Sodium Bicarbonate raises the blood and urine PH by neutralizing the Hydrogen ions. It is commonly known as "Baking Soda" and is used for a variety of medical problems including its use as a "quick-relief" home remedy for heartburn.

Sodium bicarbonate uses:

• It is used for management of
  • metabolic acidosis
  • hyperkalemia
  • overdose of certain drugs, including tricyclic antidepressants/aspirin
  • gastric hyperacidity
  • urine alkalinization
• Neutralizing additive (dental use):
  • It is helpful in reducing injection site pain by adjustment of lidocaine with epinephrine solution to appropriate physiologic pH and also enhances its analgesic effect.
• Off Label Use of Sodium Bicarbonate in Adults:
  • It can be used for preventing contrast induced nephropathy

Sodium bicarbonate dose in adults:

Note:

• 1 milliequivalent (mEq) of sodium bicarbonate is equivalent to 84 milligrams (mg).
• Each gram of sodium bicarbonate provides around 12 mEq of both sodium and bicarbonate ions.
• Each tablet, when taken orally and weighing 650 mg, contains 7.7 mEq of both sodium and bicarbonate ions.

This information helps in understanding how much sodium and bicarbonate you're getting from a specific amount of sodium bicarbonate, whether in powder or tablet form.

Sodium bicarbonate dose in Cardiac arrest:

In the treatment of cardiac arrest, as per the Advanced Cardiac Life Support (ACLS) guidelines from 2010, the use of sodium bicarbonate (NaHCO3) is specific and somewhat limited:

• Dosage: Initially, an intravenous (IV) dose of 1 milliequivalent (mEq) per kilogram (kg) of body weight is recommended. Any subsequent doses should be guided by the results of arterial blood gas analyses, which measure the acidity, oxygen, and carbon dioxide levels in the blood.
• Routine Use: Sodium bicarbonate is generally not recommended for routine use during cardiac arrest. It should be considered mainly in specific situations where the benefits outweigh the risks.
• Specific Situations for Use:
  • Prolonged Cardiac Arrest: Sodium bicarbonate may be considered if the cardiac arrest is prolonged, but only after ensuring that the patient has adequate ventilation (breathing support) and effective cardiac compressions are being performed.
  • Special Circumstances: It might be beneficial in cases of cardiac arrest accompanied by metabolic acidosis (when the body produces too much acid or the kidneys are not removing enough acid from the body), hyperkalemia (high potassium levels in the blood), or an overdose of tricyclic antidepressants (a class of medications primarily used to treat depression and certain other conditions).

These guidelines stress the importance of tailoring the use of sodium bicarbonate to the specific needs and conditions of the patient, rather than using it routinely.

Sodium bicarbonate dose in the treatment of Metabolic acidosis in patients with chronic kidney disease:

In managing metabolic acidosis in patients with chronic kidney disease (CKD), sodium bicarbonate can be administered both orally and intravenously, depending on the severity and specifics of the patient's condition.

Oral Administration for CKD:

Guidelines: According to KDIGO 2013, oral sodium bicarbonate supplementation is recommended when plasma bicarbonate (HCO3) levels are below 22 mEq/L.

Initial Dosing:

• Start with 15.4 to 23.1 mEq per day, divided into multiple doses. For example, a 650 mg tablet taken 2 to 3 times daily is typical.
• Adjust the dose to maintain normal serum bicarbonate levels, typically between 23 to 29 mEq/L, without exceeding a total of 5850 mg per day.

Alternative: Baking soda can be used if tablets are not suitable.

Caution: Avoid increasing serum bicarbonate concentrations above 32 mEq/L as this has been associated with increased mortality in CKD patients.

Intravenous Administration for Metabolic Acidosis:

Dosage Calculation:

• If blood gases and pH measurements are available, the dosage can be calculated using the formula: HCO3 (mEq)=0.5×weight (kg)×[24−serum HCO3 (mEq/L)]HCO3 (mEq)=0.5×weight (kg)×[24−serum HCO3 (mEq/L)] or HCO3 (mEq)=0.5×weight (kg)×[desired increase in serum HCO3 (mEq/L)]HCO3 (mEq)=0.5×weight (kg)×[desired increase in serum HCO3 (mEq/L)]
• The initial dose should be administered promptly, followed by the remainder over the next 24 hours.

Monitoring:

• Regular monitoring of pH, serum bicarbonate levels, and clinical status is essential to avoid over-alkalinization and adjust treatment as needed.

Without Blood Gas Data:

• If specific acid-base status measurements are not available, start with a dosage of 2 to 5 mEq/kg given as an IV infusion over 4 to 8 hours, and adjust subsequent doses based on the patient's evolving acid-base status.

