Recently, your store has helped a lot to my mother. Do you want to know how? My mother had serious problems with one of her elbow joints, and she needed a powerful antiinfective treatment. Her doctor prescribed clindamycin capsules. He said that  this is a rather new and extremely effective remedy. CLINDAMYCIN, known in the market under name of Cleocin®, is a new generation antibiotic used to cure serious blood, bone and joints, respiratory, urinary tract infections, etc.
The doctor said, that this antibiotic would stop the inflammation process in a week, but the course had to be two weeks. It is recommended to take the full course of medicine as prescribed, and not to stop taking the medicine even if you feel better. We thoroughly obeyed all prescriber’s advice, and mother was cured quickly!
It may be useful to know that, before buying the medicine, we made tests to see if my mother was allergic to clindamycin or lincomycin. Also, I was told that very often this medicine irritates stomach and throat, so it is best to take clindamycin 1 hour before or 2 hours after eating and drink plenty of water. Also, our doctor gave mother a useful advice not to lie down for 1—2 hours after taking clindamycin to avoid throat irritation and pain.

I am a swimmer and I visit swimming pool thrice a week. Last month I must have missed something about my hygienic procedures in our swimming pool, and I caught a very annoying dermatological bacterial infection. I made necessary labs, and my doctor prescribed me Cipro (Ciprofloxacin), it is an antibiotic.
I asked if I needed a prescription to buy Cipro (Ciprofloxacin) in an online drug store, and the doctor said no. So I ordered the pills, and they came in no time. I was delighted with your service and quite appropriate prices.
My doctor said that Ciprofloxacin is one of the best solutions in my case. Cipro is a new, advanced antibiotic which belongs to fluoroquinolones class. Cipro is specially designed to fight the wide range of bacteria.
As for the results, I must say that Cipro is a pleasant and quickly working medicine. The only limitation was that before taking this antibiotic, I had to stop taking one of my other pills – a nonsteroidal anti-inflammatory drug based on ibuprofen, which I used to stop pain in my joints.
Will you ask me what side effects I experienced while taking Cipro? Practically none, except for some numbness in my joints. All in all, I liked this medicine.

Why many people are displeased with the action of medicines? I myself am a doctor, so I can tell you that quite clear. For example, let’s talk about antibiotics. Nowadays, you can buy rather powerful antibiotics without a prescription in some online store like yours! Many people who see that they have some infection (ache, inflammation or something) are guided by other people’s sayings like “I have bought a very mighty antibiotic, it kills literally everything!” And so those who hear such declarations, go and buy this “mighty antibiotic” and begin taking it. They believe that they will be cured in no time! Yet, in 60 to 80 % of cases the medicine does not work. Why?
That’s because most people do not care to think that there are bacterial infections, virus infections and yeast infections. An antibiotic which is good with viruses won’t be good for bacteria, etc.
For example, me and my neighbour were recently both buying CEFACLOR (Generic Ceclor) from your store. I used it to treat a dermatological infection which my son seemed to have caught in the swimming pool. It is a really good cephalosporin antibiotic used to treat bacterial infections. The CEFACLOR I bought here was of supreme quality, and my son got cured quickly. But my neighbour told me that this medicine was awful and something was evidently wrong with it. Questioning her, I found out that she wanted to cure flu with the help of Ceclor! She did not know that this medicine will not treat infections caused by viruses…
So I am telling you, dear customers, if you are not specialists, do not make “self-prescriptions” or listen to other diletant advice. Do consult with the doctors, and everything will be OK!

CECLOR – 250mg × 80 tablet

$2.52

$201.95

Buy Now!

Generic Name: cyclophosphamide (oral/injection) (sye kloe FOSS fah mide)
Brand Names: Cytoxan, Cytoxan Lyophilized, Neosar

What is cyclophosphamide?

Cyclophosphamide is a cancer (chemotherapeutic) medication. Cyclophosphamide interferes with the growth of cancer cells and slows their growth and spread in the body.

Cyclophosphamide is used to treat several types of cancer. Cyclophosphamide is also used to treat certain cases of nephrotic syndrome (kidney disease) in children.

Cyclophosphamide may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about cyclophosphamide?

Cyclophosphamide should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Serious side effects have been reported with the use of cyclophosphamide including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection such as fever; chills, or sore throat); bladder problems; and others. Talk to your doctor about the possible side effects from treatment with cyclophosphamide.

In some cases, secondary cancers have been reported to occur during and following treatment with cyclophosphamide. Talk to your doctor about the risks and benefits of this medication.

What should I discuss with my healthcare provider before taking cyclophosphamide?

Before taking cyclophosphamide, tell your doctor if you

• have an infection or have had recent vaccinations;

• have a low level of white blood cells or platelets (detected by blood tests);

• have bone marrow problems;

• have been previously treated with x-ray therapy;

• have been previously treated with other chemotherapy medicines (i.e., Alkeran, CeeNU, Leukeran, Myleran, and others);

• have had your adrenal glands removed;

• need to have surgery;

• have any unhealed wounds;

• have a history of heart disease;

• have liver disease; or
• have kidney disease.

You may not be able to take cyclophosphamide, or you may require a dosage adjustment or special monitoring during treatment if you have any of the conditions listed above.

Cyclophosphamide is in the FDA pregnancy category D. This means that cyclophosphamide is known to be harmful to an unborn baby. Cyclophosphamide may also affect egg production in women and sperm production in men. Do not take cyclophosphamide without first talking to your doctor if you are pregnant or could become pregnant during treatment. Use of cyclophosphamide by the father prior to conception has also been associated with birth defects. Contraceptive measures are recommended during treatment with cyclophosphamide for both men and women. Cyclophosphamide passes into breast milk and may harm a nursing infant. Do not take cyclophosphamide without first talking to your doctor if you are breast feeding a baby.

How should I take cyclophosphamide?

