Sodium bicarbonate
Sodium bicarbonate/Drug Interactions:
GeneralGeneral: According to a systematic review in humans to assess the effectiveness of urine alkalization in reducing the toxic effects of poison (barbiturates, chlorophenoxy herbicides, chlorpropamide, diuresis and diflunisal, fluoride, methotrexate, mushrooms, pentachlorophenol, and salicylates), many studies showed beneficial effects of sodium bicarbonate (83). AlkalinizersAlkalinizers: According to secondary sources, the alkalinizing effect of sodium bicarbonate in urine may increase the solubility of cystine and uric acid and the ionization and excretion of lipid-soluble organic acids. In addition, review authors have stated that sodium bicarbonate reduced renal tubular damage due to its alkalinizing effect (93), and adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). AmphetamineAmphetamine: According to secondary sources, sodium bicarbonate may alkalinize the urine, increasing the renal tubular reabsorption, and thus blood levels, of amphetamines.AnalgesicsAnalgesics: According to systematic reviews and meta-analyses in humans, sodium bicarbonate used as a buffer in order to raise the pH to 7.0-7.75, given along with anesthetics such as lidocaine, lignocaine, lidocaine and epinephrine, bupivacaine, prilocaine, or chloroprocaine, consistently reduced pain associated with the treatment (97; 98; 99). AntacidsAntacids: According to case reports in humans, symptoms of metabolic alkalosis associated with calcium carbonate antacids and several tablespoons daily of sodium bicarbonate included dizziness and tachycardia, hypokalemia and dehydration, and loss of consciousness with shivering (107). In addition, according to secondary sources, sodium bicarbonate decreased the effectiveness of salicylates, possibly due to decreased renal tubular reabsorption or increased gastric emptying of enteric-coated tablets, as shown with antacids (115; 116; 117; 118). Anticlotting agentsAnticlotting agents: According to a systematic review and meta-analysis, adverse effects included intraventricular and periventricular hemorrhaging in preterm infants with metabolic acidosis (the influence of sodium bicarbonate unclear) (72). AntidiarrhealsAntidiarrheals: In human comparative studies, sodium citrate and sodium bicarbonate have been shown to be equally effective for rehydration and correction of acidosis caused by diarrheal dehydration (119; 120). Antifungal agentsAntifungal agents: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the absorption of itraconazole or ketoconazole, resulting in decreased blood levels.AntihypertensivesAntihypertensives: According to a case report in a patient with metabolic acidosis secondary to renal failure, administration of 100mL of 8.4% sodium bicarbonate resulted in decreased blood pressure and decreased cardiac output (73). According to a meta-analysis, a transient increase in blood pressure was observed in one patient during a bolus infusion (74). Antiulcer and gastric acid-reducing agentsAntiulcer and gastric acid-reducing agents: Sodium bicarbonate is also known as baking soda and is used traditionally for stomach upset and ulcers. Zegerid OTC? is an over-the-counter product consisting of omeprazole and sodium bicarbonate.AspirinAspirin: According to secondary sources, sodium bicarbonate may decrease the effectiveness of salicylates, possibly due to decreased renal tubular reabsorption or increased gastric emptying of enteric-coated tablets, as shown with antacids (115; 116; 117; 118). AtazanavirAtazanavir: According to secondary sources, sodium bicarbonate may result in reduced plasma concentrations of atazanavir.Cardiovascular agentsCardiovascular agents: Sodium bicarbonate reduced ventricular QRS complexes per minute in dogs with spontaneous ventricular tachycardia (121). According to one study, 12 out of 86 participants administered sodium bicarbonate experienced heart failure (85). Cefpodoxime proxetilCefpodoxime proxetil: In human studies, sodium bicarbonate reduced the peak concentration and area under the curve (AUC) of cefpodoxime (122). ChlorpropamideChlorpropamide: In human studies, sodium bicarbonate increased the renal clearance of chlorpropamide (123) and reduced the peak concentration and AUC of cefpodoxime (122). CorticosteroidsCorticosteroids: According to secondary sources, use of corticosteroids may increase the risk of sodium retention.DasatinibDasatinib: According to secondary sources, due