Potassium phosphate is a supplement used intravenously to treat hypophosphatemia or prevent hypophosphatemia in patients receiving parenteral nutrition (PN). Guidelines generally recommend the use of potassium phosphate for potassium serum concentration less than 4 mg/dL and sodium phosphate for potassium serum concentration more than 4 mg/dL. Potassium phosphate is also used orally in adults for urinary acidification and to augment the efficacy of methenamine therapy in treating urinary tract infections. Phosphorus is an important element in all body tissues. Phosphorus is the principal ion in the bone and cartilage; phosphate is the primary ion in extra- and intracellular fluid, cell membranes, nucleic acids, and energy mediators and exists in the body as inorganic phosphate or phosphate esters. Phosphorus serves many functions in the body including carbohydrate metabolism, energy transfer, and muscle contraction. Phosphorus is present in nearly all foods, and if a deficiency state is present, it is usually induced (e.g., diabetic acidosis treatment, excessive antacid use, long-term PN). The concomitant potassium content must be taken into consideration when replacing phosphorus, and particular caution should be used in patients with cardiac disease, renal impairment, adrenal insufficiency, or other conditions with a risk of hyperkalemia.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
Oral Solid Formulations
-Dissolve tablets in 180 to 240 mL of water. Let tablets soak in the water for 2 to 5 minutes or more, and stir. If any particles remain, they may be crushed and stirred vigorously to aid in dissolution.
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
-Check IV compatibility prior to admixing or infusing with other drugs or solutions; phosphate salts may precipitate when mixed with calcium salts under selected circumstances. Precipitation in the admixture is dependent primarily on the concentration of calcium and phosphate in the solution, the pH, and temperature of the solution; however, other factors such as amino acid concentration and the presence of other additives must also be observed.
Intravenous Administration
Dilution
-DO NOT administer IV push; potassium phosphate MUST be diluted before administration. Injection of concentrated potassium solution has been instantaneously fatal.
-Dilute in sufficient volume of a compatible IV infusion solution (i.e., 100 to 500 mL of 5% Dextrose Injection or 0.9% NaCl Injection).
--Peripheral line: Potassium infusion via a peripheral vein may cause burning pain and phlebitis at the infusion site; follow dilution recommendations.
--Adult and Pediatric patients 12 to 17 years: The maximum recommended concentration is 68 mmol/L of phosphorus (100 mEq/L of potassium).
-Pediatric patients younger than 12 years: The maximum recommended concentration is 27 mmol/L of phosphorus (40 mEq/L of potassium).
-Central line:
--Adult and Pediatric patients 12 to 17 years: The maximum recommended concentration is 180 mmol/L of phosphorus (264 mEq/L of potassium).
-Pediatric patients younger than 12 years: The maximum recommended concentration is 55 mmol/L of phosphorus (80 mEq/L of potassium).
-Storage:
--Single-dose vial: For single use only; discard any remaining contents.
-Pharmacy bulk vial: Use for admixing should be limited to up to 4 hours at room temperature after container has been penetrated; discard any remaining drug.
-After dilution, solutions are stable for 4 hours at room temperature and 14 days under refrigeration.
Intravenous infusion
-NEVER administer potassium phosphate by IV push; maximum concentrations and recommended infusion rates may differ according to institution and patient care setting.
-Do not infuse with calcium-containing IV fluids.
-Adults and Pediatric patients 12 to 17 years:
--Peripheral line: Infuse at a maximum rate of 6.8 mmol/hour (10 mEq/hour potassium).
-Central line: Infuse at a maximum rate of 15 mmol/hour (22 mEq/hour potassium). Rates as high as 20 mmol/hour (29 mEq/hour potassium) have been safely used in adult ICU patients.
-Continuous ECG monitoring is recommended for potassium infusion rates higher than 10 mEq/hour.
-Pediatric patients younger than 12 years:
--Peripheral line: Data are limited; the usual infusion rate based on potassium content is 0.17 to 0.34 mmol/kg/hour (0.25 to 0.5 mEq/kg/hour potassium).
-Central line: Continuous ECG monitoring and central line is recommended for potassium infusion rates higher than 0.5 mEq/kg/hour (Max: 10 mEq/hour).
