Dosing & Uses
Dosage Forms & Strengths
Contains mixture of monobasic potassium phosphate and dibasic potassium phosphate
intravenous solution
- Phosphorus content: 93mg (3mM)/mL
- Potassium content: 170mg (4.4 mEq)/mL
Hypophosphatemia
The dose and administration IV infusion rate for potassium 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 potassium that will be administered: Each 1 mmol of phosphate contains ~1.5 mEq of potassium; if amount of potassium to be delivered is a concern (ie, potassium serum level >4.0 mEq/L), consider use of sodium phosphates IV to replete phosphorous level
May require continuous EKG monitoring depending on potassium administration rate
Renal Impairment
Administration of solutions containing potassium and phosphorous in patients with impaired renal function may result in hyperkalemia or hyperphosphatemia
Dosage Forms & Strengths
Contains mixture of monobasic potassium phosphate and dibasic potassium phosphate
intravenous solution
- Phosphorus content: 93mg (3mM)/mL
- Potassium content: 170mg (4.4 mEq)/mL
Hypophosphatemia
Caution should be exercised in premature neonates due to aluminum toxicity
The dose and administration IV infusion rate for potassium 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 potassium that will be administered: Each 1 mmol of phosphate contains ~1.5 mEq of potassium; if amount of potassium to be delivered is a concern (ie, potassium serum level >4.0 mEq/L), consider use of sodium phosphates IV to replete phosphorous level
May require continuous EKG monitoring depending on potassium administration rate
Renal Impairment
Administration of solutions containing potassium and phosphorous in patients with impaired renal function may result in hyperkalemia or hyperphosphatemia
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (2)
- lanthanum carbonate
lanthanum carbonate decreases effects of potassium phosphates, IV by cation binding in GI tract. Contraindicated. Lanthanum carbonate decreases serum phosphate concentration by binding dietary phosphate.
- sevelamer
sevelamer decreases effects of potassium phosphates, IV by cation binding in GI tract. Contraindicated. Sevelamer decreases serum phosphate concentration by binding dietary phosphate.
Serious - Use Alternative (33)
- aliskiren
aliskiren and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- amiloride
amiloride and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- azilsartan
azilsartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- candesartan
candesartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- cyclosporine
cyclosporine and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- drospirenone
drospirenone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- enalapril
enalapril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- eplerenone
eplerenone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- eprosartan
eprosartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- fosinopril
fosinopril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- furosemide
furosemide decreases effects of potassium phosphates, IV by increasing renal clearance. Avoid or Use Alternate Drug. Furosemide lowers phosphate serum levels by enhancing renal excretion. Use alternatives if available.
- lisinopril
lisinopril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- losartan
losartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- magnesium citrate
magnesium citrate decreases effects of potassium phosphates, IV by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.
- magnesium hydroxide
magnesium hydroxide decreases effects of potassium phosphates, IV by cation binding in GI tract. Avoid or Use Alternate Drug. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.
- moexipril
moexipril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- olmesartan
olmesartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- perindopril
perindopril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- potassium acid phosphate
potassium acid phosphate and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- potassium bicarbonate
potassium bicarbonate and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- potassium chloride
potassium chloride and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- potassium citrate
potassium citrate and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- potassium phosphate
potassium phosphate and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- quinapril
quinapril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- ramipril
ramipril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- sacubitril/valsartan
sacubitril/valsartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- sodium acid phosphate
sodium acid phosphate and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- spironolactone
spironolactone and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- telmisartan
telmisartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- trandolapril
trandolapril and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- triamterene
triamterene and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
- valsartan
valsartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.
Monitor Closely (9)
- benazepril
benazepril and potassium phosphates, IV both increase serum potassium. Use Caution/Monitor. Increased risk of hyperkalemia.
- calcium carbonate
calcium carbonate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.
- calcium citrate
calcium citrate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.
- calcium gluconate
calcium gluconate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.
- canagliflozin
potassium phosphates, IV and canagliflozin both increase serum potassium. Use Caution/Monitor.