These treatment strategies aim to correct the bicarbonate levels in the body without causing overshoot into alkalosis, thereby stabilizing the patient’s condition in a controlled manner.

Sodium bicarbonate dose in the treatment of Hyperkalemia:

• IV Administration: Administer 50 mEq of sodium bicarbonate intravenously over 5 minutes.

This dose can help to temporarily reduce potassium levels in the blood, but it is typically part of a broader strategy to manage hyperkalemia. Other treatments may be needed to more permanently remove potassium from the body, including:

• Diuretics: Encourage the kidneys to excrete more potassium.
• Cation exchange resins: These bind potassium in the gastrointestinal tract for elimination in the stool.
• Dialysis: This is especially effective in severe cases, particularly if the patient has renal failure, as it directly removes potassium from the blood.

Sodium bicarbonate Dose in the treatment of Renal tubular acidosis:

Distal Renal Tubular Acidosis (Type 1):

• Dosing: Administer sodium bicarbonate in a dosage of 0.5 to 2 mEq per kilogram of body weight per day.
• Frequency: This dosage should be divided into 4 to 5 doses throughout the day to optimize absorption and minimize gastrointestinal side effects.

Proximal Renal Tubular Acidosis (Type 2):

• Initial Dosing: Start with 5 to 10 mEq per kilogram per day.
• Maintenance Dosing: Adjust the dose as necessary to maintain serum bicarbonate levels within the normal range. This often requires higher doses compared to distal RTA because the proximal tubule is less efficient at reabsorbing bicarbonate, and therefore, a greater quantity may be needed to achieve normal blood levels.

Sodium bicarbonate dose for Urine alkalinization:

Oral Administration for Urine Alkalinization:

• Initial Dose: Begin with 48 mEq (equivalent to 4 grams) of sodium bicarbonate.
• Subsequent Dosing: Continue with 12 to 24 mEq (1 to 2 grams) every 4 hours.
• Dose Adjustment: The dose should be adjusted to achieve the desired urinary pH level. Frequent urine pH testing is necessary to ensure that the urinary pH is within the target range and to adjust the dosing accordingly.
• Maximum Dose:
  • For patients under 60 years old: Up to 16 grams per day (200 mEq).
  • For patients over 60 years old: Up to 8 grams per day (100 mEq).
• Study Reference: In a study mentioned by Cohen (2013), administering 48 mEq (4 grams) every 8 hours for a total daily dose of 144 mEq (12 grams) successfully maintained a urinary pH of at least 7 after 10 hours in healthy volunteers.

Intravenous Administration:

• Indications: IV administration is preferred in cases of specific overdoses, such as salicylate poisoning, where rapid adjustments in urinary pH are crucial.
• Target Urinary pH: The goal is to achieve a urinary pH between 7.5 to 8.5, which helps in increasing the renal clearance of the toxin.

Sodium bicarbonate dose as an Antacid:

Oral Dosage for Antacid Use:

• Dose Range: From 325 mg to 2 grams per dose.
• Frequency: This dosage can be taken 1 to 4 times per day, depending on the severity of symptoms.

Sodium bicarbonate dose to Neutralize lidocaine with epinephrine dental anesthetic:

Neutralizing Lidocaine with Epinephrine Dental Anesthetic:

• Neutralizing Additive: Mix 10 parts of the anesthetic solution (lidocaine with epinephrine) with 1 part of 8.4% sodium bicarbonate.

Instructions for Different Volumes of Lidocaine with Epinephrine Solution:

• For a 1.8 mL Cartridge of Lidocaine 2% with Epinephrine 1:50,000 or 1:100,000:
  • Add 0.18 mL of 8.4% sodium bicarbonate to the cartridge.
• For a 20 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 2 mL of 8.4% sodium bicarbonate to the vial.
• For a 30 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 3 mL of 8.4% sodium bicarbonate to the vial.
• For a 50 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 5 mL of 8.4% sodium bicarbonate to the vial.

These instructions ensure that the lidocaine with epinephrine solution is properly neutralized before administration. It's important to follow these guidelines carefully to avoid any adverse effects or complications during dental procedures.

Sodium bicarbonate dose in the Prevention of contrast-induced nephropathy (off-label):

Intravenous Infusion of Sodium Bicarbonate:

• Solution Concentration: Prepare a solution containing 154 milliequivalents (mEq) per liter of sodium bicarbonate in dextrose in water (D W) solution.
• Infusion Rate:
  • Before Contrast Injection: Administer at a rate of 3 milliliters per kilogram per hour for 1 hour immediately before the administration of contrast.
  • During and After Contrast Exposure: Reduce the infusion rate to 1 milliliter per kilogram per hour during the contrast exposure and for 6 hours following the procedure.

