Natriumbikarbonat Evolan (Sodium Bicarbonate)
Oral alkalinizing agent for metabolic acidosis in chronic kidney disease
Natriumbikarbonat Evolan is a prescription medication containing sodium bicarbonate (sodium hydrogen carbonate) 1 g per tablet. It is primarily used to treat metabolic acidosis — a condition where the blood becomes too acidic — in adults and adolescents over 14 years with chronic kidney disease (CKD). By supplementing the body's bicarbonate stores, it helps restore normal acid-base balance when the kidneys can no longer adequately regulate blood pH on their own.
Quick Facts
Key Takeaways
- Natriumbikarbonat Evolan contains 1 g of sodium bicarbonate per tablet and is used to correct metabolic acidosis in chronic kidney disease
- The typical starting dose is 2–3 tablets daily in divided doses, with maintenance doses up to 8 tablets daily as guided by blood tests
- Each tablet contains 273 mg of sodium (14% of the recommended daily maximum), which is important for patients on sodium-restricted diets
- Sodium bicarbonate interacts with many medications including antibiotics, heart drugs, and anti-inflammatory medicines — always inform your doctor of all medications you take
- Regular blood monitoring is essential during long-term treatment to ensure proper acid-base balance and electrolyte levels
What Is Natriumbikarbonat Evolan and What Is It Used For?
Natriumbikarbonat Evolan contains sodium bicarbonate (also known as sodium hydrogen carbonate or NaHCO3) as its active ingredient at a strength of 1 g per tablet. Sodium bicarbonate is one of the body's most important buffering substances, playing a critical role in maintaining blood pH within the narrow range necessary for normal cellular function (7.35–7.45).
In healthy individuals, the kidneys continuously regenerate bicarbonate and excrete excess acid through the urine. However, in chronic kidney disease, the kidneys progressively lose their ability to perform these functions. As kidney function declines, acid accumulates in the blood, leading to a condition called metabolic acidosis. Left untreated, chronic metabolic acidosis can accelerate the progression of kidney disease, contribute to bone loss, promote muscle wasting, and increase cardiovascular risk.
By supplementing the body's bicarbonate stores, Natriumbikarbonat Evolan helps to neutralize excess acid in the blood, restore normal pH, and prevent the damaging downstream effects of chronic acidosis. The KDIGO (Kidney Disease: Improving Global Outcomes) clinical practice guidelines recommend maintaining serum bicarbonate levels at or above 22 mmol/L in CKD patients, and oral sodium bicarbonate supplementation is a cornerstone of achieving this target.
Specific Indications
Natriumbikarbonat Evolan is indicated for the treatment of:
- Metabolic acidosis in chronic kidney disease: When the kidneys cannot remove sufficient acid from the body, leading to a decrease in blood bicarbonate levels below normal range
- Renal tubular acidosis (RTA): A group of conditions where the kidney tubules fail to properly acidify the urine, including both distal (Type 1) and proximal (Type 2) forms
The active ingredient, sodium bicarbonate, may also be approved for other conditions not mentioned in this product information. Always follow your healthcare provider's instructions and consult them if you have additional questions about the use of this medication.
What Should You Know Before Taking Natriumbikarbonat Evolan?
Contraindications
You must not take Natriumbikarbonat Evolan if any of the following apply to you:
- You are allergic (hypersensitive) to sodium bicarbonate or any of the other ingredients in this medicine
- You have alkalosis (excess of bases in the blood and body fluids, with elevated pH)
- You have respiratory acidosis (abnormally high acid levels in the blood due to breathing problems) — sodium bicarbonate cannot correct acidosis caused by inadequate breathing and may worsen it
- You have hypokalemia (abnormally low potassium levels in the blood)
- You have hypernatremia (abnormally high sodium levels in the blood)
- You are on a sodium-restricted diet
Warnings and Precautions
Talk to your doctor or pharmacist before taking Natriumbikarbonat Evolan if you have any of the following conditions, as closer monitoring or dose adjustment may be necessary:
- Heart failure: The sodium content in the tablets (273 mg per tablet) can contribute to fluid retention and worsen heart failure symptoms. Your doctor will carefully weigh the benefits against the risks and may adjust your overall sodium intake.
