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

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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
            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) 2022 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.
            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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.