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sodium bicarbonate
generic
Adult Dosing .
Dosage forms: TAB: 325 mg, 650 mg; EFFERV TAB: 650 mg; PWDR: 2616 mg/0.5 tsp; INJ: various
Special Note
- [strength clarification]
- Info: 1 mEq = approx. 84 mg
metabolic acidosis, acute
- [2-5 mEq/kg/dose IV x1]
- Info: subsequent doses based on response and acid-base status
metabolic acidosis, chronic
- [chronic renal failure]
- Dose: 1625-2925 mg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
- [distal renal tubular acidosis]
- Dose: 42-168 mg/kg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
- [proximal renal tubular acidosis]
- Dose: 420-840 mg/kg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
urinary alkalinization
- [975-1950 mg PO q4h]
- Start: 3900 mg PO x1; Max: 15.6 g/day; Info: adjust dose based on urinary pH; max 7.8 g/day in patients 60 yo and older
dyspepsia
- [<60 yo]
- Dose: 650-2600 mg PO q4h prn; Max: 15.6 g/day; Alt: 2616 mg pwdr in 4 oz water PO q2h prn
- [60 yo and older]
- Dose: 650-1300 mg PO q4h prn; Max: 7800 mg/day; Alt: 2616 mg pwdr in 4 oz water PO q2h prn
salicylate overdose
- [1-2 mEq/kg/dose IV x1]
- Info: for patients w/ urinary pH <7.5; subsequent doses based on response and urinary pH
tricyclic antidepressant overdose (off-label)
- [1-2 mEq/kg/dose IV x1]
- Info: for patients w/ QRS >100ms or serum pH <7.45; subsequent doses based on response and serum pH
renal dosing
- [see below]
- renal impairment: not defined, caution advised; Info: may cause sodium retention
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: TAB: 325 mg, 650 mg; EFFERV TAB: 650 mg; PWDR: 2616 mg/0.5 tsp; INJ: various
Special Note
- [strength clarification]
- Info: 1 mEq = approx. 84 mg
metabolic acidosis, acute
- [individualize dose IV x1]
- Dose: dose (mEq) = 0.3 x wt (kg) x base deficit (mEq/L); Alt: dose (mEq) = 0.5 x wt (kg) x (24 - serum HCO3 (mEq/L)); Info: subsequent doses based on response and acid-base status
metabolic acidosis, chronic
- [chronic renal failure]
- Dose: 84-252 mg/kg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
- [distal renal tubular acidosis]
- Dose: 168-252 mg/kg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
- [proximal renal tubular acidosis]
- Dose: 420-840 mg/kg/day PO divided q4-6h; Info: adjust dose based on serum HCO3 levels
urinary alkalinization
- [84-840 mg/kg/day PO divided q4-6h]
- Max: 15.6 g/day; Info: adjust dose based on urinary pH
dyspepsia
- [6 yo and older]
- Dose: 2616 mg pwdr in 4 oz water PO q2h prn; Max: 15.6 g/day
renal dosing
- [not defined]
- renal impairment: consider adult renal dosing for guidance
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypochloremia
- alkalosis
- avoid: calcium intake, excessive
- caution: renal impairment
- caution: CHF
- caution: sodium restriction
- caution: hypervolemia
- caution: Bartter syndrome
- caution: hypocalcemia
- caution: hypokalemia
- caution: hypernatremia
- caution: patients <2 yo (IV use)
Drug Interactions .
Overview
sodium bicarbonate
antacid
- gastric pH modulator
- urine alkalinizer
Avoid/Use Alternative
- amphetamine
- ciprofloxacin
- dextroamphetamine
- lisdexamfetamine
- mefenamic acid
- mesalamine
- methamphetamine
- methenamine
- methylphenidate
- mexiletine
- nirogacestat
- selpercatinib
- sotorasib
Monitor/Modify Tx
- atazanavir
- belumosudil
- bisacodyl
- bosutinib
- calcium acetate
- calcium carbonate
- calcium chloride
- calcium citrate
- calcium gluconate
- cefuroxime axetil
- cysteamine
- dasatinib
- defactinib
- domperidone
- erlotinib
- ferrous fumarate
- ferrous gluconate
- ferrous sulfate
- flecainide
- fosinopril
- gefitinib
- glipizide
- itraconazole
- ketoconazole
- ledipasvir
- levoketoconazole
- levothyroxine
- lithium
- mycophenolate mofetil
- neratinib
- nilotinib
- octreotide
- pazopanib
- peppermint
- pexidartinib
- pseudoephedrine
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- rilpivirine
- rilzabrutinib
- sparsentan
- taletrectinib
- triazolam
- velpatasvir
Caution Advised
- acetazolamide
- amantadine
- cefpodoxime
- fosamprenavir
- memantine
- salsalate
Adverse Reactions .
Serious Reactions
- metabolic alkalosis
- CHF exacerbation
- seizures
- tetany
- extravasation cellulitis (IV use)
Common Reactions
- flatulence (PO use)
- gastric distension (PO use)
- metabolic alkalosis
- edema
- hypernatremia
- injection site pain
Safety/Monitoring .
Monitoring Parameters
acid-base balance if metabolic acidosis
Look/Sound-Alike Drug Names
sodium bicarbonate confused with: sodium chloride
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available, though possible risk of fluid retention based on drug's mechanism of action
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: none; CYP450: none
Excretion: urine; Half-life: unknown
Subclass: Antacids ; Metabolic Acidosis ; Toxicity: Drugs
Mechanism of Action
increases serum bicarbonate, raising pH; neutralizes gastric acidity
Formulary .
No Formulary Selected
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