Prophylactic Strategy:

• Risk Assessment: Some protocols consider the patient's risk factors for contrast-induced nephropathy and the type of procedure being performed to determine the need for prophylactic treatment.
• Individualized Approach: The decision to use sodium bicarbonate for prevention may vary based on factors such as the patient's renal function, comorbidities, and the type of contrast agent being used.

Sodium bicarbonate dose in children:

Note: Dose should be adjusted to patient response and target parameters for condition being treated.

Sodium bicarbonate dose as an Antacid:

Dosage for Children (5 years and older) and Adolescents:

• Form: Sodium bicarbonate is available as an oral powder.
• Dosage: Take one teaspoonful per dose.
• Frequency: It can be taken as needed, but not more often than every 2 hours.
• Limit: Do not take more than 7 doses in a 24-hour period.
• Duration: It's best not to use sodium bicarbonate as an antacid for longer than 2 weeks.

Important Note:

• Avoid Chronic Use: Using sodium bicarbonate as a long-term solution for managing GERD (gastroesophageal reflux disease) in children is not recommended by medical guidelines.

Sodium bicarbonate dose in children with Cardiac arrest (PALS guidelines):

Dosage for Infants, Children, and Adolescents:

• Route: Intravenous (IV) or intraosseous (IO) administration.
• Dosage: 1 milliequivalent (mEq) per kilogram (kg) of body weight per dose.
• Solution Strength:
  • For infants and children under 2 years old: Use a 4.2% solution, which is equivalent to 0.5 mEq per milliliter (mL).
• Guidance for Repeat Doses: Subsequent doses should be guided by arterial blood gas analysis, which helps assess the body's acid-base balance.

Important Notes:

• Caution on Routine Use: Sodium bicarbonate is not routinely recommended for cardiac arrest treatment. It may be considered only in cases of prolonged cardiac arrest, after ensuring adequate ventilation and effective chest compressions.
• Specific Situations: Sodium bicarbonate might be beneficial in certain cardiac arrest scenarios, such as metabolic acidosis, hyperkalemia, or tricyclic antidepressant overdose.

Sodium bicarbonate dose in children with acidosis due to chronic kidney disease (CKD):

For infants, children, and adolescents:

Dosage Calculation:

• Initial Dose: The initial dose is calculated based on the following equation: HCO3 (mEq)=0.5×weight (kg)×[desired HCO3 (mEq/L)−serum HCO3 (mEq/L)]HCO3 (mEq)=0.5×weight (kg)×[desired HCO3 (mEq/L)−serum HCO3 (mEq/L)]
• Target Serum Bicarbonate Levels:
  • Children: Targeted normal range is typically 22 to 23 mEq/L.
  • Adults: Targeted normal range is typically 24 to 25 mEq/L.
• Adjustment: The dose should be adjusted to maintain serum bicarbonate within the targeted normal range. Divide the total daily dose into smaller doses if needed for better tolerability.

Important Considerations:

• Serum Bicarbonate Levels: Sodium bicarbonate treatment is initiated if serum bicarbonate levels fall below 22 mEq/L.
• Monitoring: Regular monitoring of serum bicarbonate levels is necessary to ensure they remain within the target range.
• Growth Considerations: Undertreatment should be avoided as acidosis can negatively impact growth in children.

Example:

If a child weighs 20 kg and has a serum bicarbonate level of 20 mEq/L, and the desired target is 23 mEq/L, the initial dose calculation would be: HCO3 (mEq)=0.5×20×(23−20)=30 mEqHCO3 (mEq)=0.5×20×(23−20)=30 mEq

This calculated dose would then be divided into smaller doses throughout the day for administration.

Sodium bicarbonate dose in the management of Hyperkalemia in children:

For infants, children, and adolescents:

Dosage:

• Intravenous (IV): Administer 1 to 2 milliequivalents (mEq) per kilogram (kg) of body weight per dose.

Effectiveness:

• Mechanism: Sodium bicarbonate works by redistributing potassium from the extracellular space into cells.
• Limited Data: While sodium bicarbonate has been used for this purpose, its effectiveness in rapidly lowering serum potassium levels within a short timeframe (e.g., within 60 minutes) is variable and not well-established.
• Long Duration Infusion: In some cases, a long-duration hypertonic bicarbonate infusion (e.g., 150 mEq/L in D5W) has shown some efficacy, particularly when used as rehydration fluid or in the presence of metabolic acidosis.

