Sodium Bicarbonate - Aspirin, Butalbital, Caffeine, Phenacetin Interaction

Interaction Details

Aspirin, Butalbital, Caffeine, Phenacetin is classified as belonging to the following category: Methylxanthines

Theoretically, sodium bicarbonate may increase the risk of hypokalemia in patients taking methylxanthines.
Orally, use of excessive sodium bicarbonate (such as the intake of "tablespoons" of sodium bicarbonate daily or up to one box of baking soda weekly) has been associated with cases of hypokalemia. Furthermore, the most common complication of intravenous sodium bicarbonate is hypokalemia. Theophylline and related drugs can reduce serum potassium levels, possibly by increasing intracellular uptake of potassium. Hypokalemia is most likely to occur after acute overdose of these drugs. However, reduced potassium levels can occur with therapeutic doses, and the incidence and degree of hypokalemia increases with increasing serum theophylline levels.

Interaction Rating

Likelihood of Occurrence

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists

References

• Ellenhorn MJ, et al. Ellenhorn's Medical Toxicology: Diagnoses and Treatment of Human Poisoning. 2nd ed. Baltimore, MD: Williams & Wilkins, 1997.
• Crane J, Burgess CD, Graham AN, Maling TJB. Hypokalemic and electrocardiographic effects of aminophylline and salbutamol in obstructive airways disease. NZ Med J 1987;100:309-11.
• Zantvoort FA, Derkx FHM, Boomsma F, et al. Theophylline and serum electrolytes (letter). Ann Int Med 1986;104:134-5.
• Braat MCP, Jonkers RE, Bel EH, Van Boxtel CJ. Quantification of theophylline-induced eosinopenia and hypokalamia in healthy volunteers. Clin Pharmacokinet 1992;22:231-7..
• Flack JM, Ryder KW, Strickland D, Whang R. Metabolic correlates of theophylline therapy: a concentration-related phenomenon. Ann Pharmacother 1994;28:175-9..
• Proudfoot, A. T., Krenzelok, E. P., and Vale, J. A. Position Paper on urine alkalinization. J Toxicol Clin Toxicol 2004;42(1):1-26.
• Fitzgibbons, L. J. and Snoey, E. R. Severe metabolic alkalosis due to baking soda ingestion: case reports of two patients with unsuspected antacid overdose. J Emerg Med 1999;17(1):57-61.

Interaction Details

Aspirin, Butalbital, Caffeine, Phenacetin is classified as belonging to the following category: Aspirin

Theoretically, sodium bicarbonate may reduce the levels and clinical effects of aspirin.
In humans, oral or intravenous administration of sodium bicarbonate increases salicylate elimination. Although the exact mechanism of this effect is not clear, some researchers hypothesize that sodium bicarbonate increases urinary pH, which increases salicylate ionization and subsequent excretion by the kidneys. In patients with urine pH of about 5.5, renal clearance of salicylate is approximately 55 mL/min. When urine pH is increased with oral sodium bicarbonate to about 7.5, renal clearance of salicylate increases to approximately 100 mL/min. Similarly, urine alkalinization with sodium bicarbonate increases the mean total body clearance of salicylate by approximately 60% compared with urine acidification.

Interaction Rating

Likelihood of Occurrence

Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.

References

• Proudfoot AT, Krenzelok EP, Brent J, Vale JA. Does urine alkalinization increase salicylate elimination? If so, why? Toxicol Rev 2003;22(3):129-36.
• Neavyn MJ, Boyer EW, Bird SB, Babu KM. Sodium acetate as a replacement for sodium bicarbonate in medical toxicology: a review. J Med Toxicol 2013;9(3):250-4.

Sodium Bicarbonate - More Interactions

Sodium Bicarbonate interacts with 257 drugs

Interaction Rating Key

These severity listings are for informational use only. Never start, stop or otherwise change your therapy before speaking with your provider.