Take cyclophosphamide exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse or pharmacist to explain them to you.

Take each oral dose with a large glass of water.

To avoid urinary bladder irritation during treatment with either oral or injectable cyclophosphamide, drink plenty of fluid during treatment and for 48 hours following treatment, usually 7 to 12 cups (3 quarts) per day, and empty your bladder frequently, every 2 to 3 hours including once during the night.

Taking oral cyclophosphamide on an empty stomach is preferable. If severe stomach upset occurs, take cyclophosphamide with food. Continue to take cyclophosphamide even if nausea and vomiting occurs. Do not stop taking the medicine without first talking to your doctor. Check with your doctor if vomiting occurs shortly after taking a dose of cyclophosphamide. Your doctor may want you to take another dose, but do not do this without checking with your doctor first.

If you are taking a liquid form of cyclophosphamide by mouth, use a dose measuring spoon or cup to ensure that you get the correct dose.

Injectable cyclophosphamide should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Your doctor will determine the correct amount and frequency of treatment with cyclophosphamide depending upon the type of cancer being treated and other factors. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with cyclophosphamide to monitor progress and side effects.

Store cyclophosphamide oral tablets at or below 77 degrees Fahrenheit (25 degrees Celsius). Brief exposures to 86 degrees Fahrenheit (30 degrees Celsius) are permitted but the tablets should be protected from temperatures above 86 degrees Fahrenheit. Your healthcare provider will store cyclophosphamide injection as directed by the manufacturer. If you are storing cyclophosphamide injection at home, follow the directions provided by your healthcare provider. Store cyclophosphamide oral liquid in a glass container in the refrigerator for up to 14 days.

What happens if I miss a dose?

Take the missed oral dose as soon as you remember. If it is almost time for the next dose, skip the dose you missed and take only the next regularly scheduled dose as directed. Do not take a double dose of this medication.

Contact your doctor if you miss a dose of cyclophosphamide injection.

What happens if I overdose?

Seek emergency medical attention.

Symptoms of a cyclophosphamide overdose may include decreased bone marrow function, infection, and heart problems.

What should I avoid while taking cyclophosphamide?

Cyclophosphamide can lower the activity of the immune system making you more susceptible to infection. Avoid contact with people who have colds, the flu, or other contagious illnesses. In addition, do not receive vaccines that contain a live strain of the virus (e.g., live oral polio vaccine) and avoid contact with individuals who have recently been vaccinated with a live virus.

Cyclophosphamide side effects

If you experience any of the following serious side effects, seek emergency medical attention or contact your doctor immediately:

• an allergic reaction (shortness of breath; closing of your throat; difficulty breathing; swelling of your lips, face, or tongue; or hives);

• blood in the urine;

• black or tarry stools;

• painful or difficult urination;

• signs of infection such as fever; chills, or sore throat;

• jaundice (yellowing of the skin or eyes);

• lower back or side pain;

• chest pain, difficulty breathing, or swelling;

• unusual bleeding or bruising; or

• changes in bone marrow function (detected by blood tests).

Other less serious side effects may be more likely to occur. Talk to your doctor if you experience

• nausea, vomiting, or decreased appetite;

• mouth sores;

• abdominal pain;

• diarrhea;

• temporary hair loss;

• temporary or permanent sterility;

• rash;

• changes in skin color; or

• changes in nails.

In some cases, secondary cancers have been reported to occur during and following treatment with cyclophosphamide. Talk to your doctor about the risks and benefits of this medication.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect cyclophosphamide?

Before taking cyclophosphamide, tell your doctor if you are taking any other medicines, especially any of the following:

• phenobarbital (Luminal, Solfoton);

• allopurinol (Zyloprim);

• digoxin (Lanoxin);

• warfarin (Coumadin);

• a thiazide diuretic (water pill) such as chlorothiazide (Diuril), hydrochlorothiazide (HCTZ, HydroDiuril, Esidrix, Microzide, Oretic), chlorthalidone (Hygroton, Thalitone), indapamide (Lozol), metolazone (Mykrox, Zaroxolyn), and others; or

• another chemotherapy medicine.

You may require a dosage adjustment or special monitoring during treatment if you are taking any of the medicines listed above.

Do not receive “live” vaccines during treatment with cyclophosphamide. Administration of a live vaccine may be dangerous during treatment with cyclophosphamide.

Other drugs may interact with cyclophosphamide. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including herbal products, during treatment with cyclophosphamide.

Where can I get more information?

• Your pharmacist has additional information about cyclophosphamide written for health professionals that you may read.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.06. Revision Date: 4/12/2009 4:22:26 PM.

Generic Name: citric acid and sodium citrate (SIT rik AS id and SOE dee um SIT rayt)
Brand Names: Bicitra, Cytra-2, Liqui-Dual Citra, Oracit

What is Cytra-2 (citric acid and sodium citrate)?

Citric acid and sodium citrate are both alkalinizing agents that make the urine less acidic.

The combination of citric acid and sodium citrate is used to prevent gout or kidney stones, or metabolic acidosis in people with kidney problems.

Citric acid and sodium citrate may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Cytra-2 (citric acid and sodium citrate)?

You should not use this medication if you have kidney failure, severe heart damage (such as from a prior heart attack), Addison’s disease (an adrenal gland disorder), high levels of potassium in your blood (hyperkalemia), or if you are severely dehydrated or have heat cramps.

Before you take citric acid and sodium citrate, tell your doctor about all your medical conditions, especially kidney disease, heart disease, high blood pressure, a history of heart attack, urinary problems, swelling (edema), or chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

Also tell your doctor about all other medications you use, including over-the-counter medications and household remedies.

Citric acid and sodium citrate should be taken after meals to help prevent stomach or intestinal side effects.