• Limited Evidence: Due to limited data on its efficacy and variable results in rapidly lowering serum potassium levels, sodium bicarbonate should be used cautiously as an adjunct therapy for hyperkalemia.

Sodium bicarbonate dose in the treatment of acute Metabolic acidosis:

In infants, children, and adolescents, sodium bicarbonate can be administered intravenously.

Blood-Gas Directed Dosing:

• Equations: Two equations are commonly used to estimate the replacement dose based on the patient's weight and base deficit or serum bicarbonate levels.
  • HCO3 (mEq)=0.3×weight (kg)×base deficit (mEq/L)HCO3 (mEq)=0.3×weight (kg)×base deficit (mEq/L)
  • HCO3 (mEq)=0.5×weight (kg)×[24−serum HCO3 (mEq/L)]HCO3 (mEq)=0.5×weight (kg)×[24−serum HCO3 (mEq/L)]
• Administration: Administer the calculated dose initially, then continue with the remaining dose over the next 24 hours.
• Monitoring: Regular monitoring of pH, serum bicarbonate levels, and clinical status is crucial.

Weight-Directed Dosing (If Acid-Base Status Not Available):

• Infants, Children, and Adolescents:
  • IV or intraosseous administration:
    • Infants and younger children: 1 to 2 mEq/kg/dose.
    • Older children (>2 years) and adolescents: 2 to 5 mEq/kg IV infusion over 4 to 8 hours.
  • Subsequent doses should be based on the patient's acid-base status.

• Individualized Treatment: The dosage may vary based on the severity and underlying cause of acidosis.
• Prevention of Over-Alkalinization: The initial goal of therapy is typically to target a pH of around 7.2 to prevent over-alkalinization.

Caution:

• Careful Monitoring: Careful monitoring of the patient's response and acid-base status is necessary to avoid overcorrection or complications.

NaHCO3 dose to Neutralize local (dental) anesthetic (lidocaine with epinephrine):

Neutralizing Additive:

• Mixing Ratio: Combine 10 parts of the anesthetic solution (lidocaine with epinephrine) with 1 part of 8.4% sodium bicarbonate.

Neutralization Doses:

• For a 1.8 mL Cartridge of Lidocaine 2% with Epinephrine 1:50,000 or 1:100,000:
  • Add 0.18 mL of 8.4% sodium bicarbonate to the cartridge.
• For a 20 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 2 mL of 8.4% sodium bicarbonate to the vial.
• For a 30 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 3 mL of 8.4% sodium bicarbonate to the vial.
• For a 50 mL Vial of Lidocaine 2% with Epinephrine 1:100,000:
  • Add 5 mL of 8.4% sodium bicarbonate to the vial.

Important Note:

• Mixing the lidocaine with epinephrine and sodium bicarbonate in the correct proportions ensures proper neutralization and helps mitigate any discomfort or adverse effects from the local anesthetic

Sodamint (NaHCO3) dose in patients with Renal tubular acidosis (RTA):

Distal RTA (Type 1):

• Infants:
  • Oral: Usual range: 5 to 8 milliequivalents (mEq) per kilogram per day.
  • Reported Range: 3.9 to 10 mEq/kg/day.
• Children and Adolescents:
  • Oral:
    • Initial: At least 3 mEq/kg/day.
    • Usual Initial Range: 3 to 4 mEq/kg/day.
    • Titration: Adjust the dose as necessary based on response.

Proximal RTA (Type 2):

• Infants, Children, and Adolescents:
  • Oral:
    • Initial: 5 to 10 mEq/kg/day in divided doses.
    • Usual Range: 10 to 20 mEq/kg/day.
    • Titration: Adjust the dose as necessary to achieve the target serum bicarbonate levels.

Important Considerations:

• Individualized Approach: Dosing should be individualized based on factors such as age, severity of acidosis, and response to treatment.
• Undertreatment Avoidance: Avoid undertreatment to prevent negative effects of acidosis on growth and overall health.

NaHCO3 dose as a Skin protectant and for the relief of minor irritation:

For children aged 2 years and older:

Topical Application:

• Oral Powder (Baking Soda):
  • Bath Soak:
    • Dissolve 1 to 2 cups of baking soda in a tub of warm water.
    • Soak the affected area for 10 to 30 minutes.
    • Pat the skin dry gently after soaking.
  • Compress or Wet Dressing:
    • Mix baking soda powder with water to create a mixture.
    • Soak a clean, soft cloth with the mixture.
    • Apply the cloth loosely to the affected area for 15 to 30 minutes.
    • Repeat as needed or as directed by a physician.
  • Paste:
    • Mix baking soda powder with water to form a paste.
    • Apply the paste to the affected area of the skin as needed.

