| Brand Name | Manufacturer Name | Distributor | Drug Strength | Packaging | Formulation | Formulation Strength | Price |
|---|---|---|---|---|---|---|---|
| Sodium Bicarbonate | FreseniusLtd. | Fresenius Ltd | 8.5% | 50ml | injection | per vial | KES 384 |
| Sodium Bicarbonate | Harson | 8.4% | 10ml | Injection | Per vial | KES 65 |
American Regent and the U.S. Food and Drug Administration (FDA) notified healthcare providers of a national voluntary recall of Sodium Bicarbonate Injection, USP, 7.5% 50 mL single-dose vials and 8.4% 50 mL single-dose vials. Some vials of the affected lots contain particulates. Potential adverse events after intravenous administration include damage to blood vessels in the lung, localized swelling, and granuloma formation. Healthcare providers should not use these products in the lot numbers identified above and should immediately quarantine any product for return.
Cardiac arrest (ACLS, 2010): I.V.: Initial: 1 mEq/kg/dose; repeat doses should be guided by arterial blood gases
Routine use of NaHCO 3 is not recommended. May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. Note: In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium bicarbonate may be beneficial.
Metabolic acidosis: I.V.: Dosage should be based on the following formula if blood gases and pH measurements are available:
HCO3-(mEq) = 0.2 x weight (kg) x base deficit (mEq/L)
Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3-, and clinical status
Note: If acid-base status is not available: 2-5 mEq/kg I.V. infusion over 4-8 hours; subsequent doses should be based on patient's acid-base status
Hyperkalemia (ACLS, 2010): I.V.: 50 mEq over 5 minutes (as appropriate, consider methods of enhancing potassium removal/excretion)
Chronic renal failure: Oral: Initiate when plasma HCO3- <15 mEq/L Start with 20-36 mEq/day in divided doses, titrate to bicarbonate level of 18-20 mEq/L
Renal tubular acidosis: Oral:
Distal: 0.5-2 mEq/kg/day in 4-5 divided doses
Proximal: Initial: 5-10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range
Urine alkalinization: Oral: Initial: 48 mEq (4 g), then 12-24 mEq (1-2 g) every 4 hours; dose should be titrated to desired urinary pH; doses up to 16 g/day (200 mEq) in patients <60 years and 8 g (100 mEq) in patients >60 years
Antacid: Oral: 325 mg to 2 g 1-4 times/day
Prevention of contrast-induced nephropathy (unlabeled use): I.V. infusion: 154 mEq/L sodium bicarbonate in D5W solution: 3 mL/kg/hour for 1 hour immediately before contrast injection, then 1mL/kg/hour during contrast exposure and for 6 hours after procedure
To prepare solution, remove 154 mL from 1000 mL bag of D5W; replace with 154 mL of 8.4% sodium bicarbonate; resultant concentration is 154 mEq/L (Merten, 2004); more practically, institutions may remove 150 mL from 1000 mL bag of D5W and replace with 150 mL of 8.4% sodium bicarbonate; resultant concentration is 150 mEq/L
Cardiac arrest (PALS, 2010): I.V., I.O.: Infants and Children: 1 mEq/kg/dose; repeat doses should be guided by arterial blood gases; neonates and children <2 years of age should receive 4.2% (0.5 mEq/mL) solution. Note: If I.O. route is used for administration and is subsequently used to obtain blood samples for acid-base analysis, results will be inaccurate.
Routine use of NaHCO 3 is not recommended. May be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established and effective cardiac compressions. Note: In some cardiac arrest situations (eg, metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose), sodium bicarbonate may be beneficial.
Metabolic acidosis: I.V.: Infants and Children: Dosage should be based on the following formula if blood gases and pH measurements are available:
HCO3- (mEq) = 0.3 x weight (kg) x base deficit (mEq/L)
Administer 1/2 dose initially, then remaining 1/2 dose over the next 24 hours; monitor pH, serum HCO3-, and clinical status
Note: If acid-base status is not available: Dose for older Children: 2-5 mEq/kg I.V. infusion over 4-8 hours; subsequent doses should be based on patient's acid-base status.
