sodium bicarbonate (Rx)

Brand and Other Names:
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 4%
  • 4.2%
  • 7.5%
  • 8.4%

tablet

  • 325mg
  • 650mg

Cardiac Arrest

Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit

Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

Hyperkalemia

50 mEq IV over 5 minutes

Metabolic Acidosis

Non-life-threatening: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH

Severe (except hypercarbic acidosis): 90-180 mEq/L (~7.5-15 g) at a rate of 1-1.5 L (first hour); adjust for further management as needed

Dosing Considerations

Monitor pH, serum potassium, and CO2

Dosage Forms & Strengths

injectable solution

  • 4%
  • 4.2%
  • 7.5%
  • 8.4%

tablet

  • 325mg
  • 650mg

Cardiac Arrest

Infants, <2 years (use 4.2% solution)

  • Initial: 1 mEq/kg/min given over 1-2 minutes IV/IO, THEN
  • 1 mEq/kg IV q10min of arrest
  • Not to exceed 8 mEq/kg/day

≥2 years

  • Initial: 1 mEq/kg/dose IV x1; base subsequent doses on results of arterial blood pH and PaCO2 as well as calculation of base deficit
  • Repeat doses may be considered in the setting of prolonged cardiac arrest only after adequate alveolar ventilation has been established

Metabolic Acidosis (Non-Life-Threatening)

Older children: 2-5 mEq/kg IV infusion over 4-8 hr depending on the severity of acidosis as judged by the lowering of total CO2 content, clinical condition and pH

0.25-2mEq/kg IV infusion can be considered for acidosis with a pH <7.0-7.2

Dosing Considerations

Monitor serum potassium

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Interactions

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              Serious - Use Alternative (21)

              • atazanavir

                sodium bicarbonate will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • dapsone

                sodium bicarbonate will decrease the level or effect of dapsone by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • dasatinib

                sodium bicarbonate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • demeclocycline

                sodium bicarbonate decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • digoxin

                sodium bicarbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • doxycycline

                sodium bicarbonate decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • eltrombopag

                sodium bicarbonate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

              • fleroxacin

                sodium bicarbonate decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • gemifloxacin

                sodium bicarbonate decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • indinavir

                sodium bicarbonate will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • itraconazole

                sodium bicarbonate will decrease the level or effect of itraconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ketoconazole

                sodium bicarbonate will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • levofloxacin

                sodium bicarbonate decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • minocycline

                sodium bicarbonate decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • moxifloxacin

                sodium bicarbonate decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • nimodipine

                sodium bicarbonate will increase the level or effect of nimodipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • nisoldipine

                sodium bicarbonate will increase the level or effect of nisoldipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • nitrendipine

                sodium bicarbonate will increase the level or effect of nitrendipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

              • ofloxacin

                sodium bicarbonate decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • oxytetracycline

                sodium bicarbonate decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              • tetracycline

                sodium bicarbonate decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

              Monitor Closely (93)

              • acebutolol

                sodium bicarbonate decreases levels of acebutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • alendronate

                sodium bicarbonate decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • allopurinol

                sodium bicarbonate decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • amantadine

                sodium bicarbonate will increase the level or effect of amantadine by Other (see comment). Modify Therapy/Monitor Closely. Urine pH changes towards alkalinic conditions may lead to an accumulation of amantadine with a possible increase in adverse reactions. Monitor for adverse reactions of amantadine.

              • ampicillin

                sodium bicarbonate will decrease the level or effect of ampicillin by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • atenolol

                sodium bicarbonate decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • azithromycin

                sodium bicarbonate decreases levels of azithromycin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • bearberry

                sodium bicarbonate will increase the level or effect of bearberry by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • benazepril

                sodium bicarbonate decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

              • benzphetamine

                sodium bicarbonate will increase the level or effect of benzphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • betaxolol

                sodium bicarbonate decreases levels of betaxolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • bisoprolol

                sodium bicarbonate decreases levels of bisoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • captopril

                sodium bicarbonate decreases effects of captopril by unspecified interaction mechanism. Use Caution/Monitor. Sodium bicarbonate may decrease absorption of captopril.