Parenteral Nutrition (PN) Preparation
-Potassium phosphate injection must be diluted and used as an admixture in parenteral nutrition solutions; NEVER administer by direct IV infusion.
-Follow proper admixing sequence as related to parenteral nutrition to minimize pH-related issues. Generally, phosphate should be added first to the PN admixture, and calcium should be added to the end of the compounding sequence to take advantage of the maximum volume of PN formulation.
-Parenteral nutrition admixtures containing calcium phosphate precipitates have resulted in embolic deaths when infused. Inspect final parenteral nutrition solution to ensure no precipitates have formed during mixing or addition of additives; inspect again before administration.
-Storage:
--Single-dose vial: For single use only; discard any remaining contents.
-Pharmacy bulk vial: Use for admixing should be limited to up to 4 hours at room temperature after container has been penetrated; discard any remaining drug.
-After mixing in parenteral nutrition solutions, admixtures are stable for 24 hours under refrigeration; after removal from refrigeration, use solution promptly and complete the infusion within 24 hours. Discard any remaining admixture.
Phosphorus salts may produce hyperphosphatemia, which can lead to hypocalcemia and subsequent hypocalcemic tetany characterized by tremor, seizures, muscle cramps, and paresthesias. Symptoms of hyperphosphatemia may include paresthesias of the extremities, muscle paralysis, lethargy, listlessness, mental confusion, heaviness of the legs, weakness, acidosis, cardiac arrhythmias, hypertension, AV block, and electrocardiogram (ECG) changes. Hyperphosphatemia can also cause ectopic calcium phosphate deposition in patients where the serum calcium:phosphate solubility product exceeds 55 to 70 mg2/dL2. The precipitation of calcium phosphate is more likely to occur if hypercalcemia is present.
Administration of potassium phosphate may be associated with the development of hyperkalemia, especially in high-risk patients (i.e., patients with renal impairment, cardiac disease, adrenal insufficiency). Hyperkalemia may be asymptomatic, but it can develop rapidly into a potentially fatal situation. Manifestations of hyperkalemia include: ECG changes, disturbances in cardiac conduction and arrhythmias, including bradycardia, heart block, asystole, ventricular tachycardia, and ventricular fibrillation, chest pain (unspecified), paresthesias, muscular weakness, flaccid paralysis of the extremities, mental confusion, hypotension, shock, and cardiac arrest. Monitor potassium concentrations during potassium phosphate therapy. Continuous ECG monitoring is recommended for higher infusion rates of potassium (i.e., more than 10 mEq/hour in adults and 0.5 mEq/kg/hour in pediatrics).
Concentrated potassium phosphate injection contains aluminum. Thus, aluminum toxicity may occur with prolonged administration in high-risk patients, including those with renal impairment and premature neonates. Premature neonates are at particular risk for aluminum toxicity because of immature renal function, and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, who receive parenteral aluminum at rates greater than 4 to 5 mcg/kg/day, may develop aluminum toxicity (CNS and bone toxicity). Tissue loading may occur at lower administration rates. The use of potassium phosphate injection manufactured by Hospira is not recommended in pediatric patients because the aluminum exposure is unsafe for this population. This product has significantly more aluminum content (up to 31,000 mcg/L) compared to the product manufactured by Fresenius Kabi (up to 2,000 mcg/L). This product alone may produce daily aluminum exposures of up to twice the FDA-recommended limit for parenteral nutrition, with additional aluminum exposure expected from the other components of parenteral nutrition. Other potassium phosphate injection products may also not be recommended in neonates, infants, and children due to the aluminum content. Health care providers should use an FDA-approved potassium phosphate injection product with the aluminum content considered acceptable for each patient based on age, weight, and recommended dose of phosphorus.
Infusion of potassium phosphate may cause an injection site reaction, consisting of vein irritation, vein damage, thrombosis, or phlebitis. Remove the IV catheter as soon as possible if thrombophlebitis occurs.
Gastrointestinal adverse reactions, such as diarrhea, nausea, vomiting, and abdominal pain, have been reported with potassium phosphate. Additionally, bone pain and joint pain (arthralgia), indicating possible phosphate-induced osteomalacia, may occur.