- captopril
captopril and potassium phosphates, IV both increase serum potassium. Use Caution/Monitor. Risk of hyperkalemia. Monitor potassium.
- dichlorphenamide
dichlorphenamide and potassium phosphates, IV both decrease serum potassium. Use Caution/Monitor.
dichlorphenamide, potassium phosphates, IV. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis. - potassium citrate/citric acid
potassium phosphates, IV and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.
- voclosporin
voclosporin and potassium phosphates, IV both increase serum potassium. Use Caution/Monitor.
Minor (0)
Adverse Effects
Frequency Not Defined
Potassium
- Paresthesias of the extremities
- Flaccid paralysis
- Listlessness
- Mental confusion
- Weakness and heaviness of the legs
- Hypotension
- Cardiac arrhythmias
- Heart block
Phosphorus
- Hypocalcemic tetany
Warnings
Contraindications
Hyperphosphatemia
Hyperkalemia
Hypercalcemia or significant hypocalcemia
Severe renal impairment (eGFR <30 mL/min/1.73m2 and end stage renal disease
Cautions
Inappropriate intravenous administration of undiluted or insufficiently diluted potassium phosphates as a rapid “IV push” has resulted in cardiac arrest, cardiac arrhythmias, hypotension, and death
Drug is for intravenous infusion only after dilution or admixing; maximum initial or single dose of potassium phosphate injection in intravenous fluids to correct hypophosphatemia is phosphorus 45 mmol (potassium 71 mEq); recommended infusion rate is approximately phosphorus 6.4 mmol/hr (potassium 10 mEq/hour); continuous electrocardiographic (ECG) monitoring is recommended for higher infusion rates
Intravenous infusion of phosphate has been reported to cause a decrease in serum magnesium (and calcium) concentrations when administered to patients with hypercalcemia and diabetic ketoacidosis; monitor serum magnesium concentrations during treatment
Intravenous administration of potassium phosphates to correct hypophosphatemia in single doses of phosphorus 50 mmol and greater and/or at rapid infusion rates (over 1 to 3 hours) in intravenous fluids has resulted in death, cardiac arrest, cardiac arrhythmia (including QT prolongation), hyperkalemia, hyperphosphatemia, and seizures
Phosphorus replacement therapy with potassium phosphates should be guided primarily by the serum inorganic phosphorus levels and the limits imposed by the accompanying potassium (K+) ion
To avoid hyperkalemia or hyperphosphatemia, infuse IV solutions containing potassium phosphates slowly
Caution with severe renal or adrenal insufficiency due to risk for hyperkalemia or hyperphosphatemia
High concentrations of phosphorus may cause hypocalcemia and hypocalcemic tetany; monitor calcium levels
Pulmonary vascular precipitates
- Pulmonary vascular emboli and pulmonary distress related to precipitates in pulmonary vasculature described in patients receiving admixed products containing calcium and phosphates or parenteral nutrition;
- Cause of precipitate formation has not been determined in all cases; however, in some fatal cases, pulmonary emboli occurred as a result of calcium phosphate precipitates; precipitation has occurred following passage through an in-line filter; in vivo precipitate formation may also have occurred
- If signs of pulmonary distress occur, stop parenteral nutrition infusion, and initiate medical evaluation. In addition to inspection of solution; infusion set and catheter should also periodically be checked for precipitates
Hyperkalemia
- Therapy may increase risk of hyperkalemia, including life-threatening cardiac events, especially when administered in excessive doses, undiluted or by rapid intravenous infusion
- Patients with severe renal impairment and end stage renal disease are at increased risk of developing life-threatening hyperkalemia when administered intravenous potassium
- Other patients at increased risk of hyperkalemia include those with severe adrenal insufficiency or treated concurrently with other drugs that cause or increase risk of hyperkalemia; patients with cardiac disease may be more susceptible to effects of hyperkalemia
- Consider amount of potassium from all sources when determining dose of drug and do not exceed maximum age-appropriate recommended daily amount of potassium; in patients with moderate renal impairment (eGFR ≥30 mL/min/1.73 m2 to <60 mL/min/1.73 m2), start at low end of dose range and monitor serum potassium, phosphorus, calcium, and magnesium concentrations