to effects of sodium bicarbonate on pH, sodium bicarbonate may decrease levels of dasatinib.Dental agentsDental agents: According to a meta-analysis of two publications in humans, toothpaste containing baking soda removes plaque to a greater extent than toothpaste without baking soda in sites of less overall general plaque removal (hard-to-reach places) (82). EphedrineEphedrine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of ephedrine, resulting in increased blood ephedrine levels.Exercise performance enhancement agentsExercise performance enhancement agents In human studies, according to meta-analyses and systematic reviews, sodium bicarbonate had a small but beneficial effect on exercise performance, primarily in males (80; 81). FlecainideFlecainide: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of flecainide, resulting in increased blood flecainide levels.IronIron: In human research, sodium bicarbonate decreased the absorption of iron (124). LithiumLithium: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may increase the renal elimination of lithium, resulting in decreased blood lithium levels.MecamylamineMecamylamine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of mecamylamine, resulting in increased blood mecamylamine levels.MemantineMemantine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of memantine, resulting in increased blood memantine levels.MetforminMetformin: In a systematic review comparing metformin overdose survivors with nonsurvivors, the use of intravenous sodium bicarbonate therapy was noted but was not examined as a treatment (125). MethenamineMethenamine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the effectiveness of methenamine.Otic agentsOtic agents: Use of sodium bicarbonate drops for earwax removal improved clearance of earwax in available human studies (36; 78). Potassium-depleting agentsPotassium-depleting agents: According to a systematic review in humans, adverse effects following sodium bicarbonate administration included hypokalemia (106); however effects on serum potassium concentrations were lacking in a separate meta-analysis (74). According to a systematic review in humans, adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). According to case reports in humans, symptoms of metabolic alkalosis associated with calcium carbonate antacids and several tablespoons daily of sodium bicarbonate included dizziness and tachycardia, hypokalemia and dehydration, and loss of consciousness with shivering (107). According to a systematic review, studies investigating sodium bicarbonate for nonoliguric hyperkalemia in preterm neonates were lacking, and further research is required (10). PseudoephedrinePseudoephedrine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of pseudoephedrine, resulting in increased blood pseudoephedrine levels.Renal agentsRenal agents: Sodium bicarbonate, alone or in combination with other agents such as N-acetyl cysteine (NAC), was consistently associated with reduced contrast-induced nephropathy in multiple meta-analyses and systematic reviews (85; 92; 89; 90; 87; 91; 74; 88; 86; 95; 77; 94). According to systematic reviews and meta-analyses, in patients with kidney disorders, some participants receiving sodium bicarbonate required renal replacement therapy (94; 92; 87; 86; 91). Tricyclic antidepressants (TCA)Tricyclic antidepressants (TCA): According to a systematic review, the effects of sodium bicarbonate on TCA poisoning were mixed (108; 100). VasopressorsVasopressors: According to a systematic review in humans, coronary and cerebral vasoconstriction occurred following use of sodium bicarbonate, although the authors of the review stated that cerebral vasoconstriction may be a desirable effect (83). Zegerid OTC?Zegerid OTC?: Sodium bicarbonate is also known as baking soda and is used traditionally for stomach upset and ulcers. Zegerid OTC? is an over-the-counter product consisting of omeprazole and sodium bicarbonate.Sodium bicarbonate/Herb/Supplement Interactions:
