Trisol

A white crystal or crystalline powder used as an electrolyte replenisher, in the treatment of hypokalemia, in buffer solutions, and in fertilizers and explosives.

Sodium Bicarbonate (Trisol) is a white, crystalline powder that is commonly used as a pH buffering agent, an electrolyte replenisher, systemic alkalizer and in topical cleansing solutions.

Sodium Chloride (Trisol), also known as salt, common salt, table salt or halite, is an ionic compound with the chemical formula NaCl, representing a 1:1 ratio of sodium and chloride ions. Sodium Chloride (Trisol) is the salt most responsible for the salinity of seawater and of the extracellular fluid of many multicellular organisms. It is listed on the World Health Organization Model List of Essential Medicines.

BECAUSE OF REPORTS OF INTESTINAL AND GASTRIC ULCERATION AND BLEEDING WITH CONTROLLED-RELEASE Potassium Chloride (Trisol) PREPARATIONS, THESE DRUGS SHOULD BE RESERVED FOR THOSE PATIENTS WHO CANNOT TOLERATE OR REFUSE TO TAKE LIQUID OR EFFERVESCENT POTASSIUM PREPARATIONS OR FOR PATIENTS IN WHOM THERE IS A PROBLEM OF COMPLIANCE WITH THESE PREPARATIONS.

1. For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxications, and in patients with hypokalemic familial periodic paralysis. If hypokalemia is the result of diuretic therapy, consideration should be given to the use of a lower dose of diuretic, which may be sufficient without leading to hypokalemia.
2. For the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop e.g., digitalized patients or patients with significant cardiac arrhythmias, hepatic cirrhosis with ascites, states of aldosterone excess with normal renal function, potassium-losing nephropathy, and certain diarrheal states.

The use of potassium salts in patients receiving diuretics for uncomplicated essential hypertension is often unnecessary when such patients have a normal dietary pattern and when low doses of the diuretic are used. Serum potassium should be checked periodically, however, and if hypokalemia occurs, dietary supplementation with potassium-containing foods may be adequate to control milder cases. In more severe cases, and if dose adjustment of the diuretic is ineffective or unwarranted, supplementation with potassium salts may be indicated.

Sodium Bicarbonate (Trisol) (Sodium Bicarbonate (Trisol) 5% injection) Injection may be indicated in the treatment of metabolic acidosis which can occur in severe renal disease, uncontrolled diabetes, circulatory insufficiency due to shock, anoxia or severe dehydration, extracorporeal circulation of blood and severe primary lactic acidosis. Sodium Bicarbonate (Trisol) (Sodium Bicarbonate (Trisol) 5% injection) Injection is further indicated in the treatment of certain drug intoxications, including barbiturates, in poisoning by salicylates or methyl alcohol, and in hemolytic reactions requiring alkalinization of the urine to diminish nephrotoxicity of blood pigments. Sodium Bicarbonate (Trisol) (Sodium Bicarbonate (Trisol) 5% injection) Injection may also be indicated in severe diarrhea which is often accompanied by a significant loss of bicarbonate.

Sodium Chloride (Trisol) as isotonic solution: the dehydration of various origins. To maintain the volume of blood plasma during and after surgery. As a solvent for various drugs.

Hypertonic solution: violations of water-electrolyte metabolism: lack of sodium and chlorine ions; hypoosmotic dehydration of various origins (due to prolonged vomiting, diarrhea, burns with a gastric fistula, pulmonary hemorrhage, intestinal bleeding).

Eye drops and ointment: irritation of the cornea with inflammatory and allergic diseases (combined therapy).

Potassium Chloride (Trisol) (Potassium Chloride (Trisol)) is used to prevent or to treat low blood levels of potassium (hypokalemia). Potassium levels can be low as a result of a disease or from taking certain medicines, or after a prolonged illness with diarrhea or vomiting.

Potassium Chloride (Trisol) contains Potassium Chloride (Trisol). Potassium is a mineral that is found in many foods and is needed for several functions of your body, especially the beating of your heart.

Potassium Chloride (Trisol) may also be used for other purposes not listed here.