- Impaired kidney function: While the medication is designed to help with kidney-related acidosis, the degree of kidney impairment influences dosing. Regular monitoring of electrolytes and acid-base balance is essential.
- Abnormally slow breathing (hypoventilation): Reduced respiratory rate can impair the body's ability to compensate for changes in blood pH. Sodium bicarbonate should be used with caution in patients with respiratory depression.
- Low calcium levels (hypocalcemia): Alkalinization of the blood can further reduce ionized calcium levels, potentially leading to muscle spasms or cardiac arrhythmias. Calcium levels should be monitored.
- Hyperosmolar conditions: Conditions involving abnormal increases in dissolved substances in the blood require careful monitoring when adding sodium bicarbonate therapy.
Regular laboratory tests (blood and/or urine) are necessary during long-term treatment with Natriumbikarbonat Evolan. Your doctor will check your serum bicarbonate, potassium, sodium, and other electrolyte levels to ensure proper dosing and detect any imbalances early.
Children and Adolescents
The safety and efficacy of Natriumbikarbonat Evolan have not been established in children under 14 years of age. This medication should not be used in this age group unless specifically directed by a pediatric nephrologist who can provide individualized dosing and monitoring.
Pregnancy and Breastfeeding
If you are pregnant, breastfeeding, think you may be pregnant, or are planning to have a baby, consult your doctor or pharmacist before taking this medicine.
- Pregnancy: Natriumbikarbonat Evolan should only be used during pregnancy if your doctor considers it necessary. The potential benefits must be weighed against any possible risks. There is limited clinical data on the use of sodium bicarbonate in pregnant women, though it has a long history of use. The sodium content may contribute to fluid retention and elevated blood pressure, which are particular concerns during pregnancy.
- Breastfeeding: Sodium bicarbonate is excreted in breast milk. There are no known adverse effects on newborns with low-dose, short-term use. However, high doses and long-term use during breastfeeding are not recommended. Discuss with your doctor if you are breastfeeding and need this medication.
Driving and Using Machines
Natriumbikarbonat Evolan has no or negligible effect on the ability to drive and use machines. You are personally responsible for assessing whether you are fit to drive a motor vehicle or perform tasks requiring alertness. One factor that may affect your ability is the use of medication due to its effects and/or side effects. Read all information in this leaflet for guidance.
Important Information About Excipients
This medicine contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
This medicine contains 273 mg sodium (the main component of table salt) per tablet. This is equivalent to 14% of the recommended maximum daily dietary intake of sodium for an adult. Consult your doctor or pharmacist if you need to take one or more tablets daily for an extended period, especially if you have been advised to follow a low-sodium diet.
How Does Natriumbikarbonat Evolan Interact with Other Drugs?
Sodium bicarbonate can change the pH of the gastrointestinal tract and urine, which in turn can significantly affect how other medications are absorbed, distributed, and eliminated from the body. These interactions can either reduce the effectiveness of other drugs or increase their blood levels to potentially dangerous concentrations. It is therefore crucial to inform your healthcare provider about all medications you are currently taking, have recently taken, or might take.
Major Drug Interactions
The following medications have clinically significant interactions with sodium bicarbonate and may require dose adjustments, timing modifications, or alternative therapies:
| Drug / Class | Therapeutic Use | Interaction Effect |
|---|---|---|
| Iron sulfate | Iron-deficiency anemia | Reduced iron absorption due to increased gastric pH |
| Tetracycline | Bacterial infections | Significantly reduced antibiotic absorption; separate dosing by at least 2 hours |
| Ciprofloxacin | Bacterial infections | Reduced fluoroquinolone absorption; separate dosing |
| Ketoconazole | Cushing's syndrome | Requires acidic environment for absorption; efficacy markedly reduced |
| Itraconazole | Fungal infections | Reduced absorption due to increased gastric pH |
| Digoxin | Heart failure, arrhythmias | Altered absorption and increased risk of toxicity with electrolyte changes |
| Lithium | Bipolar disorder | Increased urinary lithium excretion leading to reduced therapeutic levels |
| Captopril | Hypertension, heart failure | Possible reduced absorption |
Additional Interactions
The following drug classes may also be affected when taken concurrently with sodium bicarbonate:
- NSAIDs (non-steroidal anti-inflammatory drugs): Used for pain, inflammation, and fever. Altered gastrointestinal pH may affect absorption of some NSAIDs.