Intravenous infusion of potassium phosphate has been reported to cause hypomagnesemia in patients with hypercalcemia and diabetic ketoacidosis. Monitor serum magnesium concentrations during treatment with potassium phosphate.
Acute phosphate nephropathy (i.e., nephrocalcinosis with acute kidney injury), decreased urine output (oliguria), and transition to chronic kidney disease have been reported with potassium phosphate injection. Edema, hypovolemia, and osmotic diuresis have also been reported.
Pulmonary embolism and respiratory distress, due to pulmonary vascular precipitates, have been reported in patients receiving admixed products containing calcium and potassium phosphate injection or parenteral nutrition. The cause of precipitate formation has not been determined in all cases; however, in some fatal cases, pulmonary emboli occurred as a result of calcium phosphate precipitates. Precipitation has occurred following passage through an in-line filter; in vivo precipitate formation may also have occurred. If signs of dyspnea or pulmonary distress occur, stop the infusion and initiate appropriate medical evaluation and/or treatment.
Potassium phosphate is contraindicated in patients with hyperkalemia. Potassium phosphate may increase the risk of hyperkalemia, and serious cardiac adverse events (i.e., hypotension, cardiac arrhythmia (including QT prolongation), and cardiac arrest), including life-threatening and fatal cases, have occurred with intravenous administration of potassium phosphate, especially when administered in excessive doses, undiluted, or by rapid IV infusion. Patients at increased risk of hyperkalemia include patients with impaired renal function, cardiac disease, severe adrenal insufficiency, or those treated concurrently with other drugs that cause or increase the risk of hyperkalemia. When administering potassium phosphate injection in intravenous fluids to correct hypophosphatemia, assess the serum potassium concentration prior to administration. If the potassium concentration is 4 mEq/dL or more, do not administer potassium phosphate injection and use an alternative source of phosphorus. Consider the amount of potassium from all sources when determining the potassium phosphate dose and do not exceed the maximum recommended daily amount of potassium. Dosing, dilution, and infusion rate recommendations for potassium phosphate should be strictly adhered to. The recommended infusion rate of potassium through a peripheral line is 10 mEq/hour. Continuous ECG monitoring and infusion through a central line is recommended for potassium infusion rates higher than 10 mEq/hour in adults and children weighing 20 kg or more and for potassium infusion rates higher than 0.5 mEq/kg/hour (Max: 10 mEq/hour) in children weighing less than 20 kg.
Oral potassium phosphate is contraindicated in patients who have a phosphate nephrolithiasis infection (i.e., infected phosphate stones). Patients with kidney stones may pass old stones when phosphate therapy is started and should be warned of this possibility.
Potassium phosphate is contraindicated in patients with renal failure or severe renal impairment (eGFR less than 30 mL/minute/1.73 m2). Patients with severe renal impairment or end-stage renal disease are at increased risk for developing life-threatening hyperkalemia when administered intravenous potassium. In patients with moderate renal impairment (eGFR 30 mL/minute/1.73 m2 or more), start at the low end of the dosage range and monitor serum potassium, phosphorus, calcium, and magnesium concentrations. Consider the amount of potassium from all sources when determining the potassium phosphate dose and do not exceed the maximum recommended daily amount of potassium. Additionally, potassium phosphate injection contains aluminum (content varies with formulation). Thus, aluminum may reach toxic concentrations with prolonged administration in patients with renal impairment. Premature neonates are at particular risk for aluminum toxicity because of immature renal function, and they require large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with renal impairment, including neonates, who receive parenteral aluminum at rates greater than 4 to 5 mcg/kg/day may accumulate aluminum at concentrations associated with central nervous system and bone toxicity. Tissue loading may occur at lower administration rates. The use of potassium phosphate injection manufactured by Hospira is not recommended in pediatric patients because the aluminum exposure is unsafe for this population. This product has significantly more aluminum content (up to 31,000 mcg/L) compared to the product manufactured by Fresenius Kabi (up to 2,000 mcg/L). This product alone may produce daily aluminum exposures of up to twice the FDA-recommended limit for parenteral nutrition, with additional aluminum exposure expected from the other components of parenteral nutrition. Other potassium phosphate injection products may also not be recommended in neonates, infants, and children due to the aluminum content. Health care providers should use an FDA-approved potassium phosphate injection product with the aluminum content considered acceptable for each patient based on age, weight, and recommended dose of phosphorus.
