Urinary acidifiers

The nurse measures the fluid intake and output, especially when the primary health care provider orders an increase in fluid intake or when a kidney infection is being treated. The primary health care provider may also order daily urinary pH levels when methenamine or nitrofurantoin is administered. These drugs work best in acid urine failure of the urine to remain acidic may require administration of a urinary acidifier, such as ascorbic acid. 

Unlabeled uses Vitamin C (at least 2 g/day) may be used as a urinary acidifier in conjunction with methenamine therapy. 

Drugs that may affect mexiletine include aluminum-magnesium hydroxide, atropine, narcotics, cimetidine, fluvoxamine, hydantoins, metoclopramide, propafenone, rifampin, urinary acidifiers, and urinary alkalinizers. 

Drugs that may affect flecainide include amiodarone, cimetidine, cisapride, disopyramide, propranolol, ritonavir, urinary acidifiers/alkalinizers, and verapamil. Smoking may also have an effect. Drugs that may be affected by flecainide include cisapride, propranolol, and digoxin. 

B. Proteus species produce urease (A) that produces ammonia and urea, alkalizing urine. Urine requires acidification for effective therapy. Hippuric (B), mandelic, or ascorbic acids or methionine are urinary acidifying agents. The normal acidic urinary environment is disturbed by recurrent Proteus in-... 

The risk of tachycardia, hypertension, and cardiotoxicity is increased with coadministration of dronabinol (an antiemetic) and dextroamphetamine. In addition, administration of dextroamphetamine with MAOIs may increase the risk of hypertensive crisis. Al-kalinizing agents can speed absorption (e.g., antacids) or delay urinary excretion (e.g., acetazolamide, thiazide diuretics) of dextroamphetamine, thus potentiating its effects. Gastric or urinary acidifying agents (e.g., ascorbic acid, ammonium chloride) can decrease the effects of dextroamphetamine. Propoxyphene overdose can potentiate amphetamine central nervous system stimulation, potentially resulting in fatal convulsions. 

Drug Interactions Urinary acidifiers Urinary acidifiers Tetracyclines... 

Urinary acidifiers may increase elimination of ephedrine, and urinary alkalinizers may decrease the elimination of ephedrine. Ephedrine is chemically incompatible with sodium bicarbonate and the two should not be used together. 

Simpson GM, Khajawall AM. Urinary acidifiers in phencyclidine detoxification. Hillside J Clin Psychiatry 1983 5(2) 161-8. 

Intermittent self-catheterization with or without a concomitant anticholinergic agent is recommended in patients with large postvoid urine residual volumes (>100 mL) or when the urinary problem is hyporeflexic in nature (failure to empty). Patients with large postvoid residual volumes are at risk for developing urinary tract infections and often are prescribed urinary acidifiers such as vitamin C or antiseptics such as methenamine mandelate to prevent infections. 

The urinary excretion of amfetamines is increased by urinary acidifiers (ammonium chloride) and reduced by urinary alkalinisers (sodium bicarbonate). 

Urinary alkalinisers can reduce the loss of diethylcarbamazine in the urine, whereas urinary acidifiers can increase the loss. The clinical importance of this is unknown. 

An established interaction, which can be exploited. Should erythromycin be used to treat urinary tract infections its efficacy can be maximised by making the urine alkaline (for example with acetazolamide or sodium bicarbonate). Treatment with urinary acidifiers will minimise the activity of the erythromycin for urinary tract infections and should be avoided. There is no evidence that the efficacy of erythromycin in other infections is affected by urinary acidifiers or alkalinisers. 

Methenamine and methenamine mandelate are only effective as urinary antisepties if the pH is about 5.5 or lower, when formaldehyde is released. This is normally achieved by giving urinary acidifiers such as ammonium chloride, ascorbic acid, or sodium acid phosphate. In the case of methenamine hippurate, the acidification of the urine is achieved by the presence of hippuric acid. The concurrent use of substances that raise the urinary pH such as acetazolamide, sodium bicarbonate, potassium or sodium citrate is clearly contraindicated. Potassium citrate mixture BPC has been shown to raise the pH by more than 1 at normal therapeutic doses, thereby making the urine sufficiently alkaline to interfere with the activation of methenamine to formaldehyde. Some antacids (containing magnesium, aluminium or calcium as well as sodium bicarbonate mentioned above) can also cause a significant rise in the pH of the urine. ... 

Pseudoephedrine and related drugs + Urinary acidifiers or alkalinisers... 

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