              • carbonyl iron

                sodium bicarbonate will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • carvedilol

                sodium bicarbonate decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • cefdinir

                sodium bicarbonate will decrease the level or effect of cefdinir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • cefditoren

                sodium bicarbonate will decrease the level or effect of cefditoren by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • cefpodoxime

                sodium bicarbonate will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • cefuroxime

                sodium bicarbonate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • celecoxib

                sodium bicarbonate decreases levels of celecoxib by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • celiprolol

                sodium bicarbonate decreases levels of celiprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • chenodiol

                sodium bicarbonate decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • chloroquine

                sodium bicarbonate will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate doses by at least 4 hr

              • ciprofloxacin

                sodium bicarbonate decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. A large proportion of ciprofloxacin is normally excreted unchanged in the urine. When urinary alkalinizing agents such as sodium bicarbonate are used concomitantly, the solubility of ciprofloxacin can be decreased because of alkaline urine. Patients should be monitored for crystalluria and nephrotoxicity.

              • crizotinib

                sodium bicarbonate decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

              • deferoxamine

                deferoxamine decreases levels of sodium bicarbonate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

              • deflazacort

                sodium bicarbonate and deflazacort both decrease serum potassium. Use Caution/Monitor.

              • dextroamphetamine

                sodium bicarbonate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • enalapril

                sodium bicarbonate decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.

              • ephedrine

                sodium bicarbonate will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • erythromycin base

                sodium bicarbonate increases levels of erythromycin base by unknown mechanism. Use Caution/Monitor.

              • erythromycin ethylsuccinate

                sodium bicarbonate increases levels of erythromycin ethylsuccinate by unknown mechanism. Use Caution/Monitor.

              • erythromycin lactobionate

                sodium bicarbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

              • erythromycin stearate

                sodium bicarbonate increases levels of erythromycin stearate by unknown mechanism. Use Caution/Monitor.

              • esmolol

                sodium bicarbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • etidronate

                sodium bicarbonate decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ferric maltol

                sodium bicarbonate will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous fumarate

                sodium bicarbonate will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous gluconate

                sodium bicarbonate will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ferrous sulfate

                sodium bicarbonate will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • flecainide

                sodium bicarbonate will increase the level or effect of flecainide by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • fosamprenavir

                sodium bicarbonate will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • fosinopril

                sodium bicarbonate decreases effects of fosinopril by unspecified interaction mechanism. Use Caution/Monitor.

              • gabapentin

                sodium bicarbonate decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • gabapentin enacarbil

                sodium bicarbonate decreases levels of gabapentin enacarbil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • glipizide

                sodium bicarbonate will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • glyburide

                sodium bicarbonate will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • ibandronate

                sodium bicarbonate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • imidapril

                sodium bicarbonate decreases effects of imidapril by unspecified interaction mechanism. Use Caution/Monitor.

              • iron dextran complex

                sodium bicarbonate will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • iron sucrose

                sodium bicarbonate will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • isoniazid

                sodium bicarbonate decreases levels of isoniazid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • itraconazole

                sodium bicarbonate decreases levels of itraconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • ketoconazole

                sodium bicarbonate decreases levels of ketoconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • labetalol

                sodium bicarbonate decreases levels of labetalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • lactulose

                sodium bicarbonate decreases effects of lactulose by pharmacodynamic antagonism. Use Caution/Monitor.

              • lisinopril

                sodium bicarbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

              • memantine

                sodium bicarbonate will increase the level or effect of memantine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • methscopolamine

                sodium bicarbonate decreases levels of methscopolamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • metoprolol

                sodium bicarbonate decreases levels of metoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • mexiletine

                sodium bicarbonate will increase the level or effect of mexiletine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

              • moexipril

                sodium bicarbonate decreases effects of moexipril by unspecified interaction mechanism. Use Caution/Monitor.

