citric acid/glucono-delta-lactone/magnesium carbonate (Renacidin)
Classes: Urinary Acidifying Agents
Dosing and uses of Renacidin (citric acid/glucono-delta-lactone/magnesium carbonate)
Adult dosage forms and strengths
citric acid/glucono-delta-lactone/magnesium carbonate
renal irrigation solution
- (1980.6mg/59.4mg/980.4mg)/30mL single-use plastic bottle
Renal Calculi
Indicated for local irrigation for dissolution of renal calculi composed of apatite (a calcium carbonate-phosphate compound) or struvite (magnesium ammonium phosphates) in patients who are not candidates for surgical removaL
Also indicated as adjunctive therapy to dissolve residual apatite or struvite calculi and fragments after surgery or to achieve partial dissolution of renal calculi to facilitate surgical removaL
Instilled via nephrostomy tube to permit calculus lavage; use second catheter for drainage if calculi obstruct ureter
Infuse NS at 60 mL/hr and increase until elevated pressure, pain, or maximum flow rate of 120 mL/hr reached
Start flow of infusion at maximum rate achieved with Ns
Bladder Calculi
Indicated or dissolution of bladder calculi of the struvite or apatite variety by local intermittent irrigation through a urethral catheter or cystostomy catheter as an alternative or adjunct to surgical procedures
30 mL instilled through a urinary catheter into the bladder and the catheter is clamped for 30-60 minutes, release clamp and drain bladder
Repeat 4-6 times daily
Urinary Catheter Incrustation
Indicated for intermittent irrigation to prevent or minimize incrustations of indwelling urinary tract catheters
Instill 30 mL of the solution through the catheter and then clamp catheter for 10 minutes, after which the clamp is removed to allow drainage of the bladder
Repeat 3 times daily
Pediatric dosage forms and strengths
Safety and efficacy not established
Renacidin (citric acid/glucono-delta-lactone/magnesium carbonate) adverse (side) effects
>10%
Flank pain, transient (>50%)
Fever (20-40%)
Urothelial ulceration with or without edema (13%)
Frequency not defined
Urinary tract infection
Back pain
Dysuria
Transient hematuria
Nausea
Hypermagnesemia
Hyperphosphatemia
Elevated serum creatinine
Candidiasis
Bladder irritability
Septicemia
Ileus
Vomiting
Thrombophlebitis
Warnings
Contraindications
Hypersensitivity
Urinary tract infections (urea-splitting bacteria reside within struvite and apatite stones); dissolution therapy in the presence of an infected urinary tract may lead to sepsis and death
Treatment (dissolution) of calcium oxalate, uric acid, cysteine calculi
Cautions
Obtain urine specimen and culture prior to initiating chemolytic therapy and treat with appropriate antibiotic therapy if infection evident
Demonstrable urinary tract extravasation
An infected stone can serve as a continual source for infection and, therefore, antibiotic therapy should be continued throughout the course of dissolution therapy
Discontinue immediately if the patient develops fever, urinary tract infection, signs and symptoms consistent with urinary tract infection, or persistent flank pain.
Discontinue if hypermagnesemia or elevated serum creatinine develops
Sterile urine must be present prior to initiating therapy
Concurrent use of magnesium containing medications may contribute to production of hypermagnesemia
Maintain patency of the irrigating catheter; calculus fragments and debris may obstruct the outflow catheter
Intrapelvic pressures must be maintained at or below 25cm of water
Patients with indwelling urethral or cystostomy catheters frequently have vesicoureteral reflux; cystogram prior to initiation irrigation is essential for such patients; if reflux demonstrated, all precautions recommended for renal pelvis irrigation must be taken
Monitor serum creatinine, phosphate, and magnesium every several days
Urine specimens should be collected for culture and antibacterial sensitivity q3Days or less and at the first sign of fever
Pregnancy and lactation
Pregnancy category: C; generally avoided in pregnancy
Lactation: Magnesium is known to be excreted in human milk; unknown whether Renacidin components distributed in breast milk, caution advised
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Renacidin (citric acid/glucono-delta-lactone/magnesium carbonate)
Mechanism of action
Action on susceptible apatite calculi results from an exchange of magnesium from the irrigating solution for calcium contained in the stone matrix; resulting magnesium salts formed are soluble in the glucono-citrate irrigating solution, thereby resulting in the calculus dissolution
Struvite calculi are composed mainly of magnesium ammonium phosphates which are solubilized by Renacidin Irrigation due to its acidic pH (ie, 3.85)