Chronic renal failure: Oral: Children: Initiate when plasma HCO3- <15 mEq/L: 1-3 mEq/kg/day
Renal tubular acidosis, distal: Oral: Children: 2-3 mEq/kg/day
Renal tubular acidosis, proximal: Children: Initial: 5-10 mEq/kg/day; maintenance: Increase as required to maintain serum bicarbonate in the normal range
Urine alkalinization: Oral: Children: 1-10 mEq (84-840 mg)/kg/day in divided doses every 4-6 hours; dose should be titrated to desired urinary pH.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Granules for solution, oral [effervescent]:
BrioschiŪ: 2.69 g/capful (120 g, 240 g) [contains sodium 770 mg/capful; lemon flavor]
BrioschiŪ: 2.69 g/packet (12s) [contains sodium 770 mg/packet; lemon flavor]
Infusion, premixed in water for injection: 5% (500 mL [DSC]) [5.95 mEq/10 mL]
Injection, solution: 4.2% (10 mL) [5 mEq/10 mL]; 7.5% (50 mL) [8.92 mEq/10 mL]; 8.4% (50 mL, 250 mL, 500 mL) [10 mEq/10 mL]
NeutŪ: 4% (5 mL) [contains edetate disodium; 2.4 mEq/5 mL]
Injection, solution [preservative free]: 4.2% (5 mL, 10 mL [DSC]) [5 mEq/10 mL]; 7.5% (50 mL) [8.92 mEq/10 mL]; 8.4% (10 mL, 50 mL) [10 mEq/10 mL]
Powder, oral: USP: 100% (120 g, 480 g)
Tablet, oral: 325 mg [3.8 mEq], 650 mg [7.6 mEq]
Yes: Excludes granules
For I.V. administration to infants, use the 0.5 mEq/mL solution or dilute the 1 mEq/mL solution 1:1 with sterile water; for direct I.V. infusion in emergencies, administer slowly (maximum rate in infants: 10 mEq/minute); for infusion, dilute to a maximum concentration of 0.5 mEq/mL in dextrose solution and infuse over 2 hours (maximum rate of administration: 1 mEq/kg/hour)
Oral product should be administered 1-3 hours after meals.
Stable in dextran 6% in dextrose, dextran 6% in NS, D51/4NS, D51/2NS, D5NS, D5W, D10W, 1/2NS, NS; incompatible with acids, acidic salts, alkaloid salts, calcium salts, catecholamines, and atropine; variable stability (consult detailed reference) in D5LR, LR, fat emulsion 10%, TPN.
Y-site administration: Compatible: Acyclovir, alatrofloxacin, amifostine, asparaginase, aztreonam, cefepime, ceftriaxone, cladribine, cyclophosphamide, cytarabine, daunorubicin, dexamethasone sodium phosphate, dexchlorpheniramine, docetaxel, doxorubicin, etoposide, famotidine, filgrastim, fludarabine, gatifloxacin, gemcitabine, granisetron, heparin, heparin with hydrocortisone sodium succinate, ifosfamide, indomethacin, insulin (regular), levofloxacin, linezolid, melphalan, mesna, methylprednisolone sodium succinate, milrinone, morphine, paclitaxel, piperacillin/tazobactam, potassium chloride, propofol, remifentanil, tacrolimus, teniposide, thiotepa, tolazoline, vancomycin, vitamin B complex with C. Incompatible: Allopurinol, amiodarone, amphotericin B cholesteryl sulfate complex, calcium chloride, doxorubicin liposome, idarubicin, imipenem/cilastatin inamrinone, leucovorin calcium, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine. Variable (consult detailed reference): Ciprofloxacin, cisatracurium, diltiazem, TPN.
Compatibility in syringe: Compatible: Milrinone, pentobarbital. Incompatible: Etidocaine, glycopyrrolate, mepivacaine, metoclopramide, thiopental. Variable (consult detailed reference): Bupivacaine, chloroprocaine, lidocaine.
