sodium phosphates, IV (Rx)

Brand and Other Names:
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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

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

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

and sodium phosphates, IV

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (2)

            • lanthanum carbonate

              lanthanum carbonate decreases effects of sodium phosphates, IV by cation binding in GI tract. Contraindicated. Lanthanum carbonate decreases serum phosphate concentration by binding dietary phosphate.

            • sevelamer

              sevelamer decreases effects of sodium phosphates, IV by cation binding in GI tract. Contraindicated. Sevelamer decreases serum phosphate concentration by binding dietary phosphate.

            Serious - Use Alternative (4)

            • baloxavir marboxil

              sodium phosphates, IV will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

            • benazepril

              benazepril increases toxicity of sodium phosphates, IV by pharmacodynamic synergism. Avoid or Use Alternate Drug. ACE Inhibitors may enhance nephrotoxic effects of sodium phosphate.

            • captopril

              captopril, sodium phosphates, IV. Either increases toxicity of the other by Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. ACE Inhibitors may enhance nephrotoxic effects of sodium phosphate.

            • erdafitinib

              sodium phosphates, IV, erdafitinib. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.

            Monitor Closely (9)

            • calcium carbonate

              calcium carbonate decreases effects of sodium 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 sodium 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 sodium 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.

            • dichlorphenamide

              dichlorphenamide and sodium phosphates, IV both decrease serum potassium. Use Caution/Monitor.

              dichlorphenamide, sodium phosphates, IV. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • furosemide

              furosemide decreases effects of sodium phosphates, IV by increasing renal clearance. Modify Therapy/Monitor Closely. Furosemide lowers phosphate serum levels by enhancing renal excretion. Use alternatives if available.

            • magnesium citrate

              magnesium citrate decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

            • magnesium hydroxide

              magnesium hydroxide decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Magnesium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

            • pseudoephedrine

              sodium phosphates, IV decreases effects of pseudoephedrine by unknown mechanism. Use Caution/Monitor. Urinary excretion of indirect acting alpha/beta agonists (eg, pseudoephedrine) may increase when administered concomitantly with urinary acidifying agents, resulting in lower serum concentrations.

            • voclosporin

              voclosporin, sodium phosphates, IV. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

            Minor (0)

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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

              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; in patients with diminished renal function, administration of solutions containing sodium ions may result in sodium retention

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

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

              Caution must be exercised in the administration of parenteral fluids, especially those containing sodium ions, to patients receiving corticosteroids or corticotropin

              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; they require large amounts of calcium and phosphate solutions, which contain aluminum
              • 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

              Animal reproduction studies not conducted with sodium phosphate; also not known whether sodium phosphate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity; sodium phosphate should be given to a pregnant woman only if clearly needed

              Lactation

              Phosphorus and sodium are normal components of human milk; decision to administer during breastfeeding should take into account risk of infant exposure, benefits of breastfeeding to infant, and benefits of therapy to mother

              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

              Do not administer unless solution is clear and seal is intact; discard unused portion

              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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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              sodium phosphate intravenous
              -
              3 mmol/mL vial
              sodium phosphate intravenous
              -
              3 mmol/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              sodium phosphate intravenous

              NO MONOGRAPH AVAILABLE AT THIS TIME

              USES: Consult your pharmacist.

              HOW TO USE: Consult your pharmacist.

              SIDE EFFECTS: Consult your pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Consult your pharmacist.

              DRUG INTERACTIONS: Consult your pharmacist.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: No monograph available at this time.

              MISSED DOSE: Consult your pharmacist.

              STORAGE: Consult your pharmacist.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised July 2016. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              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.
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              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.
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              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.