Important Note:

• Physician Notification: If there is no resolution of symptoms within 7 days, or if symptoms reappear after an initial resolution, it's important to notify a physician for further evaluation and guidance.

NaHCO3 dose in the treatment of Tricyclic antidepressant overdose:

For infants, children, and adolescents:

Dosage:

• Intravenous (IV) or Intraosseous (IO): Administer 1 to 2 milliequivalents (mEq) per kilogram (kg) per dose.

Administration:

• Titration: Adjust the dose as necessary to maintain serum pH between 7.45 to 7.55.
• Infusion: Follow with an infusion of 150 mEq of sodium bicarbonate per liter (L) to maintain the targeted pH level.

Important Note:

• Limited Data: There is limited data available regarding the specific use of sodium bicarbonate for TCA overdose. Treatment decisions should be made based on the patient's clinical condition and response to therapy.

Pregnancy Risk Category: C

• Animal studies on medication effects during pregnancy haven't been conducted.
• Treatments for cardiac arrest in pregnant women are the same as those for non-pregnant women, following current guidelines.
• Medications should be administered as needed without concern for potential harm to the fetus, based on Advanced Cardiovascular Life Support recommendations.
• However, antacids with sodium bicarbonate are not recommended during pregnancy because they could lead to metabolic alkalosis and fluid overload, posing risks to both the mother and the baby.

Use during breastfeeding:

• Sodium is indeed present in breast milk, as indicated by the Institute of Medicine in 2004.
• It's one of the essential nutrients naturally provided to infants through breastfeeding, supporting their growth and development.

Dose adjustment in renal disease:

• The manufacturer's labeling does not include specific dosage adjustments for individuals with renal impairment.
• However, caution should be exercised when prescribing this medication in such cases, as it has the potential to cause sodium retention.

Dose adjustment in liver disease:

• The manufacturer's labeling does not include specific dosage adjustments for individuals with hepatic impairment.
• However, caution is advised when prescribing this medication in such cases, particularly in clinical conditions associated with edema and sodium retention.

Side effects of sodium bicarbonate:

• Cardiovascular:
  • Cardiac Failure (Exacerbation)
  • Edema
• Central Nervous System:
  • Cerebral Hemorrhage
• Endocrine & Metabolic:
  • Acidosis (Intracranial)
  • Hypernatremia
  • Hypocalcemia
  • Hypokalemia
  • Metabolic Alkalosis
  • Milk-Alkali Syndrome (Especially With Renal Dysfunction)
• Gastrointestinal:
  • Abdominal Distention
  • Eructation
  • Flatulence (Oral Administration)
• Neuromuscular & Skeletal:
  • Tetany
• Respiratory:
  • Pulmonary Edema

Contraindication to Sodium bicarbonate:

• Alkalosis, hypernatremia, severe pulmonary edema, hypocalcemia, and unknown abdominal pain are all conditions that require careful consideration and appropriate medical management.
• It's important to note that sodium bicarbonate, often used as a neutralizing additive in dental procedures, should not be used as a systemic alkalizer.
• Instead, it should be used exclusively for its intended dental purpose and not for treating systemic conditions.

Warnings and precautions

Extravasation:

• During intravenous administration, sodium bicarbonate at concentrations equal to or greater than 8.4% can act as a vesicant, potentially causing tissue damage if it leaks into surrounding tissues.
• To prevent this complication, it's crucial to ensure the proper positioning of the catheter or needle before and during infusion.
• Careful monitoring of the infusion site is essential to detect any signs of extravasation, and immediate action should be taken if leakage occurs.
• Avoiding extravasation is critical as tissue necrosis may result from the hypertonic nature of the solution.

Cirrhosis

• In patients with cirrhosis, caution should be exercised when using sodium bicarbonate.
• Cirrhosis can affect liver function, potentially altering the body's ability to metabolize medications and maintain electrolyte balance.

Edema

• Caution should be taken when administering sodium bicarbonate to patients with edema.
• Sodium bicarbonate can contribute to fluid retention due to its sodium content, potentially exacerbating edema.

Heart failure:

• In patients with heart failure, caution is advised when using sodium bicarbonate.
• Sodium bicarbonate contains sodium, which can contribute to fluid retention and exacerbate symptoms of heart failure.

Peptic ulcer disease:

• Sodium bicarbonate is not recommended for the treatment of peptic ulcer disease.
• While it can help neutralize stomach acid, its use may aggravate peptic ulcers by increasing gastric acid production over time and potentially worsening ulcer symptoms.

Renal impairment:

• In patients with renal impairment, caution is advised when using sodium bicarbonate.
• Impaired kidney function can affect the body's ability to excrete sodium properly, potentially leading to sodium retention and fluid imbalance.

