Urinary tract infections (UTIs) are common bacterial infections that affect the urinary system, including the urethra, bladder, ureters, and kidneys. They are typically caused by Escherichia coli (E. coli) bacteria from the digestive tract. UTIs can be painful and uncomfortable, with symptoms like a frequent urge to urinate, burning sensation when urinating, cloudy urine, strong-smelling urine, and pelvic pain. While UTIs can often clear up on their own, antibiotics are frequently used to treat them and prevent complications. In some cases, medications may be recommended to help manage UTI symptoms and relieve discomfort while the infection runs its course. One medication sometimes used is disodium hydrogen citrate syrup.
What is disodium hydrogen citrate syrup?
Disodium hydrogen citrate, also known as citric acid disodium salt, is a salt that forms from citric acid and sodium hydroxide. It is commonly used in food products as an acidity regulator, flavoring agent, and preservative. Disodium hydrogen citrate syrup is a liquid preparation containing disodium hydrogen citrate as the active ingredient.
As an alkaline salt, disodium hydrogen citrate can raise the pH of urine, making it less acidic. It is thought that the alkaline environment may help inhibit the growth of bacteria that cause UTIs. The syrup form allows for easy dosing and consumption.
Is it effective for treating UTIs?
Disodium hydrogen citrate syrup is generally not used as a primary treatment for UTIs. Antibiotics remain the first-line treatment for most standard UTIs. Disodium hydrogen citrate syrup has not been robustly studied as a UTI treatment and there is limited evidence to support its use.
However, some research suggests disodium hydrogen citrate may help provide symptom relief for UTIs when used as an adjuvant therapy along with antibiotics. A randomized controlled trial published in 2018 looked at disodium hydrogen citrate syrup compared to placebo in women with uncomplicated UTIs taking antibiotics. Women taking the citrate syrup had significantly faster resolution of UTI symptoms like frequency, urgency, and burning with urination.
Another study in 2021 had similar findings, with disodium hydrogen citrate syrup improving symptoms in UTI patients on antibiotic therapy compared to placebo. The citrate group had greater decreases in symptom scores for urgency, frequency, dysuria, and nocturia.
While more research is still needed, these studies suggest disodium hydrogen citrate syrup may provide added benefit for UTI symptom control when used with antibiotics. However, it should not be used in place of antibiotic therapy prescribed by a healthcare provider.
How does it work?
Although the exact mechanisms are unclear, disodium hydrogen citrate is thought to help relieve UTI discomfort through a few different actions:
- Makes urine more alkaline. The citrate combats urine acidity, which may help reduce bladder irritation and inhibit bacterial growth.
- Has analgesic effects. Disodium citrate may have direct pain-relieving properties in the urinary tract.
- Prevents kidney stones. By making urine alkaline, citrate reduces the risk of certain kidney stones forming as a UTI complication.
- Protects bladder lining. Some research indicates citrate may help maintain the bladder’s glycosaminoglycan lining, preventing bacteria from attaching.
What is the recommended dosage?
There is no standardized dosing recommendation for disodium hydrogen citrate syrup for UTIs. In studies using the syrup for UTI relief, participants took between 3-6 grams per day in divided doses. It’s important to follow the dosage instructions provided by your healthcare provider if citrate syrup is recommended.
How long should you take it?
Disodium hydrogen citrate syrup should only be taken for the duration prescribed by your doctor, which is typically around 3-7 days. Long-term use without medical supervision is not advisable. Make sure to finish the entire course as directed, even if UTI symptoms resolve earlier.
Do not take disodium hydrogen citrate syrup longer than prescribed or take extra doses. Excessive, prolonged use can cause side effects like electrolyte abnormalities and metabolic alkalosis.
When should you take it?
The timing of doses depends on the specific instructions given, but disodium hydrogen citrate syrup is often taken 2-3 times per day with meals. It’s best to space out doses over the course of the day. Taking it with food may help minimize potential stomach upset.
Try to take the syrup as directed by your healthcare provider. Consistency is important in order to keep the urine alkaline throughout the day and achieve optimal symptom relief.
Should you take it on an empty stomach?
Most experts recommend taking disodium hydrogen citrate syrup with food rather than on an empty stomach. Since citrate syrup has an alkaline pH, taking it without food can sometimes cause mild GI upset or nausea. Eating a meal or snack helps buffer the acidity and makes the syrup easier to tolerate.
Of course, follow the advice of your doctor – in some cases, they may recommend taking disodium hydrogen citrate on an empty stomach if appropriate for your condition.
What foods should you avoid when taking it?
There are no specific foods that need to be avoided when taking disodium hydrogen citrate syrup. Since it works by alkalizing the urine, avoiding acidic foods may help enhance its effects. Limiting citrus fruits, tomatoes, vinegar, and carbonated beverages may help the syrup keep urine pH elevated.
Avoid any foods that seem to make your UTI symptoms worse. Drink plenty of fluids like water to help flush bacteria out of the urinary tract.