- Sympathomimetics: Used for asthma, severe allergic reactions, sinusitis, or ADHD. Urinary alkalinization reduces their renal clearance, potentially increasing blood levels.
- Anticholinergics: Used for asthma, Parkinson's disease, motion sickness, and urinary tract conditions. Urinary alkalinization may affect their excretion.
- Tricyclic antidepressants: Used for depression. Alkaline urine reduces their renal clearance, potentially increasing plasma levels.
- Barbiturates: Used for epilepsy. Urinary alkalinization increases their excretion, potentially reducing therapeutic levels.
- H2 blockers: Used for peptic ulcers and heartburn. Concurrent use may cause excessive gastric alkalinization.
- Salicylates: Used as blood thinners. Urinary alkalinization increases salicylate excretion, reducing efficacy.
- Quinidine: Used for irregular heart rhythm. Urinary alkalinization reduces quinidine excretion, potentially increasing blood levels to toxic concentrations.
Potassium-Lowering Interactions
Taking Natriumbikarbonat Evolan together with the following medications may decrease your blood potassium levels (hypokalemia), which can cause muscle weakness, cramps, and cardiac disturbances:
- Glucocorticoids (corticosteroids used for inflammation or allergy)
- Mineralocorticoids (corticosteroids used for conditions such as adrenal insufficiency)
- Androgens (male sex hormones used in hormone replacement therapy)
- Diuretics (water pills used for hypertension, heart failure, and edema)
To minimize drug interactions, take sodium bicarbonate at least 1–2 hours apart from other oral medications, unless your doctor advises otherwise. Your healthcare provider can help you create a dosing schedule that minimizes interactions while maintaining therapeutic effectiveness.
What Is the Correct Dosage of Natriumbikarbonat Evolan?
Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are unsure. The dose is individualized based on the severity of your symptoms and the results of your blood tests, particularly your serum bicarbonate level. The goal is to maintain serum bicarbonate at or above 22 mmol/L, as recommended by the KDIGO guidelines.
Adults and Adolescents Over 14 Years
Metabolic Acidosis in Chronic Kidney Disease
- Starting dose: 2–3 tablets (2–3 g) daily, taken in divided doses throughout the day
- Maintenance dose: Up to 8 tablets (8 g) daily, taken in divided doses
- The dose is adjusted based on regular blood test results
Distal Renal Tubular Acidosis (Type 1 RTA)
- Starting dose: 4–6 tablets (4–6 g) daily, taken in divided doses
- Maintenance dose: Determined by your doctor based on blood test results
Proximal Renal Tubular Acidosis (Type 2 RTA)
- The dose is determined by your doctor based on blood test results and adjusted according to your body weight
- Higher doses are often required compared to distal RTA because bicarbonate is continuously lost in the urine
| Indication | Starting Dose | Maintenance Dose | Monitoring |
|---|---|---|---|
| CKD Metabolic Acidosis | 2–3 g/day (divided) | Up to 8 g/day (divided) | Regular blood tests (weekly initially) |
| Distal RTA (Type 1) | 4–6 g/day (divided) | Individualized | Blood and urine tests |
| Proximal RTA (Type 2) | Weight-based | Often higher doses needed | Frequent blood tests |
How to Take the Tablets
The tablets should be divided across several dosing occasions per day to maintain stable blood bicarbonate levels and minimize gastrointestinal side effects. Swallow the tablets whole with a glass of water. If you have difficulty swallowing the tablets whole, they can be split along the score line. The score is designed specifically for this purpose.
