3 Potassium Citrate Side Effects to Know About

If you’ve ever had kidney stones, you know they can be quite painful. Kidney stones are solid masses of mineral buildup. They can form in the kidneys when you have too much of certain minerals (often, too much calcium) in your body.

In some situations, your healthcare provider may suggest taking a medication to prevent or treat kidney stones, like potassium citrate (Urocit-K) or potassium citrate / citric acid (Cytra-K). While potassium citrate can help with kidney stones, it also has some risks. Here, we’ll discuss three potassium citrate side effects, as well as the potential benefits of this medication.

What is potassium citrate?

Potassium citrate is a medication that treats and prevents certain types of kidney stones. It’s available in extended-release tablets, which are designed to last longer in your body. The medication comes as 5 mEq, 10 mEq, and 15 mEq tablets.

Potassium citrate is also available in combination with citric acid as a liquid solution (Cytra-K). This solution is approved to treat conditions associated with acidic urine, including kidney stones and gout. It may be a good option if you can’t swallow pills, but you’ll need to take it more often than potassium citrate tablets.

Potassium citrate benefits

The major benefit of potassium citrate is that it can help prevent or treat kidney stones. It does this by decreasing the acidity of your urine. Acidic urine can lead to kidney stones, and having kidney stones increases your risk of long-term kidney damage.

Some evidence suggests that taking potassium citrate may also improve bone strength and lower blood pressure. But potassium citrate isn’t FDA approved for these uses. And there are other, first-choice medications to treat low bone strength (osteoporosis) and high blood pressure (hypertension).

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Potassium citrate side effects

Potassium citrate is generally well tolerated. But, like all medications, it has risks. Below, we’ll cover three of the most important potassium citrate side effects to know about and how to manage them.

1. Gastrointestinal side effects

Potassium citrate can cause side effects related to your gastrointestinal (GI) system. These side effects include:

• Upset stomach

• Irritation of the esophagus

• Nausea

• Vomiting

• Diarrhea

One way to prevent GI upset is to take potassium citrate with meals or snacks. Taking the medication with food can minimize its irritating effect on your stomach. Avoiding laying down for at least 30 minutes after you take it can also be helpful. This ensures the medication makes it through your body properly. 

Staying hydrated can also help you avoid nausea related to potassium citrate. And drinking fluids is generally important when taking the medication, because it can help you avoid the return of kidney stones.

If you’re experiencing diarrhea, there are a few things you can try:

• Avoid foods that can worsen diarrhea, like dairy products and fried, spicy, or fatty foods.

• Eat mostly bland foods, like rice and toast, for a few days.

• Take over-the-counter antidiarrheal medications, like loperamide (imodium A-D), if your healthcare provider approves.

If you have nausea or diarrhea that doesn’t improve, reach out to your healthcare provider, as you may need a lower dose of potassium citrate. If you are having serious side effects — such as severe vomiting, abdominal pain, or blood in your stool — stop taking potassium citrate and reach out to your healthcare provider immediately.

Good to know: Your healthcare provider may recommend a specific diet or a specific amount of fluid intake per day when you’re taking potassium citrate. If this is the case, follow their directions about what to eat and drink carefully.

2. High potassium levels

One potentially serious side effect of potassium citrate is high potassium levels in your blood (hyperkalemia). This is more likely if you have a health condition that causes your kidneys not to work as well (like chronic kidney disease). It’s also more likely if you have heart failure or take other medications that raise your blood potassium levels.

Often, people don’t have symptoms with mild hyperkalemia. It is possible to experience tiredness, nausea, muscle weakness, or tingling sensations, however. In rare cases, hyperkalemia can be so severe that it’s life-threatening. In these cases, it can cause a heart attack or cause the heart to stop (cardiac arrest).

If you experience symptoms of severe hyperkalemia, contact your healthcare provider immediately. These may include:

• Trouble breathing

• Severe vomiting

• Heart palpitations

• Chest pain

Your healthcare provider may ask you to do routine blood work before and after starting treatment with potassium citrate. This will help them see how much potassium is in your blood. They may also check your heart function with an EKG.

3. GI lesions or bleeding

It’s rare, but potassium citrate can cause damage to the small intestine or stomach. This can happen when potassium builds up in these areas, causing GI lesions (openings in the lining of the GI tract). Symptoms of GI lesions include:

• Severe vomiting and blood in the vomit

• Obvious blood in the stool

• Dark, tarry-looking stool

• Stomach pain

The risk of GI lesions is higher if you take potassium citrate for a long time or you take high doses. Your risk is also higher if you take it with a medication called glycopyrrolate (Robinul, Robinul Forte, Cuvposa). 

If you experience any of the serious symptoms above, stop taking potassium citrate and contact your healthcare provider right away.

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Written by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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