The liquid medicine should be mixed with water or juice. Drink plenty of liquids while you are taking citric acid and sodium citrate. Your treatment may include a special diet. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

Avoid using antacids without your doctor’s advice, including household baking soda (sodium bicarbonate). Antacids that contain aluminum or sodium can interact with citric acid and sodium citrate, causing a serious electrolyte imbalance or aluminum toxicity.

Avoid eating foods that are high in salt, or using extra table salt on your meals.

To be sure citric acid and sodium citrate is helping your condition, your blood and urine may need to be tested often. Follow your doctor’s instructions carefully and do not miss any scheduled appointments.

Serious side effects of citric acid and sodium citrate include muscle twitching or cramps, swelling or weight gain, weakness, mood changes, rapid and shallow breathing, fast heart rate, restless feeling, black or bloody stools, severe diarrhea, or seizure (convulsions).

What should I discuss with my healthcare provider before taking Cytra-2 (citric acid and sodium citrate)?

You should not use this medication if you are allergic to it, or if you have:

• kidney failure;

• severe heart damage (such as from a prior heart attack);

• Addison’s disease (an adrenal gland disorder);

• high levels of potassium in your blood (hyperkalemia); or

• if you are severely dehydrated or have heat cramps.

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take citric acid and sodium citrate, tell your doctor if you have:

• kidney disease;

• congestive heart failure, enlarged heart, or history of heart attack;

• other heart disease or high blood pressure;

• low levels of calcium in your blood (hypocalcemia);

• a urinary tract infection;

• toxemia of pregnancy;

• urination problems (or if you are unable to urinate);

• swelling of your hands or feet, or in your lungs (pulmonary edema); or

• chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

It is not known whether this medication is harmful to an unborn baby. Before taking citric acid and sodium citrate, Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether citric acid and sodium citrate passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Cytra-2 (citric acid and sodium citrate)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Citric acid and sodium citrate should be taken after meals to help prevent stomach or intestinal side effects. You may also need to take the medicine at bedtime. Follow your doctor’s instructions.

Shake the oral solution (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. The liquid medicine should be mixed with at lease 4 ounces of water or juice. Drink this mixture slowly and then add a little more water to the same glass, swirl gently and drink right away. You may chill the mixed medicine to make it taste better, but do not allow it to freeze.

Drink plenty of liquids while you are taking citric acid and sodium citrate.

Your treatment may include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

To be sure citric acid and sodium citrate is helping your condition, your blood and urine may need to be tested often. Follow your doctor’s instructions carefully and do not miss any scheduled appointments.

Store citric acid and sodium citrate at room temperature away from moisture, heat, or freezing. Keep the medication in a closed container.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If you are more than 2 hours late in taking your medicine, wait until your next regularly scheduled time to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include muscle spasms or seizure (convulsions).

What should I avoid while taking Cytra-2 (citric acid and sodium citrate)?

Avoid using antacids without your doctor’s advice, including household baking soda (sodium bicarbonate). Antacids that contain aluminum or sodium can interact with citric acid and sodium citrate, causing a serious electrolyte imbalance or aluminum toxicity.

Avoid eating foods that are high in salt, or using extra table salt on your meals.

It is very important to follow any diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

Cytra-2 (citric acid and sodium citrate) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• swelling, tingling, or numbness in your hands or feet;

• muscle twitching or pain, leg pain or cramps;

• unusual weakness, rapid and shallow breathing, fast or slow heart rate, dizziness, confusion, or mood changes;

• feeling restless, nervous, or irritable;

• black, bloody, or tarry stools;

• severe or ongoing diarrhea; or

• seizure (convulsions).

Less serious side effects may include:

• nausea, or vomiting, stomach pain;

• mild or occasional diarrhea; or

• mild stomach pain.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cytra-2 (citric acid and sodium citrate)?

The following drugs can interact with citric acid and sodium citrate. Tell your doctor if you are using any of these:

• lithium (Eskalith, LithoBid);

• methenamine (Hiprex, Mandelamine, Urex),

• quinidine (Quinaglute, Quinidex, Quin-Release);

• cold or allergy medicine (decongestants), diet pills, ADHD medication;

• a vitamin, mineral supplement, or medication that contains calcium;

• salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan’s Pills Extra Strength, Tricosal, and others; or

• an antacid that contains aluminum or sodium, including Alka-Seltzer, Maalox, Mylanta, Di-Gel, Gelusil, Alamag Plus, Rulox Plus, Tempo, and others.

This list is not complete and there may be other drugs that can interact with citric acid and sodium citrate. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about citric acid and sodium citrate.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.03. Revision Date: 11/17/2009 3:33:51 PM.

Generic Name: citric acid, potassium citrate, and sodium citrate (SIT rik AS id, poe TASS ee um, and SOE dee um SIT rayt)
Brand Names: Cytra-3, Polycitra, Polycitra-LC, Tricitrates

What is Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

Citric acid and sodium citrate are alkalinizing agents that make the urine less acidic.

Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

The combination of citric acid, potassium citrate, and sodium citrate is used to prevent gout or kidney stones, or metabolic acidosis in people with kidney problems.

Citric acid, potassium citrate, and sodium citrate may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

You should not use this medication if you have severe kidney disease, severe heart damage (such as from a prior heart attack), Addison’s disease (an adrenal gland disorder), high levels of potassium or sodium in your blood, or if you are severely dehydrated.

You should not take citric acid, potassium citrate, and sodium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Before you take citric acid, potassium citrate, and sodium citrate, tell your doctor about all your medical conditions, especially kidney disease, heart disease, high blood pressure, a history of heart attack, urinary problems, diabetes, swelling (edema), urination problems, stomach ulcer or chronic diarrhea (such as ulcerative colitis, Crohn’s disease), or if you are on a low-salt diet.

Also tell your doctor about all other medications you use, including antacids, heart or blood pressure medications, or a diuretic (water pill).

