Potassium citrate for kidney stones

In this article:

• How does potassium citrate work for kidney stones?
• Potassium citrate dosage for kidney stones
• How long should you take potassium citrate for kidney stones?
• Benefits and drawbacks of potassium citrate for kidney stones
• Potassium citrate side effects, warnings, and interactions with other kidney stone drugs
• Potassium citrate vs. other treatments for kidney stones
• How to save on potassium citrate

In this article

• How does potassium citrate work for kidney stones?
• Potassium citrate dosage for kidney stones
• How long should you take potassium citrate for kidney stones?
• Benefits and drawbacks of potassium citrate for kidney stones
• Potassium citrate side effects, warnings, and interactions with other kidney stone drugs
• Potassium citrate vs. other treatments for kidney stones
• How to save on potassium citrate

Kidney stones are a common condition that can cause intense pain, which can send people to the emergency room. Healthcare providers sometimes recommend potassium citrate for kidney stones and renal tubular acidosis, a condition that affects the kidneys’ ability to remove acidic substances from the blood properly. Although potassium citrate is available over the counter as a supplement, it’s also available as a prescription medication. Here’s what you can expect if your healthcare provider writes you a prescription for potassium citrate for kidney stones.  

How does potassium citrate work for kidney stones?

Potassium citrate is made of the element potassium, bound to a citrate molecule. It works by preventing the formation of kidney stones. Among the different types of kidney stones, potassium citrate works on calcium oxalate and uric acid stones. The citrate molecule binds to calcium, which reduces the likelihood of forming calcium oxalate crystals. Potassium citrate also increases the pH of urine, making the stones less likely to form. 

Research estimates that about 1 in 3 people with kidney stones have low amounts of citrate in their urine (hypocitraturia)—one of the contributing factors to the formation of kidney stones. People who have hypocitraturia and take prescription potassium citrate have a 96% reduction in kidney stone formation. Potassium citrate treatment can prevent kidney stones from becoming larger and reduce the risk of future kidney stones. 

Potassium citrate dosage for kidney stones

According to its drug label, potassium citrate comes in 5, 10, and 15 milliequivalents (mEq). These are equal to 540 mg, 1,080 mg, and 1,620 mg of potassium citrate, respectively. The dose your healthcare provider may recommend depends on factors such as your diet and lifestyle, as well as your urine citrate levels. 

People with mild to moderate hypocitraturia are recommended to start at 30 mEq per day as a 15 mEq tablet twice per day with meals or a 10 mEq tablet three times per day with meals. Your healthcare provider may measure your urine citrate levels after 24 hours to determine whether your dosage needs any adjustments. 

People with severe hypocitraturia are recommended to start at 60 mEq per day as two 15 mEq tablets (30 mEq) twice a day with meals or two 10 mEq tablets (20 mEq) three times a day with meals. Your urine citrate levels will need to be measured after 24 hours to see if your dose needs to change, and your urinary citrate and pH may need to be measured every four months.

According to the drug label, doses of 100 mEq per day have not been studied and should be avoided. Healthcare providers will recommend the ideal dosage to get urine citrate levels back to normal. 

How long should you take potassium citrate for kidney stones?

Depending on the type of kidney stone and your medical history, your healthcare provider may recommend taking potassium citrate for months or years until you are no longer at risk for kidney stones. 

In patients who took potassium citrate for one to four years, kidney stone formation decreased in 98% of patients, and almost 80% of patients did not have a recurrence of kidney stones. 

Benefits and drawbacks of potassium citrate for kidney stones

Taking potassium citrate has several benefits for people with certain types of kidney stones. Because of how it works, potassium citrate is best for people with calcium oxalate and uric acid stones. People with gout may also take potassium citrate because it reduces uric acid crystal formation in the body, which causes painful gout attacks—although gout is not an FDA-approved use for prescription potassium citrate. Potassium citrate has also been found in clinical studies to reduce the recurrence of kidney stones when taken long-term.

However, potassium citrate may not be the best option for everyone. It’s not effective for all types of kidney stones, such as calcium phosphate stones or struvite stones. Another drawback is its potential for interactions with other medications because it increases the amount of potassium in the body. People taking medications that increase potassium levels, such as high blood pressure ACE inhibitor medications (such as benazepril) or ARBs (such as losartan), may be at risk of high potassium when taking both these medications together. 

“If a kidney stone is getting smaller or passing, you will likely feel less pain, especially in your lower back or side. If you were experiencing burning, cloudy, or bloody urine, those symptoms should start to clear up,” says Edmond Hakimi, internal medicine physician and medical director at Wellbridge in Calverton, New York. He says that you may even notice small grains or fragments in your urine, which means your body is breaking down the stone and flushing it out. 

