Drug reference

Sodium Bicarbonate

Systemic alkalinizing agent / antacid · Alkalinizing Agent

Also known as Baking Soda, Sodium Hydrogen Carbonate, NaHCO3

START

Check ABG (pH, HCO3-, pCO2), electrolytes (Na, K, Ca), volume status. Ensure adequate ventilation (CO2 must be excreted).

TYPICAL MAX

Titrate to HCO3- 22-26 mmol/L. Avoid over-correction (metabolic alkalosis). Monitor for sodium overload.

STOP IF

Metabolic alkalosis (pH >7.55), severe hypernatremia, pulmonary edema, tetany from hypocalcemia.

WATCH

Electrolytes (K+, Ca2+, Na+) daily during IV therapy. Volume status (edema, weight, JVP). Do NOT give with calcium salts (precipitation risk). In cardiac arrest, only use for prolonged arrest or documented hyperkalemia/acidosis.

CDSCO approvedSchedule H (for injectable forms); OTC (for antacid formulations)Jan AushadhiNPPA price-controlledATC B05XA02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 10min · Onset within minutes
PEAK: 1h · Peak 1-2 hours (PO)
t½: 0s · N/A (equilibrates rapidly)
DURATION: 8h · 8-10 hours (PO)

EXCRETION

Renal as bicarbonate, CO2 via lungs

route + CYP

INTERACTIONS

4 major

incl. contraindicated

PREGNANCY

Sodium bicarbonate crosses placenta; generally safe for short-term use. Avoid excessive sodium load in preeclampsia.

FDA category + note

Top interactionssee all 12 →

MethenamineContraindicatedDatabaseDDInter
DolutegravirSevereDatabaseDDInter
SelpercatinibSevereDatabaseDDInter
Calcium SaltsSevereDatabaseKimi deep-research + Cla

Available in India

120 branded formulations and 1 fixed-dose combination. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Dissociates to provide bicarbonate ions (HCO3-), which neutralize hydrogen ions and raise blood and urine pH. Increases plasma bicarbonate concentration, correcting metabolic acidosis. In urine, alkalinization increases solubility of uric acid and certain drugs.

Indications

Metabolic acidosis (renal tubular acidosis, CKD, lactic acidosis)Urine alkalinization (to prevent uric acid nephrolithiasis, enhance excretion of certain toxins)Antacid (short-term relief of dyspepsia)Cardiac arrest (as part of ACLS for prolonged resuscitation)Hyperkalemia (adjunctive—drives K+ intracellularly)Prevention of contrast-induced nephropathy (controversial)

Dosing

Adult: Metabolic acidosis: 325-2000mg PO TID-QID (titrate to HCO3- 22-26 mmol/L). Severe acidosis: 50-100mEq IV over 5-10 min, repeat as needed. Urine alkalinization: 325-650mg PO QID. Cardiac arrest: 1mEq/kg IV, then 0.5mEq/kg q10min.
Pediatric: <2 years: 1-10 mEq/kg/day divided. >2 years: same as adult dosing by weight.
Renal adjustment: Use caution; sodium retention risk in renal failure. Monitor for edema and hypertension.
Hepatic adjustment: No adjustment needed.
Geriatric: Use caution; increased risk of sodium overload, edema, and hypertension.
Max dose: 16,000mg/day PO (200 mEq sodium); IV: titrated to pH/HCO3- target

Pharmacokinetics

Onset

PO: within minutes; IV: immediate

Peak effect

PO: 1-2 hours; IV: immediate

Duration

PO: 8-10 hours; IV: variable

Half-life

Not applicable (rapidly equilibrates with body bicarbonate pool)

Bioavailability

~100% (oral)

Protein binding

Not applicable

Metabolism

Converted to CO2 and water in presence of acid; CO2 excreted via lungs

Excretion

Renal (as bicarbonate and sodium); CO2 via respiration

Contraindications

Metabolic or respiratory alkalosis
Hypocalcemia (risk of tetany)
Hypernatremia
Severe pulmonary edema
Hypertension (sodium load)
Hypochloremia with secondary metabolic alkalosis
Renal failure with sodium retention

Side effects

Common

Belching / flatulence (CO2 release)Gastric distensionMild hypernatremiaEdema (with high doses)

Serious

Metabolic alkalosis
Hypokalemia (intracellular shift)
Hypocalcemia / tetany
Hypernatremia
Fluid overload / pulmonary edema
Milk-alkali syndrome (hypercalcemia, alkalosis, renal impairment)

Pregnancy & lactation

Pregnancy

Sodium bicarbonate crosses placenta; generally safe for short-term use. Avoid excessive sodium load in preeclampsia.

