How is Syrup Citralka prescribed?

Syrup Citralka Prescription Guidelines

**Syrup Citralka (potassium citrate) should be prescribed at a starting dose of 60 mEq/day divided into three doses (20 mEq three times daily) or four doses (15 mEq four times daily) with meals or within 30 minutes after meals for patients with severe hypocitraturia (urinary citrate <150 mg/day).** For patients with mild to moderate hypocitraturia (>150 mg/day), the starting dose should be 30 mEq/day (10 mEq three times daily with meals) 1.

Dosing Algorithm

1. Initial Assessment:

   • Determine severity of hypocitraturia:
     • Severe: <150 mg/day urinary citrate → 60 mEq/day
     • Mild-Moderate: >150 mg/day urinary citrate → 30 mEq/day

2. Administration Schedule:

   • For 60 mEq/day: Either 20 mEq three times daily OR 15 mEq four times daily
   • For 30 mEq/day: 10 mEq three times daily
   • Always administer with meals or within 30 minutes after meals or bedtime snack

3. Treatment Goals:

   • Restore normal urinary citrate (>320 mg/day, target close to 640 mg/day)
   • Increase urinary pH to 6.0-7.0

Monitoring Requirements

• Measure 24-hour urinary citrate and/or urinary pH:

  • At baseline
  • To determine adequacy of initial dosage
  • To evaluate effectiveness of any dosage change
  • Every 4 months during treatment

• Monitor the following every 4 months:

  • Serum electrolytes (sodium, potassium, chloride, carbon dioxide)
  • Serum creatinine
  • Complete blood count

Important Precautions

• Doses greater than 100 mEq/day have not been studied and should be avoided 1
• Treatment should be discontinued if:
  • Hyperkalemia develops
  • Significant rise in serum creatinine occurs
  • Significant fall in blood hematocrit or hemoglobin occurs

Lifestyle Modifications

Treatment with Syrup Citralka should be accompanied by:

• Limited salt intake (avoid foods with high salt content and added table salt)
• Increased fluid intake (urine volume should be at least 2 liters per day)

Dosage Adjustments

Dosage adjustments should be based on 24-hour urinary citrate and/or pH measurements to achieve the target urinary citrate level and pH. The dose should be titrated to achieve the therapeutic goals while monitoring for adverse effects.

This prescription approach ensures proper dosing of Syrup Citralka based on the severity of hypocitraturia, with appropriate monitoring to maintain efficacy and safety throughout treatment.