Sodium Citrate should not be administered to patients with metabolic or respiratory alkalosis, hypocalcaemia, or hypochlorhydria. Sodium containing salts should be administered extremely cautiously to patients with heart failure, oedema, renal impairment, hypertension, or aldosteronism. (During treatment of acidosis, frequent monitoring of serum-electrolyte concentrations and acid-base status is essential. Alkalinisation of the urine by bicarbonates or bicarbonate precursors leads to increased renal clearance of acidic drugs.) However, urinary alkalinisation prolongs the half-life of basic drugs and may result in toxicity.
Citrates and Citric Acid enhance intestinal aluminium absorption in renal patients which may lead to increased, harmful serum aluminium levels. It has therefore been suggested that patients with renal failure taking aluminium compounds to control phosphate absorption should not be prescribed citrate or citric acid containing products.