Compatibility when admixed: Compatible: Amikacin, aminophylline, amobarbital, amphotericin B, ampicillin, atropine, bretylium, calcium chloride, cefoxitin, ceftazidime, chloramphenicol, chlorothiazide, cimetidine, clindamycin, cytarabine, ergonovine, erythromycin lactobionate, esmolol, fentanyl and droperidol, floxacillin, furosemide, heparin, hyaluronidase, hydrocortisone sodium phosphate, hydrocortisone sodium succinate, kanamycin, lidocaine, mannitol, metaraminol, methotrexate, methyldopate, multivitamins, nafcillin, nalmefene, netilmicin, nizatidine, ofloxacin, oxacillin, oxytocin, phenobarbital, phenylephrine, phenytoin, phytonadione, potassium chloride, prochlorperazine edisylate, thiopental, verapamil. Incompatible: Amiodarone, ascorbic acid injection, carboplatin, carmustine, cefotaxime, ciprofloxacin, cisplatin, dobutamine, dopamine, epinephrine, hydromorphone, imipenem/cilastatin, isoproterenol, labetalol, levorphanol, magnesium sulfate, meropenem, morphine, norepinephrine, pentazocine, procaine, streptomycin, succinylcholine, ticarcillin/clavulanate potassium, vitamin B complex with C. Variable (consult detailed reference): Calcium chloride, calcium gluconate, corticotropin, meperidine, methylprednisolone sodium succinate, penicillin G potassium, pentobarbital, promazine, vancomycin.
Management of metabolic acidosis; gastric hyperacidity; as an alkalinization agent for the urine; treatment of hyperkalemia; management of overdose of certain drugs, including tricyclic antidepressants and aspirin
Prevention of contrast-induced nephropathy (CIN)
Frequency not defined.
Cardiovascular: Cerebral hemorrhage, CHF (aggravated), edema
Central nervous system: Tetany
Gastrointestinal: Belching, flatulence (with oral), gastric distension
Endocrine & metabolic: Hypernatremia, hyperosmolality, hypocalcemia, hypokalemia, increased affinity of hemoglobin for oxygen-reduced pH in myocardial tissue necrosis when extravasated, intracranial acidosis, metabolic alkalosis, milk-alkali syndrome (especially with renal dysfunction)
Respiratory: Pulmonary edema
Alkalosis, hypernatremia, severe pulmonary edema, hypocalcemia, unknown abdominal pain
Disease-related concerns:
• Cirrhosis: Use with caution in patients with cirrhosis.
• Edema: Use with caution in patients with edema.
• Heart failure: Use with caution in patients with heart failure.
• Peptic ulcer disease: Not to be used in treatment of peptic ulcer disease.
• Renal impairment: Use with caution in patients with renal impairment; may cause sodium retention.
Special populations:
• Elderly: Not the antacid of choice for the elderly because of sodium content and potential for systemic alkalosis.
• Pediatrics: Rapid administration in neonates and children <2 years of age has led to hypernatremia, decreased CSF pressure and intracranial hemorrhage.
Dosage form specific issues:
• Injection: Use of I.V. NaHCO3should be reserved for documented metabolic acidosis and for hyperkalemia-induced cardiac arrest. Routine use in cardiac arrest is not recommended. Avoid extravasation, tissue necrosis can occur due to the hypertonicity of NaHCO3.