To be sure this medication is helping your condition, your blood and urine may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. Follow your doctor’s instructions carefully and do not miss any scheduled appointments.

Serious side effects of citric acid, potassium citrate, and sodium citrate include numbness or tingly feeling, swelling or rapid weight gain, muscle twitching or cramps, fast or slow heart rate, confusion, or mood changes, bloody or tarry stools, severe stomach pain, ongoing diarrhea, or seizure (convulsions).

What should I discuss with my healthcare provider before taking Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

You should not use this medication if you are allergic to it, or if you have:

• severe kidney disease;

• severe heart damage (such as from a prior heart attack);

• Addison’s disease (an adrenal gland disorder);

• high levels of potassium in your blood (hyperkalemia);

• high levels of sodium in your blood (hypernatremia); or

• if you are severely dehydrated.

You should not take citric acid, potassium citrate, and sodium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

If you have certain conditions, you may need a dose adjustment or special tests to safely take this medication. Before you take citric acid, potassium citrate, and sodium citrate, tell your doctor if you have:

• kidney disease;

• low levels of calcium in your blood (hypocalcemia);

• congestive heart failure, heart rhythm problems, or history of heart attack;

• other heart disease or high blood pressure;

• diabetes;

• a peptic ulcer in your stomach;

• swelling of your hands or feet, or in your lungs (pulmonary edema);

• toxemia of pregnancy;

• urination problems (or if you are unable to urinate);

• chronic diarrhea (such as irritable bowel disease, ulcerative colitis, Crohn’s disease); or

• if you are on a low-salt diet.

It is not known whether this medication is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether this medication passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Citric acid, potassium citrate, and sodium citrate should be taken after meals to help prevent stomach or intestinal side effects. You may also need to take the medicine at bedtime. Follow your doctor’s instructions.

Measure the liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The liquid medicine should be mixed with at lease 4 ounces of water or juice. Drink this mixture slowly and then add a little more water to the same glass, swirl gently and drink right away. You may chill the mixed medicine to make it taste better, but do not allow it to freeze. Your treatment may include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

To be sure this medication is helping your condition, your blood and urine may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. Follow your doctor’s instructions carefully and do not miss any scheduled appointments.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse. Store citric acid, potassium citrate, and sodium citrate at room temperature away from moisture, heat, or freezing. Keep the medication in a closed container.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If you are more than 2 hours late in taking your medicine, wait until your next scheduled time to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include muscle cramps or twitching, slow heart rate, and seizure (convulsions).

What should I avoid while taking Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

Avoid using antacids without your doctor’s advice, including household baking soda (sodium bicarbonate). Antacids that contain aluminum or sodium can interact with citric acid, potassium citrate, and sodium citrate, causing a serious electrolyte imbalance or aluminum toxicity.

Avoid taking potassium supplements or using other foods or products that contain potassium without first asking your doctor. Salt substitutes or low-salt dietary products often contain potassium. If you take certain products together you may accidentally get too much potassium. Read the label of any other medicine you are using to see if it contains potassium.

Avoid eating foods that are high in salt, or using extra table salt on your meals.

It is very important to follow any diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

Cytra-3 (citric acid, potassium citrate, and sodium citrate) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• swelling, rapid weight gain;

• numbness or tingly feeling in your hands or feet, or around your mouth;

• muscle twitching or pain, leg pain or cramps;

• fast, slow, or uneven heart rate;

• unusual weakness, rapid and shallow breathing, dizziness, confusion, or mood changes;

• feeling restless, nervous, or irritable;

• black, bloody, or tarry stools;

• coughing up blood or vomit that looks like coffee grounds;

• severe stomach pain, ongoing diarrhea or vomiting; or

• seizure (convulsions).

Less serious side effects may include:

• nausea, or vomiting, stomach pain;

• mild or occasional diarrhea; or

• mild stomach pain.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cytra-3 (citric acid, potassium citrate, and sodium citrate)?

The following drugs can interact with citric acid, potassium citrate, and sodium citrate. Tell your doctor if you are using any of these:

• eplerenone (Inspra);

• digoxin (digitalis, Lanoxin);

• drospirenone (Angelique, Yasmin, Yaz);

• lithium (Eskalith, LithoBid);

• quinidine (Quinaglute, Quinidex, Quin-Release);

• candesartan (Atacand), losartan (Cozaar, Hyzaar), valsartan (Diovan), or telmisartan (Micardis);

• cold or allergy medicine (decongestants), diet pills, ADHD medication;

• salicylates such as aspirin, Backache Relief Extra Strength, Novasal, Nuprin Backache Caplet, Doan’s Pills Extra Strength, Tricosal, and others;

• a vitamin, mineral supplement, or medication that contains potassium;

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik);

• a diuretic (water pill) such as amiloride (Midamor), spironolactone (Aldactone, Aldactazide), or triamterene (Dyrenium); or

• an antacid that contains aluminum or sodium, including Alka-Seltzer, Maalox, Mylanta, Di-Gel, Gelusil, Alamag Plus, Rulox Plus, Tempo, and others.

This list is not complete and there may be other drugs that can interact with citric acid, potassium citrate, and sodium citrate. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about citric acid, potassium citrate, and sodium citrate.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 2.01. Revision Date: 05/01/2009 10:10:34 AM.

Generic Name: citric acid and potassium citrate (SIT rik AS id and poe TASS ee um SIT rayt)
Brand Names: Cytra-K, Poly-Citra K Crystals, Polycitra-K

What is Cytra-K (citric acid and potassium citrate)?

Citric acid is an alkalinizing agent that make the urine less acidic.

Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

The combination of citric acid and potassium citrate is used to treat or prevent hypokalemia (low levels of potassium in the blood). Citric acid and potassium citrate is also used to treat digitalis overdose.

Citric acid and potassium citrate may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Cytra-K (citric acid and potassium citrate)?

