Drugs List

Therapeutic Indications

Uses

Hypercalcaemia
Rickets - hypophosphataemic - vitamin D resistant

Hypercalcaemia associated with such conditions as hyperparathyroidism, multiple myelomatosis and malignancy.

Hypophosphataemia associated with vitamin D resistant rickets and vitamin D resistant hypophosphataemic osteomalacia.

Contraindications

Hereditary fructose intolerance
Hypocalcaemia

Precautions and Warnings

Elderly
Restricted sodium intake
Breastfeeding
Congestive cardiac failure
Glucose-galactose malabsorption syndrome
Hyperkalaemia
Hypertension
Pre-eclampsia
Pregnancy
Renal impairment

Sodium content of effervescent preparation may be significant
Contains polyethylene glycol
Preparation contains sucrose
Indigestion remedies should not be taken at the same time
Monitor serum electrolytes before and during treatment
During long term use make clinical examinations at regular intervals
Monitor patients with renal impairment
Monitor serum phosphate levels
Monitor serum potassium and calcium
Consider dose reduction for subsequent doses if severe diarrhoea occurs
Excessive doses may cause metastatic calcification

The content of sodium (20.4mmol) and potassium (3.1mmol) in each tablet should be taken into account in patients with renal impairment associated with hypercalcaemia and in cases where restricted sodium intake is required.

Pregnancy and Lactation

Pregnancy

Use sodium acid phosphate with caution during pregnancy.

The safety of oral phosphate therapy during pregnancy has not been formally established; however it has been used for many years without any apparent ill effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use sodium acid phosphate with caution during breastfeeding.

The safety of oral phosphate therapy during breast feeding has not been formally established.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Diarrhoea
Gastro-intestinal disturbances
Nausea

Presentation

Oral formulations of sodium acid phosphate anhydrous.

Drugs List

Therapeutic Indications

Uses

Hypercalcaemia
Rickets - hypophosphataemic - vitamin D resistant

Hypercalcaemia associated with such conditions as hyperparathyroidism, multiple myelomatosis and malignancy.

Hypophosphataemia associated with vitamin D resistant rickets and vitamin D resistant hypophosphataemic osteomalacia.

Dosage

Effervescent tablets containing 1.936g of anhydrous sodium acid phosphate equivalent to phosphorus 500mg (phosphate 16.1mmol).

Dosage should be adjusted to suit individual requirements.

Adults

Children

Neonates

Contraindications

Hereditary fructose intolerance
Hypocalcaemia

Precautions and Warnings

Elderly
Restricted sodium intake
Breastfeeding
Congestive cardiac failure
Glucose-galactose malabsorption syndrome
Hyperkalaemia
Hypertension
Pre-eclampsia
Pregnancy
Renal impairment

Sodium content of effervescent preparation may be significant
Contains polyethylene glycol
Preparation contains sucrose
Indigestion remedies should not be taken at the same time
Monitor serum electrolytes before and during treatment
During long term use make clinical examinations at regular intervals
Monitor patients with renal impairment
Monitor serum phosphate levels
Monitor serum potassium and calcium
Consider dose reduction for subsequent doses if severe diarrhoea occurs
Excessive doses may cause metastatic calcification

The content of sodium (20.4mmol) and potassium (3.1mmol) in each tablet should be taken into account in patients with renal impairment associated with hypercalcaemia and in cases where restricted sodium intake is required.

Pregnancy and Lactation

Pregnancy

Use sodium acid phosphate with caution during pregnancy.

The safety of oral phosphate therapy during pregnancy has not been formally established; however it has been used for many years without any apparent ill effects.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use sodium acid phosphate with caution during breastfeeding.

The safety of oral phosphate therapy during breast feeding has not been formally established.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Diarrhoea
Gastro-intestinal disturbances
Nausea

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Further Information

Last Full Review Date: January 2019

Reference Sources

Summary of Product Characteristics: Phosphate Sandoz Effervescent Tablets. HK Pharma Ltd. Revised July 2015.

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 17 January 2019