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sodium phosphates, IV (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Contains mixture of monobasic sodium phosphate and dibasic sodium phosphate

intravenous solution

  • Phosphorus content: 93mg (3mM)/mL
  • Sodium content: 92mg (4 mEq)/mL
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Hypophosphatemia

The dose and administration IV infusion rate for sodium phosphates are dependent upon individual needs of the patient

Phosphorous serum level <0.5 mg/dL: 0.5 mmol/kg IV infused over 4-6 hr

Phosphorous serum level 0.5-1 mg/dL: 0.25 mmol/kg IV infused over 4-6 hr

Prevention of hypophosphatemia (eg, in TPN): 20-40 mmol/day IV admixed in TPN is typical dose, but adjustment according to electrolyte levels is ongoing

Administration

Calculate concomitant amount of sodium that will be administered: Each 1 mmol of phosphate contains ~1.3 mEq of sodium; if amount of sodium to be delivered is a concern (ie, sodium serum level >145 mEq/L), consider use of potassium phosphates IV to replete phosphorous level

Renal Impairment

Administration of solutions containing sodium and phosphorous in patients with impaired renal function may result in hypernatremia or hyperphosphatemia

Dosage Forms & Strengths

Contains mixture of monobasic sodium phosphate and dibasic sodium phosphate

intravenous solution

  • Phosphorus content: 93mg (3mM)/mL
  • Sodium content: 92mg (4 mEq)/mL
more...

Hypophosphatemia

Caution should be exercised in premature neonates due to aluminum toxicity

The dose and administration IV infusion rate for sodium phosphates are dependent upon individual needs of the patient

Phosphorous serum level <0.5 mg/dL: 0.5 mmol/kg IV infused over 4-6 hr

Phosphorous serum level 0.5-1 mg/dL: 0.25 mmol/kg IV infused over 4-6 hr

Prevention of hypophosphatemia (eg, in TPN)

  • Infants/children: 0.5-2 mmol/kg/day IV
  • Children >50 kg or adolescents: 10-40 mmol/day IV
  • Dose adjustment according to electrolyte levels is ongoing

Administration

Calculate concomitant amount of sodium that will be administered: Each 1 mmol of phosphate contains ~1.3 mEq of sodium; if amount of sodium to be delivered is a concern (ie, sodium serum level >145 mEq/L), consider use of potassium phosphates IV to replete phosphorous level

Renal Impairment

Administration of solutions containing sodium and phosphorous in patients with impaired renal function may result in hypernatremia or hyperphosphatemia

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Interactions

Interaction Checker

sodium phosphates, IV and

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            Adverse Effects

            Frequency Not Defined

            Sodium

            • Anorexia
            • Nausea
            • Vomiting
            • Fatigue
            • Irritability
            • Lethargy
            • Confusion
            • Stupor
            • Coma
            • Muscle twitching
            • Hyperreflexia
            • Spasticity
            • Tremor
            • Ataxia

            Phosphorus

            • Hypocalcemic tetany
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            Warnings

            Contraindications

            Hyperphosphatemia

            Hypocalcemia

            Hypernatremia

            Hypomagnesemia

            Cautions

            Must be diluted and thoroughly mixed before administration

            Phosphorus replacement therapy with sodium phosphates should be guided primarily by the serum inorganic phosphorus levels and the limits imposed by the accompanying sodium (Na+) ion

            To avoid hypernatremia or hyperphosphatemia, infuse IV solutions containing sodium phosphates slowly

            Caution with severe renal or adrenal insufficiency due to risk for hypernatremia or hyperphosphatemia

            Use with great care, if at all, in patients with congestive heart failure, severe renal insufficiency and in edematous conditions with sodium retention

            High concentrations of phosphorus may cause hypocalcemia and hypocalcemic tetany; monitor calcium levels

            Aluminum toxicity

            • This product contains aluminum that may be toxic; aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired; premature neonates are at particular risk because of immature kidneys
            • Aluminum doses exceeding 4-5 mcg/kg/day are associated with CNS and bone toxicity
            • Tissue accumulation may occur at even lower doses
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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Unknown whether distributed in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Phosphorus is involved in many biochemical functions in the body and significant metabolic and enzyme reactions in almost all organs and tissues; it exerts a modifying influence on the steady state of calcium levels, a buffering effect on acid-base equilibrium, and a primary role in the renal excretion of hydrogen ion

            Sodium is the principal cation of extracellular fluid and comprises >90% of the total cations in the body; it is critical to regulating extracellular and intravascular volume

            Elimination

            Excretion: feces (10%), urine (90%)

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            Administration

            IV Incompatibilities

            Calcium and phosphorous are incompatible and will precipitate in most aqueous solutions; may be mixed in some TPN admixtures in variable quantities depending on the composition of the preparation, order of mixing, pH, temperature, storage, and particular calcium salt (consult pharmacist)

            Y-Site Administration

            • Acyclovir, amiodarone, amphotericin B lipid complex (Abelcet), amphotericin B liposome (AmBisome), anidulafungin, caspofungin, ciprofloxacin, daunorubicin liposome, doripenem, doxacurium, doxorubicin, epirubicin, gemtuzumab ozogamicin, idarubicin, ifosfamide, ketamine, lansoprazole, leucovorin calcium, lorazepam, mitoxantrone, mycophenolate, pantoprazole, quinupristin/dalfopristin, rocuronium

            Admixture

            • Ciprofloxacin, dobutamine

            Syringe

            • Aminophylline, pantoprazole, salbutamol

            For Dilution

            • D10% in 0.9% NaCl; D2.5% in Half-strength LR; D5% in LR; Dextrose 5% in Ringer's; Lactated Ringer's; Ringer's injection

            IV Compatibilities

            Y-Site Administration

            • Alemtuzumab, aminocaproic acid, argatroban, atenolol, bivalirudin, bleomycin, carboplatin, carmustine, cisplatin, cyclophosphamide, cytarabine, dactinomycin, daptomycin, dexmedetomidine, dexrazoxane, diltiazem

            Admixture

            • Magnesium sulfate, metoclopramide, verapamil

            For Dilution

            • Dextran 70 6% in D5W; dextran 70 6% in 0.5% NaCl; D10W; D2.5W; D2.5/0.45% NaCl; D5/0.2% NaCl; D5/0.45% NaCl; D5/NS; 0.9% NaCl (NS); 0.45% NaCl; sodium lactate 1/6 M

            IV Administration

            Administered IV only after dilution in a larger volume of fluid

            Administer slowly over 4-6 hr

            Storage

            Store at 20- 25°C (68- 77°F); excursions permitted to 15-30°C (59-86°F)

            Does not contain a bacteriostatic agent or other preservatives; discard any unused portion

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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