(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 -	8.4 % (1 mEq/mL) solution
sodium bicarbonate intravenous -	1 mEq/mL (8.4 %) vial
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

Patient Handout

Select a drug:

SODIUM BICARBONATE - ORAL

(SOE-dee-um bye-KAR-bo-nate)

USES: Sodium bicarbonate reduces stomach acid. It is used as an antacid to treat heartburn, indigestion, and upset stomach. Sodium bicarbonate is a very quick-acting antacid. It should be used only for temporary relief. If you need to treat long-term stomach acid problems (such as peptic ulcer disease, GERD), talk with your doctor about other medications.Sodium bicarbonate is the active ingredient in baking soda.

HOW TO USE: Take this medication by mouth, usually every 4 hours as needed or as directed by your doctor. Some tablets should be dissolved in a glass of water before swallowing. Other tablets may be swallowed whole or dissolved in water before swallowing. Follow all directions on the product package for the product you are taking. If you have any questions, ask your doctor or pharmacist.If you are self-treating and your acid problems last or get worse after you have used this product for 2 weeks, or if you think you may have a serious medical problem, get medical help right away. If you are using this medication regularly on a daily basis for more than 2 weeks, you may have a medical problem that needs different treatment. Ask your doctor if this is the right medication for you.If your doctor has directed you to take this medication for acidosis or to alkalinize your urine, your dosage is based on your medical condition and response to treatment. To get the most benefit from this medication, take it regularly, exactly as directed. It is usually taken by mouth several times a day. To help you remember, take it at the same times each day. Do not increase the dose, take it more often, or continue taking this for longer than prescribed.

SIDE EFFECTS: Nausea, bloating, or gas may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: swelling hands/ankles/feet, unusual weight gain.When taken with sodium bicarbonate, large doses of calcium from your diet, medications, or supplements can rarely cause a serious problem called milk-alkali syndrome. Ask your doctor or pharmacist about using calcium products safely while you are using this medication. Tell your doctor right away if you have any serious side effects, including: dizziness, muscle aches/spasms, mental/mood changes (such as confusion, irritability, memory problems), vomiting, weakness, signs of kidney problems (such as change in the amount of urine).Get medical help right away if you have any very serious side effects, including: chest pain, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or 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: Before taking sodium bicarbonate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, heart failure, low calcium levels, swollen ankles/legs/feet due to retaining water (peripheral edema).Because this medication contains salt (sodium), do not use it if you are on a salt-restricted diet.During pregnancy, this medication should be used only when clearly needed. This medication may worsen high blood pressure during pregnancy. Discuss the risks and benefits with your doctor.This medication may pass into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug are: aspirin and other salicylates (such as salsalate), corticosteroids (such as prednisone), memantine, medications with a special coating to protect the stomach (enteric coating).This medication can decrease the effectiveness of certain drugs that need stomach acid to work, including ampicillin, atazanavir, certain azole antifungals (such as ketoconazole, itraconazole), iron supplements, pazopanib, sucralfate, among others. Before using this medication, ask your doctor or pharmacist how to manage this possible interaction.If your doctor has directed you to take low-dose aspirin for heart attack or stroke prevention (usually 81-162 milligrams a day), you should continue taking it unless your doctor instructs you otherwise. Ask your doctor or pharmacist for more details.

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. Symptoms of overdose may include: muscle spasms, seizures.

NOTES: Lab and/or medical tests (such as calcium/potassium/sodium levels, bicarbonate levels) should be done if you are taking large doses or taking this medication for more than 2 weeks. Keep all medical and lab appointments. Consult your doctor for more details.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.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.

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

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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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