Sodium bicarbonate: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
AcetaZOLAMIDE	Could increase the toxic/adverse effects of Sodium Bicarbonate. Particularly, renal calculus formation could be at greater risk.
Indirect-Acting Alpha-/Beta Agonists	The serum concentrations of Alpha-/Beta Agonists can be increased by alkalinizing agents (Indirect-Acting).
Amantadine	Amantadine may be increased by alkalinizing agents.
Antipsychotic Agents (Phenothiazines).	Antacids can decrease the absorption Antipsychotic Agents (Phenothiazines)
Bromperidol	Bromperidol may be less absorbed by antacids.
Captopril	Captopril serum concentration may be decreased by taking an antacid.
Cefpodoxime	Antenacids can decrease Cefpodoxime serum concentrations.
Cysteamine (Systemic)	Cysteamine (Systemic) may be affected by anantacids.
Dexmethylphenidate	Antacids can increase Dexmethylphenidate's absorption. Antacids can interfere with the normal release from extended-release capsules (FocalinXR brand) which could lead to both an increased (early) or decreased (later) absorption.
Flecainide	Flecainide's arrhythmogenic effects may be diminished by Sodium Bicarbonate. Sodium Bicarbonate can increase Flecainide serum concentrations.
Lithium	Sodium Bicarbonate could increase the excretion rate of Lithium.
Mecamylamine	The serum concentrations of Mecamylamine may be increased by alkalinizing agents.
Memantine	Memantine serum concentration may be increased by alkalinizing agents
Methylphenidate	Antacids can increase Methylphenidate's absorption. Antacids can interfere with the normal release from extended-release capsules (Ritalin LA) which may lead to both an increased (early) or decreased (later) absorption.
QuiNIDine	QuiNIDine excretion may be decreased by antacids
QuiNINE	QuiNINE serum concentrations could be increased by alkalinizing agents
Rosuvastatin	Rosuvastatin serum concentration may be decreased by anantacids
Risk Factor D (Consider therapy modifications)
Acalabrutinib	Antabuses can decrease Acalabrutinib's serum concentration. To minimize potential interactions, it is important to administer Acalabrutinib separately from any other antacids for at least 2 hours.
Amphetamines	The excretion of Amphetamines can be decreased by using alkalinizing agents. Management: There are alternatives to the combination of amphetamines with alkalinizing agents. Patients should be closely monitored for excess amphetamine effects if these agents are used together.
Atazanavir	Antacids can decrease Atazanavir's absorption.
Bisacodyl	Antacids can decrease the therapeutic effects of Bisacodyl. Antacids can cause delayed-release bisacodyl tablets not to reach the large intestine. You may experience gastric irritation or cramps.
Bismuth Subcitrate	Bismuth Subcitrate may be affected by antacids. Management: Antacids should not be administered within 30 minutes after bismuth subcitrate's (tripotassium Bismuth dicitrate-) administration.
Bosutinib	Bosutinib serum concentration may be decreased by antacids. Administration: Do not take antacids for more than two hours prior to or after taking bosutinib.
Calcium Polystyrene Sulfonate	Antacids can increase the toxic/adverse effects of Calcium Polystyrene Sulfonate. Combining these two agents can lead to metabolic alkalosis, and/or loss in efficacy for the cation exchange resin. Management: This interaction can be minimized by separating doses for a period of 2 hours or more, b)rectal administration or alternative antacids. Monitoring for metabolic alkalosis is important. Attenuation of CPS side effects should be considered. Avoid magnesium hydroxide.
Cefditoren	Antabics can decrease Cefditoren serum concentration. Management: Cefditoren should not be taken with antacids. Alternate methods of controlling acid reflux, such as diet modification or antimicrobial therapy, may be considered. Separate dosing can be done if antacid therapy cannot be avoided.
Cefuroxime	Antenacids can decrease serum Cefuroxime concentration. Management: Cefuroxime Axetil should be administered at least one hour before or two hours after administration of short-acting antacids.
Chloroquine	Chloroquine serum concentrations could be decreased by antacids. Management: It is important to separate the administration of chloroquine and antacids for at least four hours in order to minimize any negative effects on chloroquine bioavailability.
Corticosteroids (Oral)	Antacids can decrease the bioavailability (Oral) of Corticosteroids. Management: It is worth separating doses for at least 2 hours. Budesonide enteric-coated tablets may dissolve prematurely when combined with lower gastric acid drugs, which have unknown effects on the budesonide therapeutic benefits.
Dabigatran Etexilate	Antabics can decrease the serum concentrations of Dabigatran Etexilate. Management: Dabigatran Etexilate Canadian product labeling suggests that you avoid concurrent use of antacids for 24 hrs after surgery. In all other cases, dabigatran should be administered 2 hours before antacids. Monitoring the clinical response to dabigatran therapy.
Dasatinib	Antenacids can decrease serum levels of Dasatinib. Administration: Avoid simultaneous administration of Dasatinib with antacids. Do not give antacids two hours prior to or after dasatinib.
Delavirdine	Antabics can decrease Delavirdine serum concentration. Management: Give delavirdine and an antacid a separate dose for at least one hour. This combination may cause decreased therapeutic effects of delavirdine.
Elvitegravir	Antabics can decrease Elvitegravir serum concentrations. Management: Separate administration of antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction.