GeneralGeneral: According to a systematic review in humans to assess the effectiveness of urine alkalization in reducing the toxic effects of poison (barbiturates, chlorophenoxy herbicides, chlorpropamide, diuresis and diflunisal, fluoride, methotrexate, mushrooms, pentachlorophenol, and salicylates), many studies showed beneficial effects of sodium bicarbonate (83). AlkalinizersAlkalinizers: According to secondary sources, the alkalinizing effect of sodium bicarbonate in urine may increase solubility of cystine and uric acid and the ionization and excretion of lipid-soluble organic acids. In addition, review authors have stated that sodium bicarbonate reduced renal tubular damage due to its alkalinizing effect (93), and adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). AnalgesicsAnalgesics: According to systematic reviews and meta-analyses in humans, sodium bicarbonate used as a buffer in order to raise the pH to 7.0-7.75, given along with anesthetics such as lidocaine, lignocaine, lidocaine and epinephrine, bupivacaine, prilocaine, or chloroprocaine, consistently reduced pain associated with the treatment (97; 98; 99). AntacidsAntacids: According to case reports in humans, symptoms of metabolic alkalosis associated with calcium carbonate antacids and several tablespoons daily of sodium bicarbonate included dizziness and tachycardia, hypokalemia and dehydration, and loss of consciousness with shivering (107). In addition, according to secondary sources, sodium bicarbonate decreased the effectiveness of salicylates, possibly due to decreased renal tubular reabsorption or increased gastric emptying of enteric-coated tablets, as shown with antacids (115; 116; 117; 118). AnticoagulantsAnticoagulants: According to a systematic review and meta-analysis, adverse effects included intraventricular and periventricular hemorrhaging in preterm infants with metabolic acidosis (the influence of sodium bicarbonate unclear) (72). AntidiarrhealsAntidiarrheals: In human comparative studies, sodium citrate and sodium bicarbonate have been shown to be equally effective for rehydration and correction of acidosis caused by diarrheal dehydration (119; 120). Antifungal agentsAntifungal agents: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the absorption of antifungal agents, resulting in decreased blood levels.AntihypertensivesAntihypertensives: According to a case report in a patient with metabolic acidosis secondary to renal failure, administration of 100mL of an 8.4% sodium bicarbonate resulted in decreased blood pressure and decreased cardiac output (73). According to a meta-analysis, a transient increase in blood pressure was observed in one patient during a bolus infusion (74). Anti-inflammatoriesAnti-inflammatories: According to secondary sources, use of corticosteroids may increase the risk of sodium retention.Antiulcer and gastric acid-reducing agentsAntiulcer and gastric acid-reducing agents: Sodium bicarbonate is also known as baking soda and is used traditionally for stomach upset and ulcers. Zegerid OTC? is an over-the-counter product consisting of omeprazole and sodium bicarbonate.CalciumCalcium: According a case report, intravascular administration of calcium chloride and sodium bicarbonate resulted in vascular calcification of scalp vein tissue in a neonate (76), and in another case report, administration of sodium bicarbonate and calcium chloride through a misplaced umbilical catheter calcified the bladder (111). According to secondary sources, sodium bicarbonate use has been associated with extravasation and tissue calcification, and adding sodium bicarbonate to calcium-containing solutions may result in precipitation. Cardiovascular agentsCardiovascular agents: Sodium bicarbonate reduced ventricular QRS complexes per minute in dogs with spontaneous ventricular tachycardia (121). According to one study, 12 out of 86 participants administered sodium bicarbonate experienced heart failure (85). Dental agentsDental agents: According to a meta-analysis of two publications in humans, toothpaste containing baking soda removed plaque to a greater extent than toothpaste without baking soda in sites of less overall general plaque removal (hard-to-reach places) (82). EphedrineEphedrine: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may decrease the renal elimination of ephedrine, resulting in increased blood ephedrine levels.Exercise performance enhancement agentsExercise performance enhancement agents: In human studies, according to meta-analyses and systematic reviews, sodium bicarbonate had a small but beneficial effect on exercise performance, primarily in males (80; 81). IronIron: In human research, sodium bicarbonate decreased the absorption of iron (124). N-acetyl cysteine (NAC)N-acetyl cysteine (NAC): According to a meta-analysis of randomized controlled trials, a combination of NAC with intravenous sodium bicarbonate reduced