Sodium Bicarbonate (Trisol), also known as baking soda, is used to relieve heartburn, sour stomach, or acid indigestion by neutralizing excess stomach acid. When used for this purpose, it is said to belong to the group of medicines called antacids. It may be used to treat the symptoms of stomach or duodenal ulcers. Sodium Bicarbonate (Trisol) is also used to make the blood and urine more alkaline in certain conditions.

Antacids should not be given to young children (up to 6 years of age) unless prescribed by their doctor. Since children cannot usually describe their symptoms very well, a doctor should check the child before giving Sodium Bicarbonate (Trisol). The child may have a condition that needs other treatment. If so, antacids will not help and may even cause unwanted effects or make the condition worse.

Sodium Bicarbonate (Trisol) for oral use is available without a prescription.

Sodium Chloride (Trisol) is the chemical name for salt. Sodium Chloride (Trisol) can reduce some types of bacteria in certain body secretions, such as saliva.

Sodium Chloride (Trisol) inhalation is used to produce sputum (mucus, or phlegm) from the mouth to help improve lung function in people with cystic fibrosis, or to collect sputum for medical testing. This medication may also be used to dilute other medications inhaled through a nebulizer.

Sodium Chloride (Trisol) inhalation may also be used for other purposes not listed in this medication guide.

The usual dietary intake of potassium by the average adult is 50 to 100 mEq per day. Potassium depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mEq of potassium from the total body store.

Dosage must be adjusted to the individual needs of each patients. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day. Doses of 40 to 100 mEq per day or more are used for the treatment of potassium depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose. Because of the potential for gastric irritation, Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® Extencaps® should be taken with meals and with a full glass of water or other liquid.

Patients who have difficulty swallowing capsules may sprinkle the contents of the capsule onto a spoonful of soft food. The soft food, such as applesauce or pudding, should be swallowed immediately without chewing and followed with a glass of cool water or juice to ensure complete swallowing of the microcapsules. The food used should not be hot and should be soft enough to be swallowed without chewing. Any microcapsule/food mixture should be used immediately and not stored for future use.

How supplied

Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® Extencaps® are pale orange capsules monogrammed Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® and "Ther-Rx"/ "010", each containing 600 mg microencapsulated Potassium Chloride (Trisol) (equivalent to 8 mEq K) in bottles of 100 (NDC 64011-010-04), 500 (NDC 64011-010-08) and Dis-Co® unit dose packs of 100 (NDC 64011-010-11).

Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® 10 Extencaps® are pale orange and opaque white capsules monogrammed Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® 10 and "Ther-Rx"/"009", each containing 750 mg microencapsulated Potassium Chloride (Trisol) (equivalent to 10 mEq K) in bottles of 100 (NDC 64011-009-04), 100 Unit-of-Use (NDC 64011-009-21), bottles of 500 (NDC 64011-009-08), and Dis-Co® unit dose packs of 100 (NDC 64011-009-11).

Store at controlled room temperature, between 20° C and 25° C (68° F and 77° F).

Dispense in tight container.

Manufactured by KV Pharmaceutical

for Ther-Rx Corporation., St. Louis, MO 63045

FDA rev date: 8/20/2003

One vial (5 mL) of Sodium Bicarbonate (Trisol) added to a liter (1000 mL) of any of the following Hospira parenteral solutions will increase the pH to a more physiologic range. Specific pH may vary slightly from lot to lot.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Addition of one vial of Sodium Bicarbonate (Trisol) to one-half liter (500 mL) is recommended to achieve a more physiologic pH of the following Hospira parenteral solutions:

Note: Some products, e.g., Amniosyn® solutions and those lonosol® and Normosol® formulas containing dextrose will NOT be brought to near physiologic pH by the addition of Sodium Bicarbonate (Trisol). This is due to the relatively high buffer capacity of these fluids.

COMPATIBILITY & EFFECTIVNESS FO Sodium Bicarbonate (Trisol) WITH ADDITIVES TO 5% DEXTROSE INJECTION (D5-W)

When medications are added to intravenous solutions, the resultant admixtures may or may not be compatible in solutions containing Sodium Bicarbonate (Trisol) (4% Sodium Bicarbonate (Trisol) additive solution).

Following is a list of medications each added to one liter of 5% Dextrose Injection, USP (D5-W) classified according to their effect with Sodium Bicarbonate (Trisol) (4% Sodium Bicarbonate (Trisol) additive solution).