Erlotinib	Antabics can decrease serum Erlotinib concentration. Management: Keep the administration of Erlotinib and any other antacid separated for several hours to reduce the chance of an interaction.
Fosinopril	Fosinopril serum concentration may be decreased by antacids. Management: According to the Canadian and US fosinopril manufacturers labels, it is recommended that fosinopril and antacids be separated by at least 2 hours.
Gefitinib	Gefitinib serum concentration may be decreased by antacids. Gefitinib administration: Give gefitinib at the least 6 hours before or following an antacid. Monitor your patient's response to gefitinib.
Hyoscyamine	The serum concentration of Hyoscyamine may be decreased by antacids. Treatment: If you are giving these agents in combination, administer immediate release Hyoscyamine and antacids before and after meals.
Iron Salts	Iron Salts can be less absorbed by antacids. Exceptions: Ferric Carboxymaltose, Ferric Citrate, Ferric Gluconate and Ferric Gluconate. Ferric Pyrophosphate Citrate Complex; Ferumoxytol. Iron Dextran Complex. Iron Isomaltoside. Iron Sucrose.
Itraconazole	Itraconazole serum concentration may be decreased by anantacids. Antacids can increase serum Itraconazole concentrations. Sporanox brand Itraconazole should be administered at least two hours prior to or after any antacids are administered. Antibiotics may increase the exposure to Tolsura brand Itraconazole. Consider reducing itraconazole dosage.
Ketoconazole (Systemic)	Antabics can decrease serum levels of Ketoconazole Systemic. Administration: Take oral ketoconazole at the very least two hours before you start using any antacid. Watch out for any signs or symptoms that indicate an insufficient clinical response to ketoconazole.
Lanthanum	Antenacids can reduce the therapeutic effects of Lanthanum.
Ledipasvir	Antabics can decrease serum Ledipasvir concentration. Management: Keep the administration of Ledipasvir and Antacids separated for at least 4 hours.
Mesalamine	Mesalamine's therapeutic effects may be diminished by antacids. Antacid-induced increases in the gastrointestinal pH can lead to premature release mesalamine from certain sustained-release mesalamine product. Management: It is important to avoid concurrent administration of antacids and sustained-release mesalamine product. This interaction can be avoided by seperating antacid from mesalamine administration and/or using lower doses of antacids.
Methenamine	Methenamine's therapeutic effects may be diminished by antacids.
Multivitamins/Minerals (with ADEK, Folate, Iron)	Antacids may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Antacids can decrease iron absorption from orally administered iron. Management: Dose of iron-containing multivitamin preparations orally and antacids separately as soon as possible to minimize any adverse effects on the iron preparation's therapeutic efficacy.
Neratinib	Antabics can decrease Neratinib serum concentration. Antacids can decrease neratinib sorption. Management: Give neratinib to your child at least three hours after you have finished taking the antacid.
Nilotini	- Antacids can decrease Nilotinib's serum concentration. Management: It is important to separate the administration of Nilotinib from any antacid at least two hours before starting treatment. This will reduce the chance of an adverse reaction.
PAZOPanib	PAZOPanib serum concentration may be decreased by antacids. Management: If possible, avoid using pazopanib with antacids. If antacid treatment is necessary, separate doses by several hours. It has not been possible to determine the impact of dose separation.
Pexidartinib	Antineodes may lower the serum level of Pexidartinib. Administration: Pexidartinib should be administered 2 hours prior to or after taking antacids.
Supplements with phosphate	Antabics can decrease the absorption rate of phosphate supplements. Management: This only applies to oral phosphate administration. The interaction may be minimized by separating oral phosphate supplement administration from antacid management for as long as possible. Exceptions: Sodium Glycerophosphate pentahydrate.
Potassium Phosphate	Antabics can lower the serum level of Potassium Phosphate. Management: It is a good idea to separate oral potassium phosphate and antacids by at least two hours in order to reduce the risk of an interaction.
Rilpivirine	Rilpivirine may be reduced by antacids. Administration: Antacids should be administered at least 2 hours prior to or 4 hours after the administration of rilpivirine. Administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product.
Riociguat	Antacids can decrease Riociguat serum concentrations. Management: Keep Riociguat and Antacids separated for at least one hour to avoid any possible interaction.
Sotalol	Antabics can decrease Sotalol's serum concentration. Administration: It is best to avoid simultaneous administration of Sotalol and Antacids. Two hours after taking sotalol, administer antacids.
Sulpiride	Sulpiride serum concentration may be decreased by antacids. Management: Antacids should be administered separately to sulpiride for at least two hours to reduce the effect of antacids upon sulpiride absorption.
Tetracyclines	Antacids can decrease Tetracycline absorption. Management: It is best to separate the administration of antacids from oral tetracycline derivatives for several hours, if possible, in order to reduce the potential interaction. Eravacycline is an exception.
Velpatasvir	Antabics can decrease Velpatasvir serum concentration. Management: At least 4 hours of separate administration of velpatasvir or antacids is recommended.

