Noston Dosage/Direction for Use

In patients with severe hypocitraturia (urinary citrate of less than 150 mg/day), therapy should be initiated at a dosage of 60 mEq/day (20 mEq three times/day or 15 mEq four times/day) with meals or within 30 minutes after meals or bedtime snack. In patients with mild-moderate hypocitraturia (>150 mg/day), Potassium Citrate should be initiated at a dosage of 30 mEq/day (10 mEq three times/day with meals). Twenty-four hour urinary citrate and/or urinary pH measurements should be used to determine the adequacy of the initial dosage and to evaluate the effectiveness of any dosage change. In addition, urinary citrate and/or pH should be measured every four months.
Treatment with Potassium Citrate should be added to a regimen that limits salt intake (avoidance of foods with high salt content and of added salt at the table) and encourages high fluid intake (urine volume should be at least two liters per day). The objective of treatment with Potassium Citrate is to provide potassium citrate in sufficient dosage to restore normal urinary citrate (greater than 320 mg/day and as close to the normal mean of 640 mg/day as possible), and to increase urinary pH to a level of 6.0 to 7.0.
Doses of Potassium Citrate greater than 100 mEq/day have not been studied and should be avoided.
Serum electrolytes (Sodium, Potassium, Chloride and Carbon Dioxide), serum creatinine, and complete blood count should be monitored every four months.
Treatment should be discontinued if there is hyperkalemia, a significant rise in serum creatinine, or a significant fall in blood hematocrit or hemoglobin.
Use in children: Safety and effectiveness in children has not been established.