You’ll know potassium citrate is working when you experience fewer kidney stones, according to Jen Hernandez, registered dietitian and founder of Plant-Powered Kidneys. “Potassium citrate will not reduce or shrink a calcium kidney stone, but it will prevent them,” she explains. 

Healthcare professionals may also order testing or imaging to make sure your treatment is working. “For people taking potassium citrate, a urine test can show whether their citrate levels have improved and their urine pH is more balanced—both good signs that the treatment is working,” Dr. Hakimi explains. Healthcare providers may also use an ultrasound or CT scan to check on the status of your kidney stones.

It’s important to remember that these improvements may not be immediate and can vary depending on the size and type of stones and an individual’s response to the medication. Regular follow-up appointments with your healthcare provider are crucial to monitor your progress and make any necessary adjustments to your treatment plan. 

Potassium citrate side effects, warnings, and interactions with other kidney stone drugs

Potassium citrate side effects 

Potassium citrate is generally safe when taken as prescribed, but there are some side effects and interactions to consider. Digestion-related symptoms are common, such as:

• Abdominal discomfort
• Nausea and vomiting
• Diarrhea
• Loose stools

“Most people tolerate potassium citrate well, but it can cause digestive discomfort, especially if taken on an empty stomach. Taking it with food and a full glass of water can help prevent these issues,” Dr. Hakimi says. 

People taking potassium citrate may also see what looks like a shell of a pill or tablet in their stool. This is normal, and the potassium citrate contents would have already been absorbed by the body. 

Severe side effects of potassium citrate include severe vomiting, abdominal pain, and digestive system bleeding. If you experience any of these symptoms, stop taking the medication immediately and call your healthcare provider or get emergency medical help. 

Potassium citrate warnings

“One of the biggest things to watch for with potassium citrate is too much potassium (hyperkalemia), which can be dangerous for people with kidney disease, heart problems, or certain medications,” Dr. Hakimi says. People who have hyperkalemia should not take potassium citrate because it can increase the risk of a heart attack and cause heart palpitations, muscle weakness, and tingling. 

People who have severe kidney problems, stomach ulcers (peptic ulcer disease), a urinary tract infection, or intestinal obstructions should not take potassium citrate. 

There’s not enough research on whether potassium citrate can cause harm in people who are pregnant or breastfeeding or in children. 

Potassium citrate interactions

Potassium citrate interacts with drugs that increase potassium or slow down digestion. Common medications that can interact with potassium citrate include: 

• Spironolactone
• Lisinopril and other ACE inhibitors
• Losartan and other ARBs
• Imodium (loperamide)
• GLP-1 medications such as Ozempic (semaglutide)

Medications that increase potassium, such as potassium-sparing diuretics, NSAIDs, angiotensin receptor blockers (ARBs), and angiotensin-converting enzyme (ACE) inhibitors, can increase the risk of hyperkalemia. 

Medications that slow digestion, such as antacids, antidiarrheal drugs, and anticholinergic drugs, can increase the chances of potassium citrate irritating the digestive system. 

Dr. Hakimi says medications that increase the pH of urine, such as antacids or bicarbonate medications, can also interact with potassium citrate. If urine is too high in pH, it can also lead to other types of kidney stones. “If you are taking other medications, it’s always a good idea to check with your doctor to ensure potassium citrate will not interfere with them,” Dr. Hakimi says. 

Potassium citrate vs. other treatments for kidney stones

Potassium citrate is one of many options for kidney stone treatment. It’s often recommended for calcium oxalate or uric acid stones. Other treatments for kidney stones include: 

• Diuretics, medications that can help manage blood pressure and treat calcium stones
• Allopurinol, a medication for gout and uric acid stones
• Antibiotics for struvite stones (stones caused by bacterial infection), such as Lithostat (acetohydroxamic acid)
• Thiola (tiopronin), a medication used for cystine stones
• Pain relievers, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, for pain related to passing a kidney stone

In addition to these medications, other common treatments for kidney stones may include lifestyle changes, such as drinking plenty of fluids; avoiding too much salt, added sugar, and animal protein; and getting in enough calcium and fruits and vegetables, according to Melanie Betz, registered dietitian and founder of The Kidney Dietitian in Chicago, Illinois. “These recommendations should be based on your 24-hour urine test results,” she says. 

Your healthcare provider may recommend another treatment based on your medical history, the type of kidney stones you have, and your symptoms. 

How to save on potassium citrate

Potassium citrate costs about $288 per bottle of 60 extended-release tablets without insurance. Your SingleCare Prescription Discount Card provides access to coupons that can lower the cost of potassium citrate to $29.