It should be noted that the admixtures were evaluated for physical compatibility, not for pharmacological compatibility. It, therefore, would be erroneous to circumvent medical judgment which must be involved in administering any solution that appears to be compatible on the basis of having no visible haze or precipitate. The inclusion of drugsin this study of their compatibility in solution does not imply their therapeutic usefulness or safety. This matter remains the judgment of the prescribing physician.

NOTE: The compatibility information contained herein in based on the studies involving Hospira dextrose only. Variationsin compativility could occur due to lot-to-lot variations or formula changes in the additivies or dextrose solutions of other manufacturers.

All injections in VIAFLEX plastic containers are intended for intravenous administration using sterile and nonpyrogenic equipment.

As directed by a physician. Dosage, rate, and duration of administration are to be individualized and depend upon the indication for use, the patient’s age, weight, clinical condition, concomitant treatment, and on the patient’s clinical and laboratory response to treatment.

When other electrolytes or medicines are added to this solution, the dosage and the infusion rate will also be dictated by the dose regimen of the additions.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Use of a final filter is recommended during administration of all parenteral solutions, where possible.

Do not administer unless the solution is clear and seal is intact.

Additives may be incompatible with Sodium Chloride (Trisol) Injection, USP. As with all parenteral solutions, compatibility of the additives with the solution must be assessed before addition. Before adding a substance or medication, verify that it is soluble and/or stable in water and that the pH range of Sodium Chloride (Trisol) Injection, USP is appropriate. After addition, check for unexpected color changes and/or the appearance of precipitates, insoluble complexes or crystals.

The instructions for use of the medication to be added and other relevant literature must be consulted. Additives known or determined to be incompatible must not be used. When introducing additives to Sodium Chloride (Trisol) Injection, USP, aseptic technique must be used. Mix the solution thoroughly when additives have been introduced. Do not store solutions containing additives.

After opening the container, the contents should be used immediately and should not be stored for a subsequent infusion. Do not reconnect any partially used containers. Discard any unused portion.

See also:
What is the most important information I should know about Potassium Chloride (Trisol)?

Potassium supplements are contraindicated in patients with hyperkalemia since a further increase in serum potassium concentration in such patients can produce cardiac arrest. Hyperkalemia may complicate any of the following conditions: chronic renal failure, systemic acidosis such as diabetic acidosis, acute dehydration, extensive tissue breakdown as in severe burns, adrenal insufficiency, or the administration of a potassium-sparing diuretic, e.g., spironolactone, triamterene, or amiloride.

Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release tablets) tablets are contraindicated in patients with known hypersensitivity to any ingredient in this product.

Controlled-release formulations of Potassium Chloride (Trisol) have produced esophageal ulceration in certain cardiac patients with esophageal compression due to an enlarged left atrium. Potassium supplementation, when indicated in such patients, should be given as a liquid preparation.

All solid oral dosage forms of Potassium Chloride (Trisol) are contraindicated in any patient in whom there is structural, pathological, e.g., diabetic gastroparesis, or pharmacologic (use of anticholinergic agents or other agents with anticholinergic properties at sufficient doses to exert anticholinergic effects) cause for arrest or delay in tablet passage through the gastrointestinal tract.

See also:
What is the most important information I should know about Sodium Bicarbonate (Trisol)?

Sodium Bicarbonate (Trisol) (Sodium Bicarbonate (Trisol) 5% injection) Injection is contraindicated in patients with metabolic and respiratory alkalosis and in patients with hypocalcemia in which alkalosis may produce tetany.

See also:
What is the most important information I should know about Sodium Chloride (Trisol)?

Due to potential toxicity of benzyl alcohol in newborns, Bacteriostatic Sodium Chloride (Trisol) Injection, USP, 0.9% containing benzyl alcohol must not be used in this patient population.

Bacteriostatic Sodium Chloride (Trisol) Injection, USP, 0.9% should not be used for fluid or Sodium Chloride (Trisol) replacement.