You should not use this medication if you have kidney failure, a urinary tract infection, uncontrolled diabetes, a peptic ulcer in your stomach, Addison’s disease, severe burns or other tissue injury, if you are dehydrated, if you take certain diuretics (water pills), or if you have high levels of potassium in your blood (hyperkalemia).

You should not take citric acid and potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Avoid lying down for at least 30 minutes after you take this medication.

To be sure this medication is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Serious side effects of citric acid and potassium citrate include uneven heartbeat, muscle weakness or limp feeling, severe stomach pain, and numbness or tingling in your hands, feet, or around your mouth.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse.

What should I discuss with my healthcare provider before taking Cytra-K (citric acid and potassium citrate)?

You should not use this medication if you are allergic to it, or if you have certain conditions. Be sure your doctor knows if you have:

• high levels of potassium in your blood (hyperkalemia);

• a serious heart rhythm disorder called ventricular fibrillation;

• kidney failure with sodium loss;

• Addison’s disease (an adrenal gland disorder);

• a large tissue injury such as a severe burn; or

• if you are severely dehydrated.

You should not take citric acid and potassium citrate tablets if you have problems with your esophagus, stomach, or intestines that make it difficult for you to swallow or digest pills.

Before using citric acid and potassium citrate, tell your doctor if you are allergic to any drugs, or if you have:

• kidney disease;

• if you are taking a “potassium-sparing” diuretic (water pill) such as amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide), triamterene (Dyrenium, Dyazide, Maxzide).

• a urinary tract infection;

• untreated or uncontrolled diabetes;

• a peptic ulcer in your stomach;

• congestive heart failure, enlarged heart, or history of heart attack;

• other heart disease or high blood pressure;

• diabetes;

• a blockage in your stomach or intestines; or

• chronic diarrhea (such as ulcerative colitis, Crohn’s disease).

If you have any of these conditions, you may need a dose adjustment or special tests to safely take citric acid and potassium citrate.

It is not known whether this medication is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether potassium passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take Cytra-K (citric acid and potassium citrate)?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Measure the liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

The liquid form of this medication should be mixed with at least 8 ounces (one cup) of cold water or fruit juice. Drink the mixture slowly, over 5 to 10 minutes in all. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

Citric acid and potassium citrate is usually taken 3 times daily after meals. Follow your doctor’s instructions.

Avoid lying down for at least 30 minutes after you take this medication. Your treatment may include a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you should eat or avoid to help control your condition.

To be sure this medication is helping your condition, your blood may need to be tested often. Your heart rate may also be checked using an electrocardiograph or ECG (sometimes called an EKG) to measure electrical activity of the heart. This test will help your doctor determine how long to treat you with potassium. Do not miss any scheduled appointments.

Do not stop taking this medication without first talking to your doctor. If you stop taking potassium suddenly, your condition may become worse. Store citric acid and potassium citrate at room temperature away from moisture, heat, or freezing. Keep the medication in a closed container.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, wait until then to take the medicine and skip the missed dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include numbness and tingling, confusion, heavy feeling in your arms or legs, muscle weakness, limp feeling, slow heart rate, weak pulse, fainting, and slow breathing (breathing may stop).

What should I avoid while taking Cytra-K (citric acid and potassium citrate)?

Avoid taking potassium supplements or using other foods or products that contain potassium without first asking your doctor. Salt substitutes or low-salt dietary products often contain potassium. If you take certain products together you may accidentally get too much potassium. Read the label of any other medicine you are using to see if it contains potassium.

You may also need to avoid eating potassium-rich foods while you are taking this medication. Foods that are high in potassium include many green leafy vegetables, squash, yams, beets, avocado, lima beans, kidney beans, pinto beans, lentils, split peas, soybeans, papaya, figs, prunes, and fish such as halibut, cod, snapper, and tuna.

It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you must avoid to help control your condition.

Cytra-K (citric acid and potassium citrate) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have any of these serious side effects:

• severe stomach pain, ongoing diarrhea or vomiting;

• black, bloody, or tarry stools;

• coughing up blood;

• fast, slow, or uneven heart rate;

• muscle weakness, pain, or twitching;

• numbness or tingly feeling in your hands or feet, or around your mouth;

• confusion, anxiety, weakness, mood changes, or feeling irritable;

• swelling in your ankles or feet; or

• seizure (convulsions).

Less serious side effects may include:

• mild nausea, vomiting, or upset stomach;

• mild or occasional diarrhea; or

• appearance of a citric acid and potassium citrate tablet in your stool.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cytra-K (citric acid and potassium citrate)?

The following drugs can interact with citric acid and potassium citrate. Tell your doctor if you are using any of these:

• eplerenone (Inspra);

• candesartan (Atacand), losartan (Cozaar, Hyzaar), valsartan (Diovan), or telmisartan (Micardis);

• quinidine (Quinaglute, Quinidex, Quin-Release);

• an ACE inhibitor such as benazepril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik); or

• any type of diuretic (water pill) such as bumetanide (Bumex), chlorothiazide (Diuril), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), or torsemide (Demadex).

This list is not complete and there may be other drugs that can interact with citric acid and potassium citrate. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about citric acid and potassium citrate.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 3.01. Revision Date: 04/29/2009 10:19:37 AM.

Generic Name: Potassium Citrate/Citric Acid (poe-TASS-ee-um SYE-trate/SIH-trik AS-id)
Brand Name: Cytra-K

Cytra-K Solution is used for:

Preventing certain types of kidney stones. It also may be used for other conditions as determined by your doctor.

Cytra-K Solution is a urinary alkalinizing agent. It neutralizes some of the acid in your urine, which reduces the formation of crystals in your urine that could become kidney stones or aggravate gout.

