Potassium Citrate

What is potassium citrate?

Potassium citrate (CitraVet®) is used in dogs and cats to increase urine pH and prevent the formation of calcium oxalate bladder stones, uric acid bladder stones, and kidney stones. It may also be used in patients with kidney disease to treat low potassium levels and to prevent the blood and urine from becoming too acidic.

This drug is prescribed for use in dogs and cats. It may also be prescribed off-label to rabbits and small mammals. Often a human formulation is prescribed off-label for use in pets. Several generic veterinary versions are available without a prescription (over the counter). 

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

Most formulations of potassium citrate have not been reviewed by the U.S. Food and Drug Administration (FDA) for safety or effectiveness before they are sold to the public. Manufacturers of non-drug health products must ensure their products are safe and labeled accurately. The FDA requires that these non-pharmaceuticals contain a disclaimer that says, “This product is not intended to diagnose, treat, cure or prevent any disease.” Health Canada licenses “veterinary health products” after reviewing safety, efficacy, and manufacturing information provided by the manufacturer. These products are not tested by Health Canada. 

Your veterinarian is the best source of information about the safety of non-drug health products in pets.  

How do I give my pet potassium citrate?

• Potassium citrate is given orally. 
• Oral formats include tablets, granules, syrups, and chewable tablets.
• Potassium citrate may be given with or without food.
• Follow your veterinarian’s directions and measure liquid forms of this medication carefully.
• For treatment of fever in horses, potassium citrate may be given for up to 3 days in duration. 
• Potassium citrate should not be given more frequently than every 12 hours due to its potential to increase blood clotting times.

This medication should take effect within 1–2 hours; however, effects may not be noted outwardly, so laboratory tests may be needed to evaluate this medication’s effectiveness. 

What if I miss giving my pet the medication?

If you miss a dose of potassium citrate, arrange to have it given as soon as you can, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once. 

Are there any potential side effects from potassium citrate?

Potassium citrate may cause the following side effects:

• Vomiting and diarrhea
• Nausea

The following reactions are rare, but if they occur, contact your veterinarian immediately:

• Muscle weakness, collapse, and/or low energy level (symptoms of high levels of potassium in the blood)
• Stomach or esophageal ulceration

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of the treatment and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This short-acting medication should stop working after 6–12 hours, although effects can be longer in pets with liver or kidney disease. 

Are there any risk factors for this medication? 

DO NOT USE potassium citrate in:

• Pets that are allergic to it
• Pets with high levels of potassium in their blood (hyperkalemia)
• Pets with a condition that puts them at risk for hyperkalemia, such as Addison’s disease, severe dehydration, severe kidney disease, or uncontrolled diabetes
• Pets with aluminum toxicity, heart failure, or urinary tract infections associated with calcium or struvite bladder stones
• Pets with stomach or esophageal ulcers
• Pets with serious gastrointestinal (GI) tract conditions

USE WITH CAUTION in:

• Pets with chronic diarrhea
• Pets with kidney problems that cause high levels of acids in the blood

Are there any drug interactions I should be aware of?

Certain medications should NOT BE USED with potassium citrate, including:

• Ammonium Chloride
• Chlorpheniramine
• Hydroxyzine
• Hyoscyamine
• Irbesartan
• Meclizine
• Methenamine
• Methylene Blue
• Mexiletine
• Oxybutynin
• Telmisartan
• Triamterene
• Trilostane
• Trimeprazine/Prednisolone

Certain medications should be used WITH CAUTION when given with potassium citrate, including:

• Aspirin
• Ciprofloxacin
• Danofloxacin
• Enalapril
• Enrofloxacin
• Ephedrine
• Heparin
• Ipratropium
• Marbofloxacin
• Methionine
• Methylphenidate
• Minocycline
• Mycophenolate
• Orbifloxacin
• Oxytetracycline
• Phenylpropanolamine
• Pradofloxacin
• Tetracycline
• Tripelennamine

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Baseline blood work and urinalysis are recommended to assess your pet's general health before starting this medication. 
• Follow-up blood work and urinalysis are recommended to evaluate the urine pH and blood levels in your pet. Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects. 
• At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue the medication and contact your veterinarian. 

How do I store potassium citrate?

• Store potassium citrate in the original container at room temperature, between 59°F and 86°F (15°C and 30°C), and protect from light.
• Ensure potassium citrate is tightly sealed and stored in a cabinet to avoid accidental ingestion.
• Keep the container out of reach of children and pets. 

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.