Potassium phosphate is contraindicated in patients with hyperphosphatemia, hypercalcemia, and/or significant hypocalcemia. Hyperphosphatemia may occur with potassium phosphate use, particularly in patients with renal impairment. High serum phosphate concentrations may increase the incidence of insoluble calcium phosphorus products with subsequent hypocalcemia, neurological irritability with tetany, nephrocalcinosis with acute kidney injury, and more rarely, cardiac irritability with arrhythmias. Obtain serum calcium concentrations prior to potassium phosphate administration and normalize the calcium prior to administration. Intravenous infusion of potassium phosphate has also been reported to cause hypomagnesemia in patients with hypercalcemia and diabetic ketoacidosis. Monitor serum phosphorus, calcium, and magnesium concentrations during treatment with potassium phosphate.
Potassium phosphate injection must be diluted and administered in intravenous fluids or used as an admixture in parenteral nutrition solutions; NEVER administer by direct IV infusion. Hypertonic solutions (osmolarity of 900 mOsm/L or greater) should be infused through a central catheter. Infusion of hypertonic solutions through a peripheral vein may result in vein irritation/damage, thrombophlebitis, and/or thrombosis. When administered peripherally in intravenous fluids to correct hypophosphatemia, a generally maximum recommended concentration is 68 mmol/L of phosphorus (100 mEq/L of potassium). Remove the IV catheter as soon as possible if thrombophlebitis occurs.
Due to the possibility of developing hyperkalemia and subsequent cardiac arrest, potassium phosphate should be used cautiously in patients with extensive tissue breakdown (e.g., severe burns).
Use caution when considering potassium phosphate in patients who have myotonia congenita (muscle channelopathy), hypoparathyroidism, or acute pancreatitis.
Potassium phosphate should be administered cautiously to patients who have osteomalacia (rickets), which may be associated with hyperphosphatemia and/or hypocalcemia. While rickets may benefit from some phosphate therapy, high serum phosphate concentrations may increase the incidence of extra-skeletal calcification.
Administration of the recommended dose of potassium phosphate during pregnancy is not expected to cause major birth defects, miscarriage, or adverse maternal or fetal outcomes. Animal reproduction studies have not been conducted with potassium phosphate.
Administration of the recommended dose of potassium phosphate is not expected to cause harm to a breastfed infant. There are no data available on the effects of potassium phosphate on milk production. The development and health benefits of breast-feeding should be considered along with the mother's clinical need for potassium phosphate and any potential adverse effects on the breastfed child from potassium phosphate or from the underlying maternal condition.
-1 mmol of phosphorus weighs 31 mg.
-Potassium phosphate injection contains 3 mmol of phosphorus per mL equivalent to 4.4 mEq of potassium per mL.
-Potassium phosphate tablets contain 114 mg of phosphorus (3.7 mmol) and 144 mg of potassium (3.7 mEq) in each 500 mg tablet.
For the treatment of hypophosphatemia:
NOTE: Guidelines generally recommend the use of potassium phosphate for potassium serum concentration less than 4 mg/dL and sodium phosphate for potassium serum concentration more than 4 mg/dL. Potassium phosphate is usually appropriate as most conditions associated with hypophosphatemia are also associated with hypokalemia.
NOTE: Dosage is based on actual body weight; however, for obese patients, consider using adjusted body weight.