ACE Inhibitors: Antacids may decrease the serum concentration of ACE Inhibitors. Management: Separate fosinopril administration from antacids by at least 2 hours. US and Canadian recommendations for use of other ACE- inhibitors with antacids may vary. Consult appropriate labeling. Monitor for decreased therapeutic effects of ACE-inhibitors.Exceptions: Ramipril.Risk D: Consider therapy modification
Alpha-/Beta-Agonists: Antacids may decrease the excretion of Alpha-/Beta-Agonists. Exceptions: Dipivefrin.Risk C: Monitor therapy
Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Anticonvulsants (Hydantoin): Antacids may decrease the serum concentration of Anticonvulsants (Hydantoin). Risk C: Monitor therapy
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Atazanavir: Antacids may decrease the absorption of Atazanavir. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Risk D: Consider therapy modification
Calcium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis and/or loss of efficacy of the cation exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of CPS effects. Avoid magnesium hydroxide.Risk D: Consider therapy modification
Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or alternative antimicrobial therapy. If antacid therapy can not be avoided, separate dosing by several hours.Risk D: Consider therapy modification
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Consider administering antacids and cefuroxime at least 2 hours apart.Risk D: Consider therapy modification
Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability.Risk D: Consider therapy modification
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Risk D: Consider therapy modification
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Risk C: Monitor therapy
Dasatinib: Antacids may decrease the absorption of Dasatinib. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination.Risk D: Consider therapy modification
Dexmethylphenidate: Antacids may increase the absorption of Dexmethylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction.Risk D: Consider therapy modification
Flecainide: Sodium Bicarbonate may diminish the arrhythmogenic effect of Flecainide. Sodium Bicarbonate may increase the serum concentration of Flecainide. Risk C: Monitor therapy
Gabapentin: Antacids may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after antacid administration. Monitor patients closely for evidence of reduced response to gabapentin therapy when both of these drugs are being used.Risk D: Consider therapy modification
HMG-CoA Reductase Inhibitors: Antacids may decrease the serum concentration of HMG-CoA Reductase Inhibitors. Risk C: Monitor therapy
Iron Salts: Antacids may decrease the absorption of Iron Salts. Exceptions: Ferric Gluconate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose.Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk D: Consider therapy modification
Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Management: Administer itraconazole at least 1 hour after and 2 hours before administration of any antacids. Itraconazole oral suspension may be less sensitive to the effects of decreased gastric acidity.Risk D: Consider therapy modification
Ketoconazole: Antacids may decrease the serum concentration of Ketoconazole. Management: Administer oral ketoconazole at least 2 hours prior to use of any antacid product. Monitor patients closely for signs of inadequate clinical response to ketoconazole.Risk D: Consider therapy modification
Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer oral ketoconazole at least 2 hours prior to use of any antacid product. Monitor patients closely for signs of inadequate clinical response to ketoconazole.Risk D: Consider therapy modification
Lithium: Sodium Bicarbonate may increase the excretion of Lithium. Risk C: Monitor therapy
Memantine: Sodium Bicarbonate may decrease the excretion of Memantine. Risk C: Monitor therapy
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction.Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Risk D: Consider therapy modification
Methylphenidate: Antacids may increase the absorption of Methylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. Risk C: Monitor therapy
Penicillamine: Antacids may decrease the serum concentration of Penicillamine. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Exceptions: Potassium Phosphate.Risk D: Consider therapy modification
Protease Inhibitors: Antacids may decrease the absorption of Protease Inhibitors. Exceptions: Darunavir.Risk C: Monitor therapy
QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy
QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Risk C: Monitor therapy
Tetracycline Derivatives: Antacids may decrease the absorption of Tetracycline Derivatives. Risk D: Consider therapy modification
Trientine: Antacids may decrease the absorption of Trientine. Management: Separate trientine dosing from other oral drugs (eg, antacids) by at least 1 hour. Monitor for decreased therapeutic effects of trientine if an antacid is initiated/dose increased, or increased effects if an antacid is discontinued/dose decreased.Risk D: Consider therapy modification
Herb/Nutraceutical: Concurrent doses with iron may decrease iron absorption.
C
Enters breast milk/compatible
Some products may contain sodium. Oral product should be taken 1-3 hours after meals.
Dissociates to provide bicarbonate ion which neutralizes hydrogen ion concentration and raises blood and urinary pH
Onset of action: Oral: Rapid; I.V.: 15 minutes
Duration: Oral: 8-10 minutes; I.V.: 1-2 hours
Absorption: Oral: Well absorbed
Excretion: Urine (<1%)