Your doctor may ask you to have blood and/or urine tests at regular intervals — for example, weekly or less frequently — to adjust your dose of Natriumbikarbonat Evolan. Adherence to the prescribed monitoring schedule is important for safe and effective treatment.
Missed Dose
If you forget to take a dose, skip the missed dose and take your next dose at the usual time. Do not take a double dose to make up for a forgotten dose. Taking extra tablets may lead to alkalosis, which can cause symptoms such as nausea, muscle twitching, and tingling.
Overdose
If you take too much Natriumbikarbonat Evolan, or if a child accidentally ingests this medicine, contact your doctor, hospital, or poison control center immediately for risk assessment and advice.
Overdose symptoms may include: dizziness, muscle weakness, fatigue, blue discoloration of skin and mucous membranes (cyanosis), shortness of breath, involuntary muscle contractions, and excessive gas formation. In severe cases, apathy, confusion, intestinal obstruction, and circulatory shock may occur. Treatment involves restoring fluid, electrolyte, and acid-base balance, and gastric lavage if necessary.
Stopping Treatment
If you stop taking Natriumbikarbonat Evolan, your symptoms of metabolic acidosis will return as acid once again accumulates in your blood. Do not discontinue treatment without first speaking with your doctor. They can advise you on how to safely taper or stop the medication if appropriate, and will monitor your acid-base balance during any changes to your treatment regimen.
What Are the Side Effects of Natriumbikarbonat Evolan?
Like all medicines, Natriumbikarbonat Evolan can cause side effects, although not everybody gets them. Most side effects are dose-related and can often be managed by adjusting the dose or timing of administration. The most common complaints are gastrointestinal in nature, particularly bloating and gas formation, which tend to improve over time as the body adjusts to the medication.
Rare
- Alkalosis — excess of bases in the blood (elevated pH) with prolonged use of high doses. Symptoms may include nausea, vomiting, muscle twitching, numbness, and tingling in the extremities.
Frequency Not Known
- Gas formation (flatulence) — caused by the reaction of bicarbonate with stomach acid, producing carbon dioxide
- Stomach pain (abdominal discomfort) — usually mild and transient
- Muscle cramps — with excessive dosing, which may be worsened by pre-existing gastrointestinal conditions (e.g., diarrhea)
- Kidney stone formation (nephrolithiasis) — with prolonged use, due to alkalinization of the urine promoting calcium phosphate precipitation
The gastrointestinal side effects, particularly bloating and gas, are among the most commonly reported complaints in clinical practice, even though they are formally classified as "frequency not known" in the prescribing information. These effects result from the chemical reaction between sodium bicarbonate and hydrochloric acid in the stomach, which produces carbon dioxide gas. Taking the tablets with meals and dividing them across multiple doses can help reduce this effect.
Metabolic alkalosis is a more serious concern but is rare when the medication is taken at prescribed doses with appropriate monitoring. It typically occurs only with chronic use of high doses, particularly in patients with severe kidney impairment whose ability to excrete excess bicarbonate is compromised. Symptoms of alkalosis include confusion, hand tremor, light-headedness, twitching, prolonged muscle spasms, nausea, and vomiting. If you experience any of these symptoms, contact your doctor immediately.
Long-term use of sodium bicarbonate can promote the formation of calcium phosphate kidney stones due to the alkalinization of urine. Your doctor should monitor your urine pH periodically and may recommend preventive measures such as adequate hydration.
It is important to report suspected side effects after a medicine has been approved. This enables ongoing monitoring of the medicine's benefit-risk balance. Healthcare professionals and patients are encouraged to report any suspected adverse reactions to their national medicines regulatory authority.
How Should You Store Natriumbikarbonat Evolan?
Keep this medicine out of the sight and reach of children at all times. Do not use this medicine after the expiry date stated on the packaging. The expiry date refers to the last day of that month. There are no special storage requirements for Natriumbikarbonat Evolan — it can be stored at normal room temperature.
