MECHANISM OF ACTION:
The aim of the treatment is to restore the level of the urinary citrate and to increase the pH of urine to 6-7, and to this end, the dosage pattern are:
- In patients with slight hypocitraturia start the treatment with a dose of 30mEq (3 tabs/day, divided into 3 takings daily. It is recommended to take the tablets 30 minutes after meals. Approx 24 hrs after having started the treatment, make a determination of urinary citrate and pH, and adjust the dose in accordance with the needs of the patient. If necessary, the dose can be increased, though it is not advisable to exceed the dose of 100 mEq (10 tablets)/day.
-Treatment of patients with renal lithiasis and hypocitraturia, chronic formers of calcium oxalate, phospate calculia.
- Uric acid lithiasis alone or accompanied by calcium lithiasis
- Renal insufficiency¨ Persistent alkaline urinary infections
- Obstruction of the urinary tract
- Hyperpotassemia¨Adrenal insufficiency
- Respiratory or metabolic alkalosis
- Active peptic ulcer
- Intestinal obstruction
- Patients submitted to anticholinergic therapy
- Patients with slow gastric emptying.
SIDE EFFECTS/ ADVERSE EFFECTS:
- Slight gastrointestinal disorders may appear which can be palliated by means of the joint administration of food.
- The tablets must not be masticated or diluted. The active component of Acalka is contained with a porous wax matrix. As this was matrix is insoluble, it can be eliminated in visible form in the feces. The active component, however, has been released in the gastrointestinal tract.
- Must not be administered to patients receiving potassium-sparing diuretics (traimterene, spirolactone, or amyloride).
- It is advisable to carry out an evaluation of electrolytes (Na-K-Cl) and CO2, creatinine and hemogram every 4 hrs.
- It is recommended that the patients in treatment with Acalka follow a diet w/o salt and increase the intake of fluids.
- The recommended treatment in case of hyperpotassemia is: IV administratioin f 10% dextrose solution, containing 10-12 units of insulin/1000ml. Correction of the possible acidosis with IV sodium bicarboate and hemodialysis or peritoneal dialysis.