Do you transition to non-tablet formulations of potassium citrate in patients with recurrent calcium oxalate nephrolithiasis and hypocitraturia who are noticing intact tablets in their stool?

Wax matrix slow release tablets release their contents but need not dissolve and are often seen by patients. I never change meds just because of signs of the tablets, I watch the 24 hour urine K, citrate, pH, and the balance between ammonia and sulfate. If the pills are working K and pH and citrate go up and ammonia goes down compared to sulfate. So long as that is happening I am content.

Yes, although I often start citrate therapy in liquid form because increasing urine volume is one of the most effective ways to prevent kidney stones. My first beverage preference is water. Tap water is fine. If the patient is hypocitraturic, I recommend a citrate-containing beverage, typically Moonstone. I have no financial interest in the product. It has more citrate than other options (Gatorade, diet 7-Up), comes in a variety of flavors, and is competitively priced.

Stephen B. Erickson, MD