              • mycophenolate

                sodium bicarbonate will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • nadolol

                sodium bicarbonate decreases levels of nadolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • nebivolol

                sodium bicarbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • nitrofurantoin

                sodium bicarbonate decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • omadacycline

                sodium bicarbonate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • pamidronate

                sodium bicarbonate decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • penbutolol

                sodium bicarbonate decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • penicillamine

                sodium bicarbonate decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • perindopril

                sodium bicarbonate decreases effects of perindopril by unspecified interaction mechanism. Use Caution/Monitor.

              • pindolol

                sodium bicarbonate decreases levels of pindolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • polysaccharide iron

                sodium bicarbonate will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • posaconazole

                sodium bicarbonate will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • propranolol

                sodium bicarbonate decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • pseudoephedrine

                sodium bicarbonate will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

              • quinapril

                sodium bicarbonate decreases effects of quinapril by unspecified interaction mechanism. Use Caution/Monitor.

              • quinidine

                sodium bicarbonate will increase the level or effect of quinidine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Elevated quinidine plasma levels, possibly with cardiac conduction disturbances and arrhythmias, may occur.

              • ramipril

                sodium bicarbonate decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

              • rifampin

                sodium bicarbonate will decrease the level or effect of rifampin by Other (see comment). Use Caution/Monitor. Concomitant antacid administration may reduce absorption of rifampin; daily doses of rifampin should be given at least 1 hr before ingestion of antacids

              • riociguat

                sodium bicarbonate decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

              • risedronate

                sodium bicarbonate decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • rose hips

                sodium bicarbonate will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • rosuvastatin

                sodium bicarbonate decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sarecycline

                sodium bicarbonate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol

                sodium bicarbonate and sodium sulfate/potassium sulfate/magnesium sulfate/polyethylene glycol both decrease serum potassium. Modify Therapy/Monitor Closely.

              • sotalol

                sodium bicarbonate decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • tiludronate

                sodium bicarbonate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • timolol

                sodium bicarbonate decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • tolbutamide

                sodium bicarbonate will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

              • trandolapril

                sodium bicarbonate decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.

              • ursodiol

                sodium bicarbonate decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.

              • zoledronic acid

                sodium bicarbonate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              Minor (15)

              • aspirin

                sodium bicarbonate, aspirin. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • aspirin rectal

                sodium bicarbonate, aspirin rectal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • aspirin/citric acid/sodium bicarbonate

                sodium bicarbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • balsalazide

                sodium bicarbonate, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • blessed thistle

                blessed thistle decreases effects of sodium bicarbonate by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

              • choline magnesium trisalicylate

                sodium bicarbonate, choline magnesium trisalicylate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • chromium

                sodium bicarbonate decreases levels of chromium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

              • devil's claw

                devil's claw decreases effects of sodium bicarbonate by pharmacodynamic antagonism. Minor/Significance Unknown.

              • diflunisal

                sodium bicarbonate, diflunisal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • mesalamine

                sodium bicarbonate, mesalamine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • salicylates (non-asa)

                sodium bicarbonate, salicylates (non-asa). Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • salsalate

                sodium bicarbonate, salsalate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • strontium ranelate

                sodium bicarbonate decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hr when possible.

              • sulfasalazine

                sodium bicarbonate, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

              • willow bark

                sodium bicarbonate, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

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              Adverse Effects

              Frequency Not Defined

              Aggravated CHF

              Cerebral hemorrhage

              Edema

              Hypernatremia

              Hypocalcemia

              Hypokalemia

              Tetany

              Metabolic alkalosis

              Belching

              Gastric distension

              Pulmonary edema

              Hypernatremia

              Hyperosmolality

              Intracranial acidosis

              Milk-alkali syndrome

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              Warnings

              Contraindications

              Hypersensitivity

              Injection

              • Chloride loss due to vomiting or from continuous gastrointestinal suction
              • Currently treated with diuretics

              Cautions

              Not first-line for resuscitation

              Use with caution in patients with congestive heart failure, severe renal insufficiency, edematous or sodium-retaining states, HTN, children with DKA, and concurrent corticosteroid use

