PHOSPHATES (Systemic)

Some commonly used brand names are:

In the U.S.?

• K-Phos M. F. ²
• K-Phos Neutral ²
• K-Phos No. 2 ²
• K-Phos Original ¹
• Neutra-Phos ²
• Neutra-Phos-K ¹
• Uro-KP-Neutral ²

In Canada?

• Uro-KP-Neutral ²

Category

• Acidifier, urinary?Potassiumand Sodium Phosphates; Monobasic PotassiumPhosphates
• Antiurolithic, calcium calculi?Potassium and Sodium Phosphates; Monobasic Potassium Phosphates
• Electrolyte replenisher?Potassium and SodiumPhosphates; Potassium Phosphates; Sodium Phosphates

Description

Phosphates are used as dietary supplements forpatients who are unable to get enough phosphorus in their regular diet, usuallybecause of certain illnesses or diseases. Phosphate is the drug form (salt)of phosphorus. Some phosphates are used to make the urine more acid, whichhelps treat certain urinary tract infections. Some phosphates are used toprevent the formation of calcium stones in the urinary tract.

Injectable phosphates are to be administered only by or under the supervisionof your health care professional. Some of these oral preparations are availableonly with a prescription. Others are available without a prescription; however,your health care professional may have special instructions on the properdose of this medicine for your medical condition. You should take phosphatesonly under the supervision of your health care professional.

Phosphates are available in the following dosage forms:

Oral
• Potassium Phosphates
  • Capsules for solution (U.S.)
  • Powder for solution (U.S.)
  • Tablets for solution (U.S.)
• Potassium and Sodium Phosphates
  • Capsules for solution (U.S.)
  • Powder for solution (U.S.)
  • Tablets for solution (U.S. and Canada)

Parenteral
• Potassium Phosphates
  • Injection (U.S. and Canada)
• Sodium Phosphates
  • Injection (U.S.)

Importance of Diet

The best dietary sources of phosphorus include dairy products, meat, poultry,fish, and cereal products.

The daily amount of phosphorus needed is defined in several different ways.

For U.S.?
• Recommended Dietary Allowances (RDAs) are the amount of vitaminsand minerals needed to provide for adequate nutrition in most healthy persons.RDAs for a given nutrient may vary depending on a person's age, sex, and physicalcondition (e.g., pregnancy).
• Daily Values (DVs) are used on food and dietary supplement labelsto indicate the percent of the recommended daily amount of each nutrient thata serving provides. DV replaces the previous designation of United StatesRecommended Daily Allowances (USRDAs).

For Canada?
• Recommended Nutrient Intakes (RNIs) are used to determine the amountsof vitamins, minerals, and protein needed to provide adequate nutrition andlessen the risk of chronic disease.

Normal daily recommended intakes for phosphorus are generally defined asfollows:

Persons	U.S. (mg)	Canada (mg)
Infants and children Birth to 3 years of age	300-800	150-350
4 to 6 years of age	800	400
7 to 10 years ofage	800	500-800
Adolescent and adult males	800-1200	700-1000
Adolescent and adult females	800-1200	800-850
Pregnantfemales	1200	1050
Breast-feeding females	1200	1050

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your health care professional will make. Forphosphates the following should be considered:

Allergies?Tell your health care professional if you have everhad any unusual or allergic reaction to potassium, sodium, or phosphates.Also, tell your health care professional if you are allergic to any othersubstances, such as foods, preservatives, or dyes.

Pregnancy?It is especially important that you are receivingenough vitamins and minerals when you become pregnant and that you continueto receive the right amount of vitamins and minerals throughout your pregnancy.The healthy growth and development of the fetus depend on a steady supplyof nutrients from the mother. However, taking large amounts of a dietary supplementin pregnancy may be harmful to the mother and/or fetus and should be avoided.

Breast-feeding?It is especially important that you receive theright amount of vitamins and minerals so that your baby will also get thevitamins and minerals needed to grow properly. However, taking large amountsof a dietary supplement while breast-feeding may be harmful to the motherand/or baby and should be avoided.

Children?Problems in children have not been reported withintake of normal daily recommended amounts. However, use of enemas that containphosphates in children has resulted in high blood levels of phosphorus.

Older adults?Problems in older adults have not been reported withintake of normal daily recommended amounts.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your health care professionalmay want to change the dose, or other precautions may be necessary. When youare taking phosphates, it is especially important that your health care professionalknow if you are taking any of the following:

• Amiloride (e.g., Midamor) or
• Angiotensin-converting enzyme (ACE) inhibitors (benazepril [e.g.,Lotensin], captopril [e.g., Capoten], enalapril [e.g., Vasotec], fosinopril[e.g., Monopril], lisinopril [e.g., Zestril, Prinivil], quinapril [e.g., Accupril],ramipril [e.g., Altace]) or
• Cyclosporine or
• Digitalis glycosides (heart medicine) or
• Heparin (e.g., Panheprin), with long-term use, or
• Medicine for inflammation or pain (except narcotics) or
• Other potassium-containing medicine or
• Salt substitutes, low-salt foods, or milk or
• Spironolactone (e.g., Aldactone) or
• Triamterene (e.g., Dyrenium)?Use with potassium-containingphosphates may increase the risk of hyperkalemia (too much potassium in theblood), possibly leading to serious side effects

• Antacids?Use with phosphates may prevent the phosphate fromworking properly

• Calcium-containing medicine, including antacids and calcium supplements?Usewith phosphates may prevent the phosphate from working properly; calcium depositsmay form in tissues

• Corticosteroids (cortisone-like medicine)?Use with sodium-containingphosphates may increase the risk of swelling

• Phosphate-containing medications, other, including phosphate enemas?Usewith sodium or potassium phosphates may cause high blood levels of phosphoruswhich may increase the chance of side effects

• Sodium-containing medicines (other)?Use with sodium phosphatesmay cause your body to retain (keep) water

Other medical problems?The presence of other medicalproblems may affect the use of phosphates. Make sure you tell your healthcare professional if you have any other medical problems, especially:

• Burns, severe or
• Heart disease or
• Pancreatitis (inflammation of the pancreas) or
• Rickets or
• Softening of bones or
• Underactive parathyroid glands?Sodium- or potassium-containingphosphates may make these conditions worse

• Dehydration or
• Underactive adrenal glands?Potassium-containing phosphatesmay increase the risk of hyperkalemia (too much potassium in the blood)

• Edema (swelling in feet or lower legs or fluid in lungs) or
• High blood pressure or
• Liver disease or
• Toxemia of pregnancy?Sodium-containing phosphates may makethese conditions worse

• High blood levels of phosphate (hyperphosphatemia)?Use of phosphatesmay make this condition worse

• Infected kidney stones?Phosphates may make this condition worse

• Kidney disease?Sodium-containing phosphates may make this conditionworse; potassium-containing phosphates may increase the risk of hyperkalemia(too much potassium in the blood)

• Myotonia congenita?Potassium-containing phosphates may increasethe risk of hyperkalemia (too much potassium in the blood), and make thiscondition worse

Proper Use of This Medicine

For patientstaking the tablet form of this medicine:

• Do not swallow the tablet. Before taking,dissolve the tablet in 3/4 to 1 glass (6 to 8 ounces) of water. Let thetablet soak in water for 2 to 5 minutes and then stir until completely dissolved.

For patients using the capsule form of thismedicine:

• Do not swallow the capsule. Before taking,mix the contents of 1 capsule in one-third glass (about 21/2 ounces)of water or juice or the contents of 2 capsules in two-thirds glass (about5 ounces) of water and stir well until dissolved.

For patients using the powder form of thismedicine:

• Add the entire contents of 1 bottle (21/4 ounces) to enoughwarm water to make 1 gallon of solution or thecontents of one packet to enough warm water to make 1/3 of a glass (about2.5 ounces) of solution. Shake the container for 2 or 3 minutes or until allthe powder is dissolved.
• Do not dilute solution further.
• This solution may be chilled to improve the flavor; do not allowit to freeze.
• Discard unused solution after 60 days.

Take this medicine immediately after meals or withfood to lessen possible stomach upset or laxative action.

To help prevent kidney stones, drink at least a fullglass (8 ounces) of water every hour during waking hours, unless otherwisedirected by your health care professional.

Take this medicine only as directed. Do nottake more of it and do not take it more often than recommended on the label,unless otherwise directed by your health care professional.

Dosing?The dose of these single or combination medicineswill be different for different patients. Follow yourhealth care professional's orders or the directions on the label. Thefollowing information includes only the average doses of these medicines. If your dose is different, do not change it unlessyour health care professional tells you to do so.

The number of teaspoonfuls or ounces of prepared solution that you drinkdepends on the equivalent amount of phosphorus contained in the product. Also, the number of doses you take each day, the time allowedbetween doses, and the length of time you take the medicine depend on themedical problem for which you are taking the single or combination medicine.

