Sodium Phosphates

Sodium Phosphates Injection, USP, 3 mM P/mL is indicated as a source of phosphorus, for addition to large volume intravenous fluids, to prevent or correct hypophosphatemia in patients with restricted or no oral intake. It is also useful as an additive for preparing specific parenteral fluid formulas when the needs of the patient cannot be met by standard electrolyte or nutrient solutions.

The concomitant amount of sodium (Na+ 4 mEq/mL) must be calculated into total electrolyte dose of such prepared solutions.

In the event of overdosage, discontinue infusions containing sodium phosphate immediately and institute corrective therapy to restore depressed serum calcium and to reduce elevated serum sodium levels. See WARNINGS, PRECAUTIONS and ADVERSE REACTIONS.

Sodium Phosphates Injection, USP, 3 mM P/mL is administered intravenously only after dilution and thorough mixing in a larger volume of fluid. The dose and rate of administration are dependent upon the individual needs of the patient. Serum sodium, phosphorus and calcium levels should be monitored as a guide to dosage. Using aseptic technique, all or part of the contents of one or more vials may be added to other intravenous fluids to provide any desired number of millimoles (mM) of phosphorus.

In patients on total parenteral nutrition, approximately 12 to 15 mM of phosphorus (equivalent to 372 to 465 mg elemental phosphorus) per liter bottle of TPN solution containing 250 g dextrose is usually adequate to maintain normal serum phosphorus, though larger amounts may be required in hypermetabolic states. The amount of sodium and phosphorus which accompanies the addition of sodium phosphate also should be kept in mind, and if necessary, serum sodium levels should be monitored.

The suggested dose of phosphorus for infants receiving TPN is 1.5 to 2 mM P/kg/day.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, solution [concentrate; preservative free]: Phosphorus 3 mmol and sodium 4 mEq per 1 mL (5 mL, 15 mL, 50 mL) [equivalent to phosphorus 93 mg and sodium 92 mg per 1 mL; source of electrolytes: monobasic and dibasic sodium phosphate]

Solution, oral: Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL (45 mL) [sugar free; contains sodium 556 mg/5 mL, sodium benzoate; ginger-lemon flavor]

Solution, rectal [enema]: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL)

Fleet Enema: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) [contains sodium 4.4 g/118 mL]

Fleet Enema Extra: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium phosphate heptahydrate 7 g per 197 mL delivered dose (230 mL) [contains sodium 4.4 g/197 mL]

Fleet Pedia-Lax™ Enema: Monobasic sodium phosphate monohydrate 9.5 g and dibasic sodium phosphate heptahydrate 3.5 g per 59 mL delivered dose (66 mL) [contains sodium 2.2 g/59 mL]

LaCrosse Complete: Monobasic sodium phosphate monohydrate 19 g and dibasic sodium phosphate heptahydrate 7 g per 118 mL delivered dose (133 mL) [contains sodium 4.4 g/118 mL]

Tablet, oral [scored]:

OsmoPrep: Monobasic sodium phosphate monohydrate 1.102 g and dibasic sodium phosphate anhydrous 0.398 g [sodium phosphate 1.5 g per tablet; gluten free]

Cathartic: 3 to 6 hours; Rectal: 2 to 5 minutes

Oral solution, rectal: Short-term treatment of constipation

Oral tablets: Bowel cleansing prior to colonoscopy

IV: Source of phosphate in large volume IV fluids and parenteral nutrition; treatment and prevention of hypophosphatemia

Solution for injection: In general, the dose, concentration of infusion, and rate of administration may be dependent on patient condition and specific institution policy. Intermittent infusion doses are typically prepared in 100-250 mL of NS or D5W (usual concentration range: 0.15-0.6 mmol/mL). Observe the vial for the presence of crystals. Do not use vial if crystals are present.

Frequency not always defined.

Central nervous system: Dizziness, headache

Gastrointestinal: Bloating (31% to 47%), nausea (26% to 35%), abdominal pain (23% to 30%), vomiting (4% to 7%), mucosal bleeding, superficial mucosal ulcerations

Endocrine & metabolic: Hyperphosphatemia (≤96%), hypocalcemia (on colonoscopy day; 47%), hypophosphatemia (2-3 days postcolonoscopy; 34%), hypokalemia (on colonoscopy day; 28%), hypernatremia

Postmarketing and/or case reports (Limited to important or life-threatening): Acute phosphate nephropathy, anaphylaxis, bronchospasm, calcium nephrolithiasis, cardiac arrhythmia, dehydration, dysphagia, dyspnea, facial edema, increased blood urea nitrogen, increased serum creatinine, ischemic colitis, lip edema, paresthesia, pharyngeal edema, pruritus, rectal bleeding, renal failure, renal insufficiency, renal tubular necrosis, seizure, skin rash, tightness in throat, tongue edema, urticaria

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber signs of fluid and electrolyte problems (mood changes, confusion, muscle pain or weakness, abnormal heartbeat, severe dizziness, passing out, tachycardia, increased thirst, seizures, loss of strength and energy, lack of appetite, urinary retention or change in amount of urine passed, dry mouth, dry eyes, or nausea or vomiting), signs of kidney problems (urinary retention, hematuria, change in amount of urine passed, or weight gain), severe abdominal cramps or bloating, severe abdominal pain, severe headache, severe nausea, vomiting, angina, or tachycardia (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.