Do NOT use Cytra-K Solution if:

• you are allergic to any ingredient in Cytra-K Solution
• you have high potassium levels in the blood, aluminum toxicity, heart failure or injury, or severe kidney problems
• you are taking an aldosterone blocker (eg, spironolactone), an aluminum salt (eg, aluminum hydroxide), a potassium-sparing diuretic (eg, triamterene), or sucralfate

Contact your doctor or health care provider right away if any of these apply to you.

Before using Cytra-K Solution:

Some medical conditions may interact with Cytra-K Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
• if you have allergies to medicines, foods, or other substances
• if you have heart problems, kidney problems, difficulty swallowing, blockage in your intestine or stomach, peptic ulcer, or uncontrolled diabetes
• if you have diarrhea or a urinary tract infection, or you are dehydrated
• if you are on a sodium-restricted diet
• if you have severe burns or other tissue damage or high acid levels or toxic substances in your blood, or your adrenal glands are not functioning correctly

Some MEDICINES MAY INTERACT with Cytra-K Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

• Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), aldosterone blockers (eg, spironolactone), or potassium-sparing diuretics (eg, triamterene) because they may increase the risk of Cytra-K Solution’s side effects, especially on the heart
• Aluminum salts (eg, aluminum hydroxide), anorexiants (eg, phentermine), flecainide, mecamylamine, quinidine, sucralfate, or certain stimulants (eg, albuterol, amphetamine, pseudoephedrine) because the risk of their side effects may be increased by Cytra-K Solution
• Lithium because its effectiveness may be decreased by Cytra-K Solution

This may not be a complete list of all interactions that may occur. Ask your health care provider if Cytra-K Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Cytra-K Solution:

Use Cytra-K Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Cytra-K Solution by mouth with food or milk.
• Be sure to dilute Cytra-K Solution in water as directed on the packaging or by your doctor.
• Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• Shake well before each use.
• Drinking extra fluids while you are taking Cytra-K Solution is recommended. Check with your doctor for instructions.
• If you take a tetracycline antibiotic (eg, doxycycline), do not take Cytra-K Solution within 2 hours before or after taking the tetracycline. Check with your doctor if you have questions
• If you miss a dose of Cytra-K Solution, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Cytra-K Solution.

Important safety information:

• Check with your doctor before you use a salt substitute or a product that has potassium in it.
• Additional monitoring of your dose may be needed if you are taking a salicylate (eg, aspirin) or a sulfonylurea (eg, glyburide).
• Lab tests, including blood potassium levels, other blood electrolyte levels, and electrocardiogram (ECG), may be performed while you use Cytra-K Solution. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
• PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Cytra-K Solution while you are pregnant. It is not known if Cytra-K Solution is found in breast milk. If you are or will be breast-feeding while you use Cytra-K Solution, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of Cytra-K Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; loose stools; nausea; upset stomach; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); black, tarry stools; confusion; severe stomach pain; tingling of hands or feet; vomit that looks like coffee grounds; weakness.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects at http://www.fda.gov/medwatch.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center (http://www.aapcc.org), or emergency room immediately. Symptoms may include confusion; fainting; irregular heartbeat; seizures; sluggishness; weakness.

Proper storage of Cytra-K Solution:

Store Cytra-K Solution at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Cytra-K Solution out of the reach of children and away from pets.

General information:

• If you have any questions about Cytra-K Solution, please talk with your doctor, pharmacist, or other health care provider.
• Cytra-K Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people.
• If your symptoms do not improve or if they become worse, check with your doctor.

This information is a summary only. It does not contain all information about Cytra-K Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Generic Name: citrate (Oral route)

Commonly used brand name(s):

In the U.S.

• Citra pH
• Cytra-K
• Cytra-K Crystals
• Liqui-DualCitra
• Polycitra-K
• Polycitra-K Crystals
• Urocit-K 10
• Urocit-K 15
• Urocit-K 5

In Canada

• Pms-Dicitrate

Available Dosage Forms:

• Tablet
• Solution
• Tablet, Extended Release
• Syrup
• Powder for Suspension

Uses For Cytra-K Crystals

Citrates are used to make the urine more alkaline (less acid). This helps prevent certain kinds of kidney stones. Citrates are sometimes used with other medicines to help treat kidney stones that may occur with gout. They are also used to make the blood more alkaline in certain conditions

Citrates are available only with your doctor’s prescription.

Before Using Cytra-K Crystals

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Although there is no specific information comparing use of citrates in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of citrates in the elderly with use in other age groups.

Pregnancy

Studies on effects in pregnancy have not been done in either humans or animals.

Breast Feeding

Although it is not known whether citrates pass into the breast milk, this medicine has not been reported to cause problems in nursing babies.

Interactions with Medicines

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

• Addison’s disease (underactive adrenal glands) or
• Type 2 diabetes mellitus or
• Kidney disease—The potassium in potassium-containing citrates may worsen or cause heart problems in patients with these conditions.

• Diarrhea (chronic)—Treatment with citrates may not be effective; a change in dose of citrate may be needed.

• Edema (swelling of the feet or lower legs) or
• High blood pressure or
• Toxemia of pregnancy—The sodium in sodium-containing citrates may cause the body to retain (keep) water.

• Heart disease—The sodium in sodium-containing citrates may cause the body to retain (keep) water; the potassium in potassium-containing citrates may make heart disease worse.

• Intestinal or esophageal blockage—Potassium citrate tablets may cause irritation of the stomach or intestines.

• Stomach ulcer or other stomach problems—Potassium citrate–containing products may make these conditions worse.

• Urinary tract infection—Citrates may make conditions worse.

Proper Use of citrate

This section provides information on the proper use of a number of products that contain citrate. It may not be specific to Cytra-K Crystals. Please read with care.

For patients taking the tablet form of this medicine:

• Swallow the tablets whole. Do not crush, chew, or suck the tablet.
• Take with a full glass (8 ounces) of water.
• If you have trouble swallowing the tablets or they seem to stick in your throat, check with your doctor at once. If this medicine is not completely swallowed and not properly dissolved, it can cause severe irritation.

