using this product safely.Because this medication contains salt (sodium), tell your doctor if you are on a salt-restricted diet.During pregnancy, this medication should be used only when clearly needed. This medication may worsen high blood pressure during pregnancy (toxemia of pregnancy). Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding. DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: antacids that contain aluminum, aspirin and other salicylates (such as salsalate), lithium, quinidine.If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details. OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: muscle spasms, seizures. NOTES: Do not share this medication with others.Lab and/or medical tests (such as sodium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details. MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up. STORAGE: Store at room temperature away from heat, light, and moisture. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company. Information last revised May 2023. Copyright(c) 2023 First Databank, Inc. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs. FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions Tier Description 1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs. 2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. NC NOT COVERED – Drugs that are not covered by the plan. Code Definition PA Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires