Sodium bicarbonate
NaHCO₃
Pronunciation: SOE-dee-um bye-KAR-bon-ayt
What it isAlkalinizing agent; metabolic acidosis, urinary alkalinization and sodium channel blocker overdose.
Why this oneIt is the antidote for tricyclic and other sodium channel blocker cardiotoxicity, working by both pH and sodium load.
What limits itHypernatremia, volume overload and hypokalemia. Paradoxical intracellular acidosis if ventilation is inadequate.
FDA-approved for
- metabolic acidosis
- antacid (OTC)
Off-label
- urinary alkalinization in salicylate overdose
- serum alkalinization in tricyclic overdose
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Antacid (acid indigestion/upset stomach) | Adults | 1 tablet dissolved in water PRN | 24 tablets/day (≤60 yr); 12 tablets/day (>60 yr) |
Renal Undefined
Hepatic Undefined
Max daily dose 24 tablets (≤60 yr) or 12 tablets (>60 yr)
Instructions
- Dissolve tablet completely in a glass of water before drinking
- Do not take when overly full from food or drink
- Not recommended for children
Available strengths
- tab 325, 391, 648, 650, 782, 977.5, 978, 2860/65 mg
- powder 2.6 g/2.6 g
- powder 2.616 g/2.616 g
- powder 1 g/g
- powder 22.8/77.8 mg/100 mg
- powder 700/2300 mg/3000 mg
- powder 315, 616, 1000 mg/g
- sol 5, 8.4 g/100 mL
- + 15 other marketed forms not shown
Cautions
- Do not take until the tablet is completely dissolved
- Do not take when overly full from food or drink
- Consult a doctor if severe stomach pain occurs after taking
Pregnancy Undefined
Lactation Undefined
Cost
| Strength | #/mo | generic $/unit | brand $/unit | CostPlus | |
|---|---|---|---|---|---|
| 325 mg | tab | per unit | $0.01/ea | — | not offered |
| 391 mg | tab | per unit | $0.45/ea | — | not offered |
| 648 mg | tab | per unit | — | not offered | |
| 650 mg | tab | per unit | $0.01/ea | — | not offered |
| 782 mg | tab | per unit | $0.52/ea | — | not offered |
| 977.5 mg | tab | per unit | $0.36/ea | — | not offered |
| 978 mg | tab | per unit | — | $0.86/ea | not offered |
| 2860/65 mg | tab | per unit | — | not offered |
Available combined with: PEG 3350/ electrolytes (GOLYTELY)
Generic entry2005
NO BOXED WARNINGS
Principal riskHypernatremia, volume overload and hypokalemia
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityUsually well tolerated at replacement doses; excessive dosing can cause agent-specific metabolic or organ toxicity.
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