sodium phosphates IV

Sodium phosphate intravenous (IV) is a combination of sodium and phosphate used to prevent and correct low serum phosphate levels (hypophosphatemia) in people who have restricted or no oral intake.

Sodium phosphate is administered as an intravenous infusion and is also used as part of the fluid formulas used to provide the necessary nutrients and electrolytes to patients dependent on total parenteral (intravenous) nutrition (TPN).

Phosphate is one of the essential electrolytes in the body that has many vital biochemical functions in metabolic processes and enzyme reactions in almost all organs and tissues. Phosphate plays important roles in maintaining a steady state of calcium level, as a buffer in acid-base equilibrium, and in the excretion of hydrogen ions in the kidneys. Sodium is the principal mineral that regulates blood volume levels and extracellular fluid levels in the body.

• Do not administer sodium phosphate IV to patients with:
  • High phosphate levels (hyperphosphatemia)
  • Low calcium levels (hypocalcemia)
  • High sodium levels (hypernatremia)
• Dilute the sodium phosphate solution and mix thoroughly before administration.
• Infuse the solution slowly to avoid phosphate intoxication. Infusion of high concentrations of phosphates can result in hypocalcemia and hypocalcemic tetany. Monitor calcium levels.
• Sodium phosphate IV solution contains aluminum that can be toxic with prolonged parenteral administration in patients with impaired kidney function. The risk is higher in premature newborns because they require large amounts of calcium and phosphate solutions and their kidneys are immature. Aluminum toxicity can damage the bones and the central nervous system (CNS).
• Solutions containing sodium should be used with care, only if unavoidable, in patients with the following conditions:
  • Congestive heart failure
  • Severe kidney insufficiency
  • Liver cirrhosis
  • Fluid collection (edema) with sodium retention
• In patients with reduced kidney function, administration of solutions containing sodium can result in sodium retention.
• Exercise caution in the administration of parenteral fluids, especially those containing sodium ions, to patients receiving corticosteroids or corticotropin.

Common side effects of sodium phosphates IV include:

• High levels of phosphates in the blood (hyperphosphatemia)
• Low potassium in the blood (hypokalemia)
• High or low sodium level in the blood (hypernatremia or hyponatremia)
• Low calcium in the blood (hypocalcemia)
• Involuntary muscle contractions (tetany) from hypocalcemia
• Bloating
• Abdominal pain
• Nausea
• Vomiting
• Canker sores (aphthous stomatitis)
• Loss of appetite (anorexia)
• Fatigue
• Lethargy
• Irritability
• Confusion
• Stupor
• Coma
• Muscle twitching
• Muscle stiffness (spasticity)
• Tremor
• Impaired balance, coordination, and speech (ataxia)
• Seizure
• Irregular heart rhythm (cardiac arrhythmia)
• Hypersensitivity reactions
• Swelling under the skin and in the mucous tissue (angioedema)
• Severe allergic reaction (anaphylaxis)
• Acute kidney injury
• Kidney disease (acute phosphate nephropathy)
• Kidney insufficiency
• Destruction of tubules in the kidney (renal tubular necrosis)
• Calcium kidney stones (nephrolithiasis)
• Increase in blood urea nitrogen (BUN)
• Increase in serum creatinine

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Contains a mixture of monobasic sodium phosphate and dibasic sodium phosphate

intravenous solution

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

Hypophosphatemia

Adult:

• The dose and administration IV infusion rate for sodium phosphates are dependent upon the individual needs of the patient
• Phosphorous serum level below 0.5 mg/dL: 0.5 mmol/kg IV infused over 4-6 hours
• Phosphorous serum level 0.5-1 mg/dL: 0.25 mmol/kg IV infused over 4-6 hours
• Prevention of hypophosphatemia (e.g., in total parenteral nutrition [TPN]): 20-40 mmol/day IV admixed in TPN is the typical dose, but adjustment according to electrolyte levels is ongoing

Pediatric:

• Caution should be exercised in premature neonates due to aluminum toxicity
• The dose and administration IV infusion rate for sodium phosphates are dependent upon the individual needs of the patient
• Phosphorous serum level below 0.5 mg/dL: 0.5 mmol/kg IV infused over 4-6 hours
• Phosphorous serum level 0.5-1 mg/dL: 0.25 mmol/kg IV infused over 4-6 hours
• Prevention of hypophosphatemia (e.g., in TPN)
  • Infants/children: 0.5-2 mmol/kg/day IV
  • Children above 50 kg or adolescents: 10-40 mmol/day IV
  • Dose adjustment according to electrolyte levels is ongoing

Administration

• Calculate the concomitant amount of sodium that will be administered: Each 1 mmol of phosphate contains 1.3 mEq of sodium; if the amount of sodium to be delivered is a concern (i.e., sodium serum level above 145 mEq/L), consider the 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

Overdose

• A sodium phosphates IV overdose can result in phosphate toxicity and electrolyte imbalance with symptoms that include involuntary muscle contractions (tetany), dehydration, low blood pressure (hypotension), rapid heart rate (tachycardia), high temperature (hyperpyrexia), cardiac arrest, and coma.
• Overdose is treated with the administration of appropriate electrolytes and general symptomatic and supportive care as required.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Sodium phosphate IV has severe interactions with the following drugs:
  • lanthanum carbonate
  • sevelamer
• Sodium phosphate IV has serious interactions with the following drugs:
  • baloxavir marboxil
  • benazepril
  • captopril
  • erdafitinib
• Sodium phosphate IV has moderate interactions with the following drugs:
  • calcium carbonate
  • calcium citrate
  • calcium gluconate
  • dichlorphenamide
  • furosemide
  • magnesium citrate
  • magnesium hydroxide
  • pseudoephedrine
  • voclosporin
• Sodium phosphate IV has no minor interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider about all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or healthcare provider if you have any questions about the medication.

• There are no animal reproductive studies or adequate and well-controlled studies on the safety of sodium phosphates IV use in pregnant women. It is not known if sodium phosphates IV  causes fetal harm of what effects it has on reproduction capacity. Use in pregnancy only if clearly needed.
• Phosphorous and sodium are normal components of breastmilk, and it is not known if supplementation increases the concentration. The decision to breastfeed during sodium phosphate IV therapy should be taken based on the importance of maternal treatment, the benefits of breastfeeding the infant, and the risks to the infant from drug exposure.