Use Potassium Chloride (Trisol) solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Potassium Chloride (Trisol) solution is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Potassium Chloride (Trisol) solution at home, a health care provider will teach you how to use it. Be sure you understand how to use Potassium Chloride (Trisol) solution. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
• Do not use Potassium Chloride (Trisol) solution if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
• Potassium Chloride (Trisol) solution MUST be diluted before use.
• It is very important to carefully check that the right amount of medicine is drawn into the syringe before injecting the medicine into its diluent solution.
• If this solution is given by way of a pumping device, be sure to stop the pumping action before the container runs dry or air embolism may occur.
• Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
• If you miss a dose of Potassium Chloride (Trisol) solution, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Potassium Chloride (Trisol) solution.

Use Sodium Bicarbonate (Trisol) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Sodium Bicarbonate (Trisol) is usually administered as an injection at your doctor's office, hospital, or clinic. If you are using Sodium Bicarbonate (Trisol) at home, carefully follow the injection procedures taught to you by your health care provider.
• If Sodium Bicarbonate (Trisol) contains particles or is discolored, or if the vial is cracked or damaged in any way, do not use it.
• Keep this product, as well as syringes and needles, out of the reach of children and away from pets. Do not reuse needles, syringes, or other materials. Dispose of properly after use. Ask your doctor or pharmacist to explain local regulations for proper disposal.
• If you miss a dose of Sodium Bicarbonate (Trisol), contact your doctor immediately.

Ask your health care provider any questions you may have about how to use Sodium Bicarbonate (Trisol).

Use Sodium Chloride (Trisol) as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Sodium Chloride (Trisol) is for inhalation in a nebulizer only. Do not take Sodium Chloride (Trisol) by mouth or inject it.
• Sodium Chloride (Trisol) is used to dilute other medicines. Follow the instructions provided by your doctor.
• Sodium Chloride (Trisol) may come in a single-dose vial or in a container with multiple doses. Be sure to use the proper amount of Sodium Chloride (Trisol). If you are using Sodium Chloride (Trisol) from a multiple-dose container, use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
• If you are using a vial, use your dose immediately after opening the vial and throw away any unused medicine. Do not save the contents of an opened vial for later use.
• Do not use Sodium Chloride (Trisol) if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
• This product is intended to dilute other medicines for use in a nebulizer. If you miss a dose of your medicine, follow the missed dose instructions for the medicine that you are mixing with this product.

Ask your health care provider any questions you may have about how to use Sodium Chloride (Trisol).

This medication is a mineral supplement used to treat or prevent low amounts of potassium in the blood. A normal level of potassium in the blood is important. Potassium helps your cells, kidneys, heart, muscles, and nerves work properly. Most people get enough potassium by eating a well-balanced diet. Some conditions that can lower your body's potassium level include severe prolonged diarrhea and vomiting, hormone problems such as hyperaldosteronism, or treatment with "water pills"/diuretics.

How to use Potassium Chloride (Trisol)

Take this medication by mouth as directed by your doctor. To prevent stomach upset, take each dose with a meal and a full glass of water (8 ounces/240 milliliters) unless your doctor directs you otherwise. Do not lie down for 10 minutes after taking this medication.

Do not crush, chew, or suck extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.

Swallow the capsules whole. If you have trouble swallowing the capsules, tell your doctor or pharmacist. Some brands may be opened and the contents sprinkled onto a spoonful of cool, soft food such as applesauce or pudding. Immediately swallow the food/medication mixture without chewing. Do not prepare the mixture ahead of time. Drink a glass of cool water after each dose to make sure you swallow all the medication. Ask your pharmacist if you have questions about your brand.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day. The dosage is based on your medical condition and response to treatment. Do not increase your dose or take it more often than prescribed. Do not take more than 20 milliequivalents per dose.

Tell your doctor if your condition does not improve or if you have symptoms of low potassium in the blood (such as irregular heartbeat, muscle weakness/cramps).

Use: Labeled Indications

Management of metabolic acidosis; gastric hyperacidity; alkalinization of the urine; treatment of hyperkalemia; management of overdose of certain drugs, including tricyclic antidepressants and aspirin

Neutralizing additive (dental use): Improves onset of analgesia and reduces injection site pain by adjusting lidocaine with epinephrine solution to a more physiologic pH.

Off Label Uses

Contrast-induced nephropathy (CIN) (prevention)

Evidence from controlled trials supports the use of isotonic Sodium Bicarbonate (Trisol) as an effective option in the prevention of contrast-induced nephropathy (CIN), demonstrating reduced incidence compared to sodium chloride.