Lactation

Compatible with breastfeeding; bicarbonate is a normal constituent of breast milk.

Drug interactions

Methenamine

Contraindicated

Database

Complete loss of therapeutic efficacy of methenamine, rendering it ineffective for treating urinary tract infections.

Concurrent use is contraindicated. If methenamine is prescribed, avoid all alkalinizing agents, including sodium bicarbonate. Choose an alternative antimicrobial or an alternative urinary acidifier if needed.

Source: DDInter

Dolutegravir

Severe

Database

Clinical effect not specified

Source: DDInter

Selpercatinib

Severe

Database

Clinical effect not specified

Source: DDInter

Calcium Salts

Severe

Database

Forms insoluble calcium carbonate precipitate; risk of milk-alkali syndrome.

Do not administer simultaneously; separate by 2-4 hours.

Source: Kimi deep-research + Cla

Amphetamines

Moderate

Database

Increased plasma concentrations and prolonged duration of action of amphetamines, potentially leading to enhanced stimulant effects and toxicity.

Monitor for increased amphetamine effects. Consider dose reduction of amphetamines if co-administration is necessary. Avoid concurrent use if possible, especially in patients prone to cardiac or CNS side effects.

Corticosteroids (e.g., Prednisone)

Moderate

Database

Increased risk of hypernatremia, fluid retention, edema, and hypokalemia.

Monitor serum electrolytes and fluid balance closely. Use with caution, especially in patients with pre-existing cardiovascular or renal conditions. Adjust doses as needed.

Fluoroquinolones (e.g., Ciprofloxacin)

Moderate

Database

Decreased plasma concentrations and reduced therapeutic efficacy of fluoroquinolones, potentially leading to treatment failure for infections.

Administer fluoroquinolones at least 2-4 hours before or after sodium bicarbonate. Advise patients about the importance of timing. Consider alternative antibiotics if adherence is an issue.

Iron Supplements (e.g., Ferrous Sulfate)

Moderate

Database

Decreased absorption and reduced therapeutic efficacy of iron supplements, potentially leading to inadequate treatment of iron deficiency anemia.

Administer iron supplements at least 2-4 hours before or after sodium bicarbonate. Advise patients about the importance of timing. Consider alternative iron formulations or routes if necessary.

Potassium Sparing Diuretics (e.g., Spironolactone, Amiloride)

Moderate

Database

Increased risk of electrolyte disturbances, including hypernatremia and potentially hypokalemia, especially in patients with renal impairment.

Monitor serum electrolytes (sodium, potassium, bicarbonate) closely. Adjust doses of either drug as needed. Use with caution in patients with renal impairment.

Quinidine

Moderate

Database

Increased plasma concentrations of quinidine, potentially leading to enhanced antiarrhythmic effects and increased risk of cardiotoxicity (e.g., QT prolongation, arrhythmias).

Monitor quinidine levels and ECG closely. Adjust quinidine dose as needed. Avoid concurrent use if possible, especially in patients with pre-existing cardiac conditions.

Source: DDInter

Salicylates (e.g., Aspirin)

Moderate

Database

Decreased plasma concentrations of salicylates, potentially leading to reduced therapeutic efficacy (e.g., anti-inflammatory, antiplatelet effects). In salicylate overdose, this interaction is therapeutically exploited to enhance excretion.

For therapeutic use of salicylates, monitor for reduced efficacy. For salicylate overdose, sodium bicarbonate is intentionally used to enhance excretion; monitor pH and salicylate levels.

Enteric Coated

Moderate

Database

Rapid gastric pH increase may cause premature dissolution of enteric coatings.

Separate administration by 1-2 hours.

Source: Kimi deep-research + Cla