From the FDA Drug Label
Directions: Adults - Take 1 tablet, dissolved in a glass of water, as needed. Maximum daily dose for adults upto 60 years of age is 24 tablets. Maximum daily dose for adults 60 years of age and older is 12 tablets. Warnings Do not use this product if you are on a sodium-restricted diet unless directed by a doctor. Do not take more than 24 tablets for adults up to 60 years of age (or 12 tablets for adults 60 years of age and older) in a 24-hour period nor use the maximum dosage for more than 2 weeks, except under the advice and supervision of a physician. Drug Facts Active Ingredient (in each tablet) Sodium bicarbonate 10 gr (650 mg)
The maximum daily dose of sodium bicarbonate PO is:
- 24 tablets (containing 650 mg or 10 gr of sodium bicarbonate each) for adults up to 60 years of age 1 1
- 12 tablets (containing 650 mg or 10 gr of sodium bicarbonate each) for adults 60 years of age and older 1 1 This translates to a maximum dose of 15,600 mg (or 156 gr) for adults up to 60 years of age and 7,800 mg (or 78 gr) for adults 60 years of age and older, per day 1.
From the Research
The maximum oral dose of sodium bicarbonate for adults is typically 1.13 mEq/kg per day, as this dose has been shown to be safe and effective in improving kidney and patient survival in patients with chronic kidney disease (CKD) stage 3-5, without advanced stages of chronic heart failure, as demonstrated in the study by 2. When using sodium bicarbonate, patients should be monitored for signs of electrolyte disturbances such as edema, shortness of breath, or muscle twitching, and therapy should be adjusted or discontinued if these adverse effects occur. Some key points to consider when prescribing sodium bicarbonate include:
- The dose should be individualized based on the patient's specific needs and medical condition.
- Patients with renal impairment, heart failure, or hypertension should be closely monitored for signs of sodium overload and electrolyte imbalances.
- Sodium bicarbonate should be taken with a full glass of water, and patients should wait at least 2 hours between doses.
- Long-term use of high-dose sodium bicarbonate can lead to metabolic alkalosis, electrolyte imbalances, and sodium overload, and patients should be regularly assessed for these potential adverse effects. It's also important to note that the use of sodium bicarbonate in patients with metabolic acidosis is a common practice, but its effectiveness in improving clinical outcomes or mortality rate is still a topic of debate, as discussed in the study by 3. However, the most recent and highest quality study, 2, provides strong evidence for the safety and efficacy of sodium bicarbonate therapy in patients with CKD stage 3-5, and should be prioritized when making treatment decisions.