Monitoring parameters:

Monitor arterial/ venous PH, Blood pressure, serum sodium levels, and signs of fluid overload. Monitor the patient for heart failure if at-risk Observe the site for extravasation.

How to administer Sodium bicarbonate?

• IV Infusion:
  • Administer slowly for direct IV infusion during emergencies.
  • Dilute for infusion to a maximum concentration of 0.5 mEq/mL in dextrose solution.
  • Infuse over at least 2 hours, with a maximum rate of administration of 1 mEq/kg/hour.
• Vesicant Properties:
  • Solutions with concentrations ≥8.4% can act as vesicants.
  • Ensure proper needle or catheter placement before and during IV infusion to prevent extravasation.
• Extravasation Management:
  • If extravasation occurs, stop infusion immediately and disconnect, leaving the needle/cannula in place.
  • Gently aspirate extravasated solution without flushing the line.
  • Initiate hyaluronidase antidote and remove the needle/cannula.
  • Apply dry cold compresses and elevate the extremity.
• Hyaluronidase Administration:
  • Administer intradermally or subcutaneously.
  • Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections using a 25-gauge needle into the area of extravasation at the leading edge in a clockwise manner.
• Oral Administration:
  • Administer oral product 1 to 3 hours after meals for optimal absorption.
• Infiltration (Dental Use; Onpharma):
  • Add the specified volume of 8.4% sodium bicarbonate directly to lidocaine and epinephrine injection.
  • Mix and use the solution immediately after mixing.

Mechanism of action of Sodium bicarbonate:

• Sodium bicarbonate dissociates to release bicarbonate ions, which help neutralize the concentration of hydrogen ions, thus raising the pH levels in both blood and urine.
• In dental procedures, it serves as a neutralizing additive, elevating the pH of lidocaine and epinephrine solutions.
• This adjustment enhances the tolerability of the solution and promotes better absorption into the tissues.

Onset of Action:

• Oral: Typically takes around 15 minutes to take effect.
• IV: Rapid onset, with effects felt within 8 to 10 minutes after administration.

Duration:

• Oral: Effects last for 1 to 3 hours.
• IV: Effects are relatively short-lived, lasting for 8 to 10 minutes.

Absorption:

• Oral: Sodium bicarbonate is well absorbed when taken orally.

Excretion:

• Primarily excreted through urine, with less than 1% excreted unchanged.

Sodium bicarbonate Brand Names (International):

• Neut
• Betsol "Z"
• Bicafres
• Bicart
• Natribic
• Natrium bicarbonicum
• Solunate

Sodium bicarbonate Brand Names in Pakistan:

Sodium Bicarbonate Injection 7.5 % W/V
Sodium Bicarbonate	Elko Organization (Pvt) Ltd.
Sodium Bicarbonate	Venus Pharma

Sodium Bicarbonate Injection 8.4 % W/V
Meylon	Hospital Supply Corporation
Sobicarb	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Sodium Bi Carbonate	Usman-co International
Sodium Bicarbonate	Venus Pharma

Sodium Bicarbonate tablets 300 mg
Sodamint	Irza Pharma (Pvt) Ltd.
Sodamint	Karachi Pharmaceutical Laboratory
Sodamint	Ideal Pharmaceutical Industries
Sodium Bicarbonate	Biosynth Pharma (Pvt) Ltd.

Sodium Bicarbonate capsules 1100 mg
Neusec	Biorex Pharmaceuticals
Operos	Medizan Labs (Pvt) Ltd