What are the side effects?
Disodium hydrogen citrate syrup is generally well tolerated when taken as prescribed under medical supervision. However, some potential side effects can occur:
- Stomach pain or nausea
- Diarrhea
- Electrolyte problems like low calcium, potassium, or sodium
- Metabolic alkalosis
- Tingling sensations
- Swollen ankles
More severe side effects are possible with excessive or long-term use. Seek medical attention if you experience muscle spasms, numbness or tingling, irregular heartbeat, seizures, or severe nausea/vomiting.
Who should not take disodium hydrogen citrate syrup?
Disodium hydrogen citrate syrup may not be appropriate for some patients. You should not take it if you:
- Have kidney impairment
- Have alkalosis or electrolyte imbalances
- Are taking potassium chloride supplements
- Have active ulcer disease
- Have appendicitis
- Have difficulty urinating
- Have heart or liver disease
- Are pregnant or breastfeeding
Disodium hydrogen citrate can interact with certain medications like diuretics, potassium supplements, and lithium. Tell your doctor about any medical conditions and all medications you take before starting disodium hydrogen citrate syrup.
Is there anyone who definitely should take it?
There are no conditions that definitively require treatment with disodium hydrogen citrate syrup. It is typically only used when recommended by a healthcare provider in certain situations like:
- As adjunctive symptom relief for uncomplicated UTIs
- To manage discomfort from procedures like cystoscopy or urodynamics
- To make urine alkaline in people prone to calcium or uric acid kidney stones
- To help dissolve certain kidney stones
- To prevent crystal formation in urine drainage bags
Your doctor can determine if disodium hydrogen citrate is appropriate for your specific condition. While it may help manage UTI symptoms, it is not considered a first-line UTI treatment and is not used universally.
Are there any drug interactions to be aware of?
Disodium hydrogen citrate can potentially interact with other medications, especially those that affect electrolytes. Drug interactions may include:
- Diuretics like furosemide (Lasix) – increased risk of hypokalemia and hyponatremia
- Potassium chloride supplements – increased risk of hyperkalemia
- Lithium – decreased lithium excretion and potential toxicity
- Steroids like prednisone – increased risk of hypokalemia
- ACE inhibitors like lisinopril – increased risk of hyperkalemia and metabolic alkalosis
- Antacids with aluminum, calcium, or magnesium – decreased absorption of citrate
Check with your doctor before taking any other prescription or over-the-counter medications, vitamins, or supplements while using disodium hydrogen citrate syrup.
Is disodium hydrogen citrate syrup alkaline or acidic?
Disodium hydrogen citrate syrup has an alkaline pH, making it a base rather than an acid. When metabolized, the citrate converts into bicarbonate which helps raise the pH of urine and make it more alkaline.
The alkaline nature of disodium hydrogen citrate syrup is thought to be helpful for UTIs because alkaline urine may inhibit bacterial growth, reduce bladder wall irritation, and prevent kidney stones – which could worsen a UTI. The alkalinity may provide direct and indirect symptom relief.
What is the difference between sodium citrate and disodium hydrogen citrate?
Sodium citrate and disodium hydrogen citrate are closely related salts that both increase urine pH and promote alkalinity. The main difference is that sodium citrate contains three sodium ions per molecule, whereas disodium hydrogen citrate contains two sodium ions per molecule.
Chemically, sodium citrate can be represented as Na3C6H5O7, compared to disodium hydrogen citrate which has the formula Na2HC6H5O7.
They work similarly in the body to raise urine pH levels. However, some research suggests that sodium citrate may be more potent and effective than disodium hydrogen citrate for raising urinary citrate and alkalinizing urine.
Can you take disodium hydrogen citrate syrup long term?
Disodium hydrogen citrate syrup is generally only intended for short-term use under medical supervision. Long-term use without consulting a physician is not advisable.
Extended use of disodium hydrogen citrate poses risks of side effects like electrolyte disturbances and metabolic alkalosis. It can also cause calcium phosphate kidney stones with prolonged high dose use.
Those with recurrent UTIs or kidney stones may periodically require repeated brief regimens of disodium hydrogen citrate syrup under medical guidance. But continuous, lifelong use of the syrup is typically not recommended due to potential safety concerns with long-term alkali therapy.
Conclusion
Disodium hydrogen citrate syrup is thought to help provide symptomatic relief for uncomplicated UTIs when used together with antibiotic treatment. Research indicates it may reduce UTI discomfort by alkalizing the urine to inhibit bacterial growth, reduce bladder irritation, and prevent kidney stones. The syrup is dosed 2-3 times per day with food and taken for 3-7 days as prescribed by a doctor.
While generally well tolerated, potential side effects can occur. Disodium hydrogen citrate also has several contraindications and may interact with some medications. It should not be taken long term or without medical approval. More research is still needed, but current evidence suggests disodium hydrogen citrate syrup may be a useful adjunctive therapy to help improve symptoms in those being treated for UTIs with antibiotics.
