(sodium bicarbonate (Antidote)) dosing, indications, interactions, adverse effects, and more

Sections

Sections sodium bicarbonate (Antidote)
Dosing & Uses
Adverse Effects
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

IV solution

4%
4.2%
7.5%
8.4%

Cocaine Toxicity

1-2 mEq/kg IV push bolus

Cyanide Toxicity

1-2 mEq/kg IV push bolus

Salicylate Toxicity

100-150 mEq IV with 40-80 mEq of potassium chloride in each liter of D5W; administer at 150-250 mL/hr to maintain higher than normal urine output

Barbiturate Toxicity

1 mEq/kg IV bolus, followed by an IV drip of 1000 mL of D5W to which 2-3 ampules of sodium bicarbonate are added, initiate drip rate at 200 mL/hr, titrate drip rate to blood pH (7.45) and urinary pH (7.5-8)

Cardiac Arrest

Initial: 1 mEq/kg/dose IV push bolus

Maintenance: 0.5 mEq/kg/dose q10min or as indicated by arterial blood gases

Tricyclic Antidepressant Toxicity

Use if QRS >100-200 ms or hypotension

Initial bolus: 1-2 mEq/kg IV push over 1-2 minutes; not to exceed 100 mEq/dose

Follow-up infusion: 100-150 mEq in 1 L D5/0.45% NaCl infused 100-200 mL/hr IV; titrate infusion to achieve blood pH of 7.45-7.55

Other Indications & Uses

All Class 1 antidysryhthmics (quinidine, procainamide, encainide, flecainide; cardiac conduction defect)

Antihistamines (H1 blockers & nonsedating varieties)

Amantidine

Ethylene glycol, methanol

Na+ channel blocking drugs in general

Salicylates, phenobarbital, chlorpropamide (see Urinary Alkalinization)

Dosage Forms & Strengths

IV solution

4%
4.2%
7.5%
8.4%

Metabolic Acidosis

Dosage based on blood gases and pH measurements (if available)

If acid-base status unavailable, older children may receive 2-5 mEq/kg IV infusion over 4-8 hr; titrate infusion rate to maintain pH of 6-7

Frequency Not Defined

Tetany

Hypernatremia

Alkalosis

Gastric distension

Hypocalcemia

Hyperosmolality

Milk-alkali syndrome

Pulmonary edema

Pregnancy & Lactation

Pregnancy Category: C

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.

Mechanism of Action

Increases blood and urinary pH by releasing a bicarbonate ion, which in turn neutralizes hydrogen ion concentrations

1g of sodium bicarbonate is equivalent to 11.9 mEq each of sodium and bicarbonate

Pharmacokinetics

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

Excretion: Urine (<1%)

Onset of action: Rapid (PO); 15 min (IV)

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 -	325 mg tablet
sodium bicarbonate oral -	650 mg tablet
sodium bicarbonate oral -	650 mg tablet

Patient Handout

Select a drug:

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.

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.

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.

Create Your List of Plans

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.

View explanations for tiers and restrictions

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.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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