              IV administration can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema

              Avoid extravasation (may cause chemical cellulitis, tissue necrosis, ulceration & sloughing due to alkalinity)

              Potassium depletion may predispose to metabolic alkalosis and coexistent hypocalcemia may be associated with carpopedal spasm as plasma pH rises; treat appropriately before or during the infusion to minimize the risk of such electrolyte imbalance

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              Pregnancy & Lactation

              Pregnancy

              Unknown if fetal harm may occur when administered to pregnant females or can affect reproduction capacity

              Use if clearly needed

              Lactation

              Unknown if excreted in breast milk

              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.

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              Pharmacology

              Mechanism of Action

              Bicarbonate reacts with H+ ions to form water & carbon dioxide. It acts as a buffer against acidosis by raising blood pH

              Pharmacokinetics

              Onset: 15 min (IV)

              Duration: 1-2 hr (IV); 8-10 min (PO)

              Therapeutic range: 24-31 mEq/L

              Excretion: Urine

              Absorption: Well absorbed orally

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              Administration

              IV Incompatibilities

              Additive: ascorbic acid, carboplatin, carmustine, ciprofloxacin, cisplatin, dobutamine, dopamine, epinephrine, hydromorphone, imipenem-cilastatin, labetalol, meperidine (?), meropenem, morphine, norepinephrine, penicillin G potassium, pentazocine, pentobarbital, procaine, sodium lactate, streptomycin, succinylcholine, vancomycin(?), vit B/C

              Syringe: bupivacaine(?), epinephrine(?), etidocaine, glycopyrrolate, lidocaine(?), mepivacaine, metoclopramide, thiopental

              Y-site: allopurinol, amiodarone, ampho B cholesterylSO4, CaCl2, Ca gluconate, ciprofloxacin(?), cisatarcurium(?), doxorubicin liposomal, fenoldopam, hetastarch, idarubicin, imipenem-cilastatin, inamrinone, leucovorin, midazolam, nalbuphine, ondansetron, oxacillin, sargramostim, verapamil, vincristine, vindesine, vinorelbine

              Not spec: diazepam, tetracycline

              IV Compatibilities

              Additive: aminophylline, ampho B, atropine, Ca gluconate, clindamycin, erythromycin, heparin, hydrocortisone, KCl, verapamil

              Syringe: heparin

              Y-site: heparin, morphine, KCl, vancomycin, vit B/C

              IV Administration

              Direct IV infusion for emergencies (eg, cardiac arrest): Rapid IV dose of 1-2 vials of 50 mL (44.6-100 mEq) initially and continued at a rate of 50 mL (44.6 to 50 mEq) every 5-10 minutes if necessary

              Diluted solutions: Infuse over at least 2 hr (not to exceed 1 mEq/kg/hr)

              Storage

              Unused vials

              • Store at controlled room temperature
              • Protect from freezing & temp >40ºC
              • Do not use if unclear or contains a precipitate

              Tablets

              • Store at 20-25ºC (68-77ºF)
              • Keep out of reach of children
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              sodium bicarbonate intravenous
              -
              4.2 % (0.5 mEq/mL) solution
              sodium bicarbonate intravenous
              -
              7.5 % (0.9 mEq/mL) solution
              sodium bicarbonate intravenous
              -
              10 mEq/10 mL (8.4 %) solution
              sodium bicarbonate intravenous
              -
              4.2 % vial
              sodium bicarbonate intravenous
              -
              1 mEq/mL (8.4 %) vial
              sodium bicarbonate intravenous
              -
              1 mEq/mL (8.4 %) vial
              sodium bicarbonate intravenous
              -
              1 mEq/mL (8.4 %) vial
              sodium bicarbonate intravenous
              -
              8.4 % (1 mEq/mL) solution
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              325 mg tablet
              sodium bicarbonate oral
              -
              325 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              325 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              650 mg tablet
              sodium bicarbonate oral
              -
              325 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              sodium bicarbonate intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.