For patients taking the liquid form of this medicine:

• Dilute with a full glass (6 ounces) of water or juice and drink; follow with additional water, if desired.
• Chill, but do not freeze, this medicine before taking it, for a better taste.

For patients taking the crystals form of this medicine:

• Add the contents of one packet to at least 6 ounces of cool water or juice.
• Stir well to make sure the crystals are completely dissolved.
• Drink all the mixture to be sure you are taking the correct dose. Follow with additional water or juice, if desired.

Take each dose immediately after a meal or within 30 minutes after a meal or bedtime snack. This helps prevent the medicine from causing stomach pain or a laxative effect.

Drink at least a full glass (8 ounces) of water or other liquid (except milk) every hour during the day (about 3 quarts a day), unless otherwise directed by your doctor. This will increase the flow of urine and help prevent kidney stones.

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. This is especially important if you are also taking a diuretic (water pill) or digitalis medicine for your heart.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For potassium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1.08 to 2.16 grams three times a day with meals. Some people may take 1.62 grams four times a day with meals or within thirty minutes after a meal or bedtime snack. Your doctor may change your dose if needed. However, most people usually will not take more than 10.8 grams a day.
    • Children—Dose must be determined by your doctor.

• For potassium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children—Dose must be determined by your doctor.
  • To make the urine more alkaline (less acidic):
    • Children—At first, 1 to 3 teaspoonfuls of solution, mixed with water or juice, four times a day after meals and at bedtime. Your doctor may change the dose if needed.
• For oral dosage form (crystals for solution):
  • To make the urine or blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 3.3 grams of potassium citrate, mixed with water or juice, four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
    • Children—Use is not recommended.

• For potassium citrate and sodium citrate
• For oral dosage form (tablets):
  • To make the urine more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 4 tablets after meals and at bedtime.
    • Children—Dose must be determined by your doctor.

• For sodium citrate and citric acid
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 2 to 6 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed. However, most people will usually not take more than five ounces a day.
  • To make the blood more alkaline (less acidic):
    • Adults—1 to 2 tablespoonfuls as a single dose. You may mix it in one to two tablespoonfuls of water.
  • To make the contents of the stomach less acidic before surgery:
    • Children—At first, 1 to 3 teaspoonfuls of solution four times a day, after meals and at bedtime. The solution should be mixed in one to three ounces of water. Your doctor may change the dose if needed.

• For tricitrates
• For oral dosage form (solution):
  • To make the urine and blood more alkaline (less acidic) and to prevent kidney stones:
    • Adults—At first, 1 to 2 tablespoonfuls of solution four times a day, after meals and at bedtime. Your doctor may change the dose if needed.
  • To make the contents of the stomach less acidic before surgery:
    • Adults—1 tablespoonful as a single dose. You should mix the solution in one tablespoonful of water.
  • To make the urine or blood more alkaline (less acidic):
    • Children—At first, 5 to 10 mL four times a day after meals and at bedtime. Your doctor may change the dose if needed.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using Cytra-K Crystals

It is important that your doctor check your progress at regular visits. This is to make sure the medicine is working properly and to check for unwanted effects.

Do not eat salty foods or use extra table salt on your food while you are taking citrates. This will help prevent kidney stones and unwanted effects.

Check with your doctor before starting any strenuous physical exercise, especially if you are out of condition and are taking any other medication. Exercise and certain medications may increase the amount of potassium in the blood.

For patients taking potassium citrate–containing medicines:

• Do not use salt substitutes and low-salt milk unless told to do so by your doctor. They may contain potassium.
• Check with your doctor at once if you are taking the tablet form and notice black, tarry stools or other signs of stomach or intestinal bleeding.
• Do not be alarmed if you notice what appears to be a whole tablet in the stool after taking potassium citrate tablets. Your body has received the proper amount of medicine from the tablet and has expelled the tablet shell. However, it is a good idea to check with your doctor also.
• If you are on a potassium-rich or potassium-restricted diet, check with your health care professional. Potassium citrate–containing medicines contain a large amount of potassium.

For patients taking sodium citrate–containing medicines:

• If you are on a sodium-restricted diet, check with your health care professional. Sodium citrate–containing medicines contain a large amount of sodium.

Cytra-K Crystals Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Stop taking this medicine and get emergency help immediately if any of the following effects occur:

Rare

• Abdominal or stomach pain or cramping (severe)
• black, tarry stools
• vomiting (severe), sometimes with blood

Check with your doctor as soon as possible if any of the following side effects occur:

• Confusion
• convulsions (seizures)
• dizziness
• high blood pressure
• irregular or fast heartbeat
• irritability
• mood or mental changes
• muscle pain or twitching
• nervousness or restlessness
• numbness or tingling in hands, feet, or lips
• shortness of breath, difficult breathing, or slow breathing
• swelling of feet or lower legs
• unexplained anxiety
• unpleasant taste
• unusual tiredness or weakness
• weakness or heaviness of legs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Abdominal or stomach soreness or pain (mild)
• diarrhea or loose bowel movements
• nausea or vomiting

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Generic Name: dexbrompheniramine, hydrocodone, and phenylephrine (DEX brom fen IR a meen, HYE dro KOE done, FEN il EFF rin)
Brand Names: Cytuss-HC NR, H-C Tussive-NR, Histussin HC

What is Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Brompheniramine is an antihistamine that reduces the natural chemical histamine in the body. Histamine can produce symptoms of sneezing, itching, watery eyes, and runny nose.

Hydrocodone is a narcotic cough suppressant.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose).

The combination of dexbrompheniramine, hydrocodone, and phenylephrine is used to treat nasal congestion, sneezing, runny nose, itchy or water eyes, and cough caused by allergies or the common cold.