For potassium phosphates
• For tablets for oral solution dosageform:
  • To replace phosphorus lost by the body or to make the urine moreacid or to prevent the formation of kidney stones in the urinary tract:
    • Adults and teenagers?The equivalent of 228 milligrams (mg)of phosphorus (2 tablets) dissolved in six to eight ounces of water four timesa day, with meals and at bedtime.
  • To replace phosphorus lost by the body:
    • Children over 4 years of age?The equivalent of 228 mg of phosphorus(2 tablets) dissolved in six to eight ounces of water four times a day, withmeals and at bedtime.
    • Children up to 4 years of age?The dose must be determined byyour doctor.
• For capsules for oral solution dosageform:
  • To replace phosphorus lost by the body:
    • Adults, teenagers, and children over 4 years of age?The equivalentof 250 mg of phosphorus (contents of 1 capsule) dissolved in two and one-halfounces of water or juice four times a day, after meals and at bedtime.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.
• For powder for oral solution dosage form:
  • To replace phosphorus lost by the body:
    • Adults, teenagers, and children over 4 years of age?The equivalentof 250 mg of phosphorus dissolved in two and one-half ounces of water fourtimes a day, after meals and at bedtime.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.

For potassium and sodium phosphates
• For tablets for oral solution dosageform:
  • To replace phosphorus lost by the body or to make the urine moreacid or to prevent the formation of kidney stones in the urinary tract:
    • Adults and teenagers?The equivalent of 250 milligrams (mg)of phosphorus dissolved in eight ounces of water four times a day, after mealsand at bedtime.
  • To replace phosphorus lost by the body:
    • Children over 4 years of age?The equivalent of 250 mg of phosphorusdissolved in eight ounces of water four times a day, after meals and at bedtime.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.
• For capsules for oral solution dosageform:
  • To replace phosphorus lost by the body:
    • Adults, teenagers, and children over 4 years of age?The equivalentof 250 mg of phosphorus (the contents of 1 capsule) dissolved in two and one-halfounces of water or juice four times a day, after meals and at bedtime.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.
• For powder for oral solution dosage form:
  • To replace phosphorus lost by the body:
    • Adults, teenagers, and children over 4 years of age?The equivalentof 250 mg of phosphorus dissolved in two and one-half ounces of water fourtimes a day, after meals and at bedtime.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.
• For tablets for oral solution dosageform:
  • To replace phosphorus lost by the body:
    • Adults, teenagers, and children over 4 years of age?The equivalentof 250 mg of phosphorus (1 tablet) dissolved in eight ounces of water fourtimes a day.
    • Children up to 4 years of age?Dose must be determined by yourdoctor.

Missed dose?If you miss a dose of this medicine, take it assoon as possible. However, if it is within 1 or 2 hours of your next dose,skip the missed dose and go back to your regular dosing schedule. Do not doubledoses.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule, tablet, or powder form of this medicinein the bathroom, near the kitchen sink, or in other damp places. Heat or moisturemay cause the medicine to break down.
• Keep the liquid form of this medicine from freezing.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

Yourhealth care professional should check your progress at regular visits to makesure that this medicine does not cause unwanted effects.

Do not take iron supplements within 1 to 2 hours oftaking this medicine. To do so may keep the iron from working properly.

For patients taking potassium phosphate-containingmedicines:

• Check with your health care professional before starting any strenuousphysical exercise, especially if you are out of condition and are taking othermedication. Exercise and certain medicines may increase the amount of potassiumin the blood.

For patients on a potassium-restricted diet:

• This medicine may contain a large amount of potassium. If you haveany questions about this, check with your health care professional.
• Do not use salt substitutes and low-salt milk unless told to do soby your health care professional. They may contain potassium.

For patients on a sodium-restricted diet:

• This medicine may contain a large amount of sodium. If you have anyquestions about this, check with your health care professional.

Side Effects of This Medicine

Along with its needed effects, a medicine maycause some unwanted effects. Although not all of these side effects may occur,if they do occur they may need medical attention.

Check with your health care professional as soon as possible if any ofthe following side effects occur:

Less common or rare

Confusion; convulsions (seizures); decrease in amount of urine or in frequency of urination; fast, slow, or irregular heartbeat; headache or dizziness; increased thirst; muscle cramps; numbness, tingling, pain,or weakness in hands or feet; numbness or tinglingaround lips; shortness of breath or troubled breathing; swelling of feet or lower legs; tremor; unexplained anxiety; unusual tiredness or weakness; weakness or heavinessof legs; weight gain

Other side effects may occurthat usually do not need medical attention. These side effects may go awayduring treatment as your body adjusts to the medicine. However, check withyour health care professional if any of the following side effects continueor are bothersome:

Diarrhea; nausea or vomiting; stomach pain

Other side effectsnot listed above may also occur in some patients. If you notice any othereffects, check with your health care professional.