Kidney Disease Improving Global Outcomes (KDIGO) guidelines state that in patients at increased risk of contrast-induced acute kidney injury (CI-AKI), IV volume expansion with either isotonic sodium chloride or isotonic Sodium Bicarbonate (Trisol) solutions is recommended rather than no IV volume expansion. Isotonic Sodium Bicarbonate (Trisol) is not commercially available, and thus carries a risk for compounding error during preparation. Based on the potential for harm and additional burden of preparing bicarbonate solutions, no preference is given to one solution; either agent can be used, with ease of use recognized for isotonic saline (KDIGO 2012a). European Society of Urogenital Radiology (ESUR) Contrast Media Safety Committee guidelines state that IV isotonic Sodium Bicarbonate (Trisol) appears to provide protection equal or superior to IV isotonic saline, but either regimen may be used (ESUR [Stacul 2011]).

This product is used to treat dryness inside the nose (nasal passages). It helps add moisture inside the nose to dissolve and soften thick or crusty mucus. In babies and young children with stuffy noses who cannot blow their noses, using this product helps to make the mucus easier to remove with a nasal bulb syringe. This helps relieve stuffiness and makes breathing easier.

This product contains a purified gentle salt solution (also called saline or Sodium Chloride (Trisol) solution). It does not contain any medication.

How to use Sodium Chloride (Trisol) nasal

Spray this product into each nostril as needed or as directed by your doctor. This product may also be given into the nose as drops or a stream. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

Try not to touch the container tip to the inside of your nose. If this happens, rinse the tip with hot water and dry with a clean tissue before recapping the container.

If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

See also:
What other drugs will affect Potassium Chloride (Trisol)?

Aliskiren: Potassium Salts may enhance the hyperkalemic effect of Aliskiren. Monitor therapy

Angiotensin II Receptor Blockers: Potassium Salts may enhance the hyperkalemic effect of Angiotensin II Receptor Blockers. Monitor therapy

Angiotensin-Converting Enzyme Inhibitors: Potassium Salts may enhance the hyperkalemic effect of Angiotensin-Converting Enzyme Inhibitors. Monitor therapy

Anticholinergic Agents: May enhance the ulcerogenic effect of Potassium Chloride (Trisol). Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of Potassium Chloride (Trisol). Avoid combination

Drospirenone: Potassium Salts may enhance the hyperkalemic effect of Drospirenone. Monitor therapy

Eplerenone: May enhance the hyperkalemic effect of Potassium Salts. Management: This combination is contraindicated in patients receiving eplerenone for treatment of hypertension. Consider therapy modification

Glycopyrrolate (Systemic): May enhance the adverse/toxic effect of Potassium Chloride (Trisol). This is specific to solid oral dosage forms of Potassium Chloride (Trisol). Avoid combination

Heparin: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Heparins (Low Molecular Weight): May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Nicorandil: May enhance the hyperkalemic effect of Potassium Salts. Monitor therapy

Potassium-Sparing Diuretics: Potassium Salts may enhance the hyperkalemic effect of Potassium-Sparing Diuretics. Management: Avoid coadministration of a potassium-sparing diuretic and a potassium salt. This combination should only be used in cases of significant hypokalemia, and only if serum potassium can be closely monitored. Consider therapy modification

See also:
What other drugs will affect Sodium Bicarbonate (Trisol)?

Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib from the administration of any antacids by at least 2 hours in order to minimize the potential for a significant interaction. Consider therapy modification

AcetaZOLAMIDE: May enhance the adverse/toxic effect of Sodium Bicarbonate (Trisol). Specifically, the risk of renal calculus formation may be increased. Monitor therapy

Alpha-/Beta-Agonists (Indirect-Acting): Alkalinizing Agents may increase the serum concentration of Alpha-/Beta-Agonists (Indirect-Acting). Monitor therapy

Amantadine: Alkalinizing Agents may increase the serum concentration of Amantadine. Monitor therapy

Amphetamines: Alkalinizing Agents may decrease the excretion of Amphetamines. Management: Consider alternatives to using amphetamines and alkalinizing agents in combination. If these agents must be used together, patients should be monitored closely for excessive amphetamine effects. Consider therapy modification

Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Monitor therapy

Atazanavir: Antacids may decrease the absorption of Atazanavir. Management: Administer antacids 1 hour before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Consider therapy modification

Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration. Consider therapy modification

Bismuth Subcitrate: Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Consider therapy modification

Bosutinib: Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Consider therapy modification

Bromperidol: Antacids may decrease the absorption of Bromperidol. Monitor therapy

Calcium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis and/or loss of efficacy of the cation exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of CPS effects. Avoid magnesium hydroxide. Consider therapy modification

Captopril: Antacids may decrease the serum concentration of Captopril. Monitor therapy

Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Management: Concomitant use of cefditoren with antacids is not recommended. Consider alternative methods to control acid reflux (eg, diet modification) or alternative antimicrobial therapy. If antacid therapy can not be avoided, separate dosing by several hours. Consider therapy modification

Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Monitor therapy

Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Consider therapy modification

Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Consider therapy modification

Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Consider therapy modification

Cysteamine (Systemic): Antacids may diminish the therapeutic effect of Cysteamine (Systemic). Monitor therapy

Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Consider therapy modification

Dasatinib: Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Consider therapy modification

Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Consider therapy modification

Dexmethylphenidate: Antacids may increase the absorption of Dexmethylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Focalin XR brand), which could result in both increased absorption (early) and decreased delayed absorption. Monitor therapy

Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Consider therapy modification

Flecainide: Sodium Bicarbonate (Trisol) may diminish the arrhythmogenic effect of Flecainide. Sodium Bicarbonate (Trisol) may increase the serum concentration of Flecainide. Monitor therapy

Fosinopril: Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Consider therapy modification

Gefitinib: Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or after administration of an antacid, and closely monitor clinical response to gefitinib. Consider therapy modification

Hyoscyamine: Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before meals and antacids after meals when these agents are given in combination. Consider therapy modification

Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: Separate dosing of oral iron preparations and antacids as much as possible to avoid decreased efficacy of iron preparation. If coadministered with antacids, monitor for decreased therapeutic effects of iron preparations. Exceptions: Ferric Carboxymaltose; Ferric Citrate; Ferric Derisomaltose; Ferric Gluconate; Ferric Hydroxide Polymaltose Complex; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Consider therapy modification

Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Consider therapy modification

Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer oral ketoconazole at least 2 hours prior to use of any antacid product. Monitor patients closely for signs of inadequate clinical response to ketoconazole. Consider therapy modification

Lanthanum: Antacids may diminish the therapeutic effect of Lanthanum. Consider therapy modification

Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Consider therapy modification

Lithium: Sodium Bicarbonate (Trisol) may increase the excretion of Lithium. Monitor therapy

Mecamylamine: Alkalinizing Agents may increase the serum concentration of Mecamylamine. Monitor therapy

Memantine: Alkalinizing Agents may increase the serum concentration of Memantine. Monitor therapy

Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with sustained-release mesalamine products. Separating antacid and mesalamine administration, and/or using lower antacid doses may be adequate means of avoiding this interaction. Consider therapy modification

Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding this combination if possible. Antacids may decrease the therapeutic effects of methenamine; Sodium Bicarbonate (Trisol) is of most concern. If coadministering methenamine and antacids, monitor for decreased methenamine efficacy. Consider therapy modification

Methylphenidate: Antacids may increase the absorption of Methylphenidate. Specifically, antacids may interfere with the normal release of drug from the extended-release capsules (Ritalin LA brand), which could result in both increased absorption (early) and decreased delayed absorption. Monitor therapy

Multivitamins/Minerals (with ADEK, Folate, Iron): Antacids may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, antacids may decrease the absorption of orally administered iron. Management: Separate dosing of oral iron-containing multivitamin preparations and antacids by as much time as possible in order to minimize impact on therapeutic efficacy of the iron preparation. Consider therapy modification

Neratinib: Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Consider therapy modification

Nilotinib: Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Consider therapy modification

PAZOPanib: Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Consider therapy modification

Pexidartinib: Antacids may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib 2 hours before or after antacids. Consider therapy modification

Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administer of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification

Potassium Phosphate: Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Consider therapy modification

QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Monitor therapy

QuiNINE: Alkalinizing Agents may increase the serum concentration of QuiNINE. Monitor therapy

Rilpivirine: Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Consider therapy modification

Riociguat: Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Consider therapy modification

Rosuvastatin: Antacids may decrease the serum concentration of Rosuvastatin. Monitor therapy

Sotalol: Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Consider therapy modification

Sulpiride: Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Consider therapy modification

Tetracyclines: Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Exceptions: Eravacycline. Consider therapy modification

Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Consider therapy modification

See also:
What other drugs will affect Sodium Chloride (Trisol)?