Dexbrompheniramine, hydrocodone, and phenylephrine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough and cold medicine before the MAO inhibitor has cleared from your body.

You should not use dexbrompheniramine, hydrocodone, and phenylephrine if you are allergic to it, or if you have severe or uncontrolled high blood pressure, coronary artery disease, ischemic heart disease (reduced circulation of blood to the heart), narrow-angle glaucoma, peptic ulcer, if you are unable to urinate, or if you are pregnant or breast-feeding.

Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children. Dexbrompheniramine, hydrocodone, and phenylephrine should not be given to a child younger than 6 years old.

What should I discuss with my healthcare provider before taking Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Do not use this medication if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take a cough and cold medicine before the MAO inhibitor has cleared from your body. You should not use dexbrompheniramine, hydrocodone, or phenylephrine, if you have ever had an allergic reaction to it, or if you have:

• severe or uncontrolled high blood pressure;

• coronary artery disease;

• an enlarged prostate;

• narrow-angle glaucoma;

• peptic ulcer;

• asthma;

• pheochromocytoma;

• if you are breast-feeding a baby; or

• if you are having an asthma attack.

If you have certain conditions, you may need a dose adjustment or special tests to safely take dexbrompheniramine, hydrocodone, and phenylephrine. Before taking this medication, tell your doctor if you have:

• heart disease or high blood pressure;

• asthma, COPD, or other breathing disorder;

• diabetes;

• glaucoma;

• thyroid disorder;

• a history of head injury or brain tumor;

• enlarged prostate, urination problems.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Hydrocodone can cause breathing problems or addiction/withdrawal symptoms in a newborn. Do not take this medication while you are pregnant. This medication can pass into breast milk and may harm a nursing baby. Do not take this medication if you are breast-feeding a baby. Hydrocodone may be habit-forming and should be used only by the person it was prescribed for. This medication should never be shared with another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Older adults may be more likely to have side effects from this medication.

How should I take Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label. Cold medicine is usually taken for only a short time until your symptoms clear up.

Always ask a doctor before giving cough or cold medicine to a child. Death can occur from the misuse of cough or cold medicine in very young children. Dexbrompheniramine, hydrocodone, and phenylephrine should not be given to a child younger than 6 years old. Take the medicine with a full glass of water.

Measure liquid medicine with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Talk with your doctor if your symptoms do not improve after 7 days of treatment, or if you have a fever with a headache or skin rash. Store dexbrompheniramine, hydrocodone, and phenylephrine at room temperature away from moisture and heat.

Keep track of how much of this medicine has been used from the bottle. Hydrocodone is a drug of abuse and you should be aware if any person in the household is using this medicine improperly or without a prescription.

What happens if I miss a dose?

Since cough and cold medicine is usually taken only as needed, you may not be on a dosing schedule. If you are taking the medication regularly, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine. An overdose of hydrocodone can be fatal.

Overdose symptoms may include feeling restless or hyperactive, agitation, dizziness, confusion, hallucinations, fast or uneven heart rate, tremor, hallucinations, extreme drowsiness, loss of coordination, warmth or redness in your face, fever, cold or clammy skin, dilated pupils, pinpoint pupils, slow heart rate, blue-colored lips or fingernails, seizure (convulsions), weak or shallow breathing, or breathing that stops.

What should I avoid while taking Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

This medication can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol while you are taking this medication.

Tell your doctor if you regularly use other medicines that make you sleepy (such as pain medication, sleeping pills, muscle relaxers, and medicine for seizures, depression or anxiety). They can add to sleepiness caused by dexbrompheniramine, hydrocodone, and phenylephrine.

Do not use any other over-the-counter cold, allergy, or pain medication without first asking your doctor or pharmacist. Brompheniramine or phenylephrine are contained in many medicines available over the counter. If you take certain products together you may accidentally take too much of a certain drug. Read the label of any other medicine you are using to see if it contains brompheniramine or phenylephrine.

Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine) side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor at once if you have any of these serious side effects:

• shallow breathing, slow heartbeat;

• fast or pounding heartbeat;

• slow heart rate, weak pulse, fainting, slow breathing (breathing may stop);

• confusion, hallucinations, unusual thoughts or behavior;

• seizure (convulsions);

• painful or difficult urination;

• urinating less than usual or not at all; or

• severe dizziness, anxiety, fear, or tremors.

Less serious side effects may include:

• dizziness, drowsiness, headache;

• feeling restless or nervous;

• sleep problems (insomnia);

• nausea, vomiting, heartburn, loss of appetite;

• dry mouth;

• increased urination; or

• blurred vision.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Cytuss-HC NR (dexbrompheniramine, hydrocodone, and phenylephrine)?

Before taking this medication, tell your doctor if you regularly use other medicines that make you sleepy (such as narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, anxiety, or mental illness). They can add to sleepiness caused by dexbrompheniramine or hydrocodone.

Also tell your doctor about all other medicines you use, especially:

• medicines to treat high blood pressure;

• indomethacin (Indocin);

• mecamylamine (Inversine);

• methyldopa (Aldomet);

• reserpine;

• a beta-blocker such as atenolol (Tenormin), carteolol (Cartrol), metoprolol (Lopressor, Toprol), nadolol (Corgard), propranolol (Inderal), sotalol (Betapace), timolol (Blocadren), and others; or

• an antidepressant such as amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Janimine, Tofranil), and others.

This list is not complete and there may be other drugs that can interact with dexbrompheniramine, hydrocodone, and phenylephrine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

Where can I get more information?

• Your pharmacist can provide more information about dexbrompheniramine, hydrocodone, and phenylephrine.

• Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
• Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (‘Multum’) is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum’s drug information does not endorse drugs, diagnose patients or recommend therapy. Multum’s drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2006 Cerner Multum, Inc. Version: 1.02. Revision Date: 4/12/2009 4:46:13 PM.