However, like all medicines, it is advisable to store it in a cool, dry place away from direct sunlight and excessive heat or humidity. The original container should be kept tightly closed to protect the tablets from moisture, which can cause the sodium bicarbonate to degrade over time.
Do not dispose of medicines via the drain or with household waste. Ask your pharmacist how to dispose of medicines you no longer use. These measures help protect the environment and ensure that unused medications do not accidentally end up in the hands of children or animals.
What Does Natriumbikarbonat Evolan Contain?
Understanding the full composition of your medication is important, particularly if you have known allergies or intolerances to specific excipients. Below is the complete list of ingredients.
Active Substance
The active substance is sodium hydrogen carbonate (sodium bicarbonate), 1 g per tablet. This is a well-characterized inorganic compound with the chemical formula NaHCO3 and a molecular weight of 84.01 g/mol.
Other Ingredients (Excipients)
- Corn starch — used as a filler and disintegrant to help the tablet break apart in the gastrointestinal tract
- Lactose monohydrate — a sugar-based filler; patients with lactose intolerance should consult their doctor
- Povidone — a binding agent that holds the tablet together
- Croscarmellose sodium — a disintegrant that helps the tablet dissolve quickly
- Talc (E 553b) — a glidant used to improve powder flow during manufacturing
- Magnesium stearate — a lubricant that prevents the tablet from sticking to manufacturing equipment
Appearance and Pack Sizes
Natriumbikarbonat Evolan tablets are white, capsule-shaped, measuring 19 × 8 mm, with a score line. The score line is intended to help break the tablet in half if you have difficulty swallowing the whole tablet. The tablets are supplied in plastic containers in the following pack sizes: 90, 100, 105, 300 (3 × 100), and 500 (5 × 100) tablets. Not all pack sizes may be marketed in every country.
Frequently Asked Questions
Medical References
All information is based on international medical guidelines, product labeling, and peer-reviewed research. Evidence level: 1A.
- KDIGO (2024). "Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease." Kidney International Supplements. International guidelines recommending serum bicarbonate target ≥22 mmol/L in CKD patients.
- European Medicines Agency (EMA). "Summary of Product Characteristics: Sodium Bicarbonate Oral Tablets." Official European regulatory drug information for sodium bicarbonate products.
- British National Formulary (BNF). "Sodium Bicarbonate - Drug Monograph." Comprehensive UK prescribing reference for sodium bicarbonate including dosing, interactions, and monitoring.
- de Brito-Ashurst I, et al. (2009). "Bicarbonate supplementation slows progression of CKD and improves nutritional status." Journal of the American Society of Nephrology. 20(9):2075-2084. Landmark randomized controlled trial demonstrating renoprotective effects of oral bicarbonate supplementation.
- World Health Organization (WHO) (2023). "WHO Model List of Essential Medicines." WHO's comprehensive list of essential medicines including sodium bicarbonate.
- Navaneethan SD, et al. (2019). "Effects of Treatment of Metabolic Acidosis in CKD: A Systematic Review and Meta-Analysis." Clinical Journal of the American Society of Nephrology. 14(7):1011-1020. Systematic review evaluating outcomes of metabolic acidosis treatment in chronic kidney disease.
Evidence grading: This article uses the GRADE framework (Grading of Recommendations Assessment, Development and Evaluation) for evidence-based medicine. Evidence level 1A represents the highest quality of evidence, based on systematic reviews of randomized controlled trials.
iMedic Medical Editorial Team
Specialists in nephrology and clinical pharmacology
Our Editorial Team
iMedic's medical content is produced by a team of licensed specialist physicians and medical experts with solid academic background and clinical experience. Our editorial team includes:
Nephrology Specialists
Licensed physicians specializing in kidney diseases and acid-base disorders, with experience in managing chronic kidney disease and metabolic acidosis.
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Experts in drug interactions, pharmacokinetics, and medication safety, ensuring accurate and comprehensive drug information.
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Practicing physicians with over 10 years of clinical experience treating patients with kidney disease and related metabolic conditions.
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