Caution must be exercised in the administration of Sodium Chloride (Trisol) Injection, USP to patients receiving corticosteroids or corticotropin.

Studies have not been conducted to evaluate additional drug/drug or drug/food interactions with Sodium Chloride (Trisol) (Sodium Chloride (Trisol) (Sodium Chloride (Trisol) injection) injection) Injection, USP.

See also:
What are the possible side effects of Potassium Chloride (Trisol)?

One of the most severe adverse effects is hyperkalemia. Gastrointestinal bleeding and ulceration have been reported in patients treated with Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® Extencaps®. In addition to gastrointestinal bleeding and ulceration, perforation and obstruction have been reported in patients treated with other solid KCl dosage forms, and may occur with Potassium Chloride (Trisol) (Potassium Chloride (Trisol) extended-release) ® Extencaps®.

The most common adverse reactions to the oral potassium salts are nausea, vomiting, flatulence, abdominal discomfort, and diarrhea. These symptoms are due to irritation of the gastrointestinal tract and are best managed by taking the dose with meals, or reducing the amount taken at one time. Skin rash has been reported rarely with potassium preparations.

See also:
What are the possible side effects of Sodium Bicarbonate (Trisol)?

Applies to Sodium Bicarbonate (Trisol): capsule, granule, powder, solution, tablet

Along with its needed effects, Sodium Bicarbonate (Trisol) (the active ingredient contained in Sodium Bicarbonate (Trisol)) may cause some unwanted effects. Although the following side effects occur very rarely when this medicine is taken as recommended, they may be more likely to occur if it is taken: in large doses, for a long time, or by patients with kidney disease.

Severity: Moderate

If any of the following side effects occur while taking Sodium Bicarbonate (Trisol), check with your doctor or nurse as soon as possible:

• Frequent urge to urinate
• headache (continuing)
• loss of appetite (continuing)
• mood or mental changes
• muscle pain or twitching
• nausea or vomiting
• nervousness or restlessness
• slow breathing
• swelling of feet or lower legs
• unpleasant taste
• unusual tiredness or weakness

Minor Side Effects

Some of the side effects that can occur with Sodium Bicarbonate (Trisol) may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common:

• Increased thirst
• stomach cramps

See also:
What are the possible side effects of Sodium Chloride (Trisol)?

Post-Marketing Adverse Reactions

The following adverse reactions have been identified during postapproval use of Sodium Chloride (Trisol) Injection, USP. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

The following adverse reactions have been reported in the post-marketing experience during use of 0.9% Sodium Chloride (Trisol) Injection, USP and include the following:

hypersensitivity/infusion reactions, including hypotension, pyrexia, tremor, chills, urticaria, rash, and pruritus.

Also reported are infusion site reactions, such as infusion site erythema, injection site streaking, burning sensation, and infusion site urticaria.

The following adverse reactions have not been reported with 0.9% Sodium Chloride (Trisol) Injection, USP but may occur: hypernatremia, hyperchloremic metabolic acidosis, and hyponatremia, which may be symptomatic.

Hyponatremia has been reported for 0.45% Sodium Chloride (Trisol) Injection, USP.

The following adverse reactions have not been reported with 0.45% Sodium Chloride (Trisol) Injection, USP but may occur: hyperchloremic metabolic acidosis, hypersensitivity/infusion reactions (including hypotension, pyrexia, tremor, chills, urticaria, rash, and pruritus), and infusion site reactions (such as infusion site erythema, injection site streaking, burning sensation, infusion site urticaria).

If an adverse reaction does occur, discontinue the infusion, evaluate the patient, institute appropriate therapeutic countermeasures and save the remainder of the fluid for examination if deemed necessary.