- When administering in intravenous fluids to correct hypophosphatemia, check serum potassium concentration prior to administration; if potassium concentration is 4 mEq/dL or more, do not administer drug and use alternative source of phosphate
- Maximum initial or single dose in intravenous fluids to correct hypophosphatemia is phosphorus 45 mmol (potassium 71 mEq); recommended infusion rate of potassium is 10 mEq/hour; continuous electrocardiographic (ECG) monitoring is recommended for higher infusion rates of potassium
Hyperphosphatemia and hypocalcemia
- Hyperphosphatemia can occur with intravenous administration of potassium phosphates, especially in patients with renal impairment; hyperphosphatemia can cause formation of insoluble calcium phosphorus products with consequent hypocalcemia, neurological irritability with tetany, nephrocalcinosis with acute kidney injury and more rarely, cardiac irritability with arrhythmias
- Obtain serum calcium concentrations prior to administration and normalize calcium before administering therapy; monitor serum phosphorus and calcium concentrations during treatment
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
- Preterm infants are at risk for aluminum toxicity because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which also contain aluminum
- Patients with renal impairment, including preterm infants, who receive greater than 4 - 5 mcg/kg/day of parenteral aluminum can accumulate aluminum to levels associated with central nervous system and bone toxicity; tissue loading may occur at even lower rates of administration
- Exposure to aluminum from therapy is not more than 4.9 mcg/kg/day when adults weighing at least 45 kg are administered recommended maximum dosage of phosphorus (45 mmol/day) for parenteral nutrition or pediatric patients 12 years of age and older weighing at least 40 kg are administered recommended maximum dosage of phosphorus (40 mmol/day) for parenteral nutrition
- When prescribing therapy for use in parenteral nutrition solutions containing other small volume parenteral products, total daily patient exposure to aluminum from admixture should be considered and maintained at no more than 5 mcg/kg/day
- When used for parenteral nutrition not recommended in adults weighing <45 kg or pediatric patients <12 years of age or weighing <40 kg due to risks of aluminum toxicity
- Pediatric patients 12 years of age and older weighing at least 40 kg are administered recommended maximum dosage of phosphorus (40 mmol/day) for parenteral nutrition
- Tissue accumulation may occur at even lower doses
Vein damage and thrombosis
- Drug must be diluted and administered in intravenous fluids or used as an admixture in parenteral nutrition; not for direct intravenous infusion; infusion of hypertonic solutions into a peripheral vein may result in vein irritation, vein damage, and/or thrombosis
- The primary complication of peripheral administration is venous thrombophlebitis, which manifests as pain, erythema, tenderness or a palpable cord; remove catheter as soon as possible and initiate appropriate medical treatment if thrombophlebitis develops
- When administered peripherally in intravenous fluids to correct hypophosphatemia, a generally recommended maximum concentration is phosphorus 6.4 mmol/100 mL (potassium 10 mEq/100 mL)
- Parenteral nutrition solutions with an osmolarity of 900 mOsm/L or greater must be infused through a central catheter
Pregnancy & Lactation
Pregnancy
Administration of pproved recommended dose of potassium phosphate injection is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes; animal reproduction studies have not been conducted with intravenous potassium phosphates
Phosphorus is an essential mineral element; parenteral supplementation with potassium phosphates should be considered if pregnant woman’s requirements cannot be fulfilled by oral or enteral intake
Lactation
Phosphorus and potassium are present in human milk; administration of approved recommended dose is not expected to cause harm to breastfed infant; there is no information on effects of potassium phosphates on milk production; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition
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.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
Potassium is the principal intracellular cation; it helps transport dextrose across the cell membrane and contributes to normal renal function
Elimination
Excretion: feces (10%), urine (90%)
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
Monitor with EKG
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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