contrast-induced acute kidney injury; however, the effects of sodium bicarbonate alone are unclear (126). Otic agentsOtic agents: Use of sodium bicarbonate drops for earwax removal improved clearance of earwax in available human studies (36; 78). Potassium-depleting agentsPotassium-depleting agents: According to a systematic review in humans, adverse effects following sodium bicarbonate administration included hypokalemia (106); however, effects on serum potassium concentrations were lacking in a separate meta-analysis (74). According to a systematic review in humans, adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). According to case reports in humans, symptoms of metabolic alkalosis associated with calcium carbonate antacids and several tablespoons daily of sodium bicarbonate included dizziness and tachycardia, hypokalemia and dehydration, and loss of consciousness with shivering (107). According to a systematic review, studies investigating sodium bicarbonate for nonoliguric hyperkalemia in preterm neonates were lacking, and further research is required (10). Renal agentsRenal agents: Sodium bicarbonate, alone or in combination with other agents such as N-acetyl cysteine, was consistently associated with reduced contrast-induced nephropathy in multiple meta-analyses and systematic reviews (85; 92; 89; 90; 87; 91; 74; 88; 86; 95; 77; 94). According to systematic reviews and meta-analyses, in patients with kidney disorders, some participants receiving sodium bicarbonate required renal replacement therapy (94; 92; 87; 86; 91). VasopressorsVasopressors: According to a systematic review in humans, coronary and cerebral vasoconstriction occurred following use of sodium bicarbonate, although the authors of the review stated that cerebral vasoconstriction may be a desirable effect (83). Sodium bicarbonate/Food Interactions:
GeneralGeneral: According to secondary sources, due to the effects of sodium bicarbonate on pH, sodium bicarbonate may affect the general digestion of food.Sodium bicarbonate/Lab Interactions:
BicarbonateBicarbonate: According to systematic review, there was a statistically significant correlation between the dose of sodium bicarbonate and the increase in bicarbonate levels in the blood (81) and serum bicarbonate levels poststudy compared to normal saline (91). Blood calciumlevelsBlood calciumlevels: According to a systematic review, adverse effects following sodium bicarbonate administration included hypocalcemia (106). According to a systematic review, the adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). According to secondary sources, use of sodium bicarbonate may be associated with metabolic alkalosis and decreased ionized calcium. Blood phosphatelevelsBlood phosphatelevels: According to a review, use of sodium bicarbonate may contribute to hypophosphatemia (75). Blood potassiumlevelsBlood potassiumlevels: According to a systematic review in humans, adverse effects following sodium bicarbonate administration included hypokalemia (106); however, effects on serum potassium concentrations were lacking in a separate meta-analysis (74). According to a systematic review in humans, adverse effects specific to the use of sodium bicarbonate for urinary alkalization included severe alkalemia leading to tetany, hypokalemia, and hypocalcemia (83). According to case reports in humans, symptoms of metabolic alkalosis associated with calcium carbonate antacids and several tablespoons daily of sodium bicarbonate included dizziness and tachycardia, hypokalemia and dehydration, and loss of consciousness with shivering (107). Blood sodiumlevelsBlood sodiumlevels: According to a systematic review in humans, adverse effects following sodium bicarbonate administration included hypernatremia (106). CreatinineCreatinine: According to meta-analyses, there was a reduced relative risk of increased creatinine with sodium bicarbonate treatment compared to placebo or normal saline groups (74; 88). IronIron: In human research, sodium bicarbonate decreased the absorption of iron (124). KetonesKetones: According to animal and human research, sodium bicarbonate increased ketone production in patients with diabetic ketoacidosis (127; 128; 129; 63; 130; 131; 132). Urinary pHUrinary pH: According to a meta-analysis, urinary pH increased with isotonic sodium bicarbonate treatment (74). Urinary sodiumUrinary sodium: In human research, sodium excretion increased with sodium bicarbonate treatment (96).