-for the treatment of mild hypophosphatemia (i.e., phosphorus serum concentration 1.8 mg/dL to lower end of reference range [2.5 mg/dL for adults and pediatric patients 12 months and older and 4 mg/dL for neonates and infants younger than 12 months of age]):
Intravenous dosage (Fresenius Kabi product):
Adults: 0.16 to 0.31 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Infants, Children, and Adolescents: 0.16 to 0.31 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Neonates: 0.16 to 0.31 mmol/kg/dose IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (CMP Pharma product):
Adults: 0.16 to 0.31 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Children and Adolescents 12 to 17 years: 0.16 to 0.31 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (Hospira product):
Adults: 0.16 to 0.31 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
-for the treatment of moderate hypophosphatemia (i.e., phosphorus serum concentration 1 to 1.7 mg/dL):
Intravenous dosage (Fresenius Kabi product):
Adults: 0.32 to 0.43 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (0.64 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Infants, Children, and Adolescents: 0.32 to 0.43 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Neonates: 0.32 to 0.43 mmol/kg/dose IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (CMP Pharma product):
Adults: 0.32 to 0.43 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (0.64 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Children and Adolescents 12 to 17 years: 0.32 to 0.43 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (Hospira product):
Adults: 0.32 to 0.43 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (0.64 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
-for the treatment of severe hypophosphatemia (i.e., phosphorus serum concentration less than 1 mg/dL):
Intravenous dosage (Fresenius Kabi product):
Adults: 0.44 to 0.64 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (1 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Infants, Children, and Adolescents: 0.44 to 0.64 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (1 mmol/kg/dose [Usual Adult Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Neonates: 0.44 to 0.64 mmol/kg/dose IV over 2 to 6 hours; repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (CMP Pharma product):
Adults: 0.44 to 0.64 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (1 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Children and Adolescents 12 to 17 years: 0.44 to 0.64 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (1 mmol/kg/dose [Usual Adult Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
Intravenous dosage (Hospira product):
Adults: 0.44 to 0.64 mmol/kg/dose (Max: 45 mmol/dose) IV over 2 to 6 hours is FDA-approved dosage. However, higher doses have been used (1 mmol/kg/dose [Usual Max: 50 mmol/dose]). Repeat doses may be necessary. Specific infusion rate dependent on dose and route of administration (peripheral or central venous catheter).
For nutritional supplementation to prevent hypophosphatemia in patients receiving parenteral nutrition (PN):
NOTE: Supplementation of phosphate in PN may be limited by physical incompatibility, particularly in neonates who have higher calcium and phosphate requirements.
Intravenous dosage (Fresenius Kabi product):
Adults: 20 to 40 mmol/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
Children and Adolescents 12 to 17 years: 20 to 40 mmol/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
Infants and Children 1 to 11 years: 0.5 to 2 mmol/kg/day IV (Max: 40 mmol/day). Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
Neonates: 1 to 2 mmol/kg/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
Intravenous dosage (CMP Pharma product):
Adults weighing 45 kg or more: 20 to 40 mmol/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations. Max: 45 mmol/day IV (based on aluminum content).
Children and Adolescents 12 to 17 years weighing 40 kg or more: 20 to 40 mmol/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
Intravenous dosage (Hospira product):
NOTE: The use of potassium phosphate injection manufactured by Hospira is not recommended in pediatric patients because the aluminum exposure is unsafe for this population. This product has significantly more aluminum content (up to 31,000 mcg/L) compared to the product manufactured by Fresenius Kabi (up to 2,000 mcg/L). This product alone may produce daily aluminum exposures of up to twice the FDA-recommended limit for parenteral nutrition, with additional aluminum exposure expected from the other components of parenteral nutrition. Health care providers should use an FDA-approved potassium phosphate injection product with the aluminum content considered acceptable for each patient based on age, weight, and recommended dose of phosphorus.
Adults: 20 to 40 mmol/day IV. Titrate dose depending on patient's clinical condition, nutritional requirements, and desired serum concentrations.
For urinary acidification and to augment the efficacy of methenamine therapy in treating urinary tract infections:
Oral dosage:
Adults: 2 tablets (1,000 mg; 7.5 mmol of phosphorus) PO four times daily with meals and at bedtime.
Maximum Dosage Limits:
-Adults
8 tablets/day PO; 0.64 mmol/kg (Max: 45 mmol/dose) IV is FDA-approved single maximum dose; however, single maximum doses of 1 mmol/kg/dose (Usual Max: 50 mmol/dose) IV have been used; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
-Geriatric
8 tablets/day PO; 0.64 mmol/kg (Max: 45 mmol/dose) IV is FDA-approved single maximum dose; however, single maximum doses of 1 mmol/kg/dose (Usual Max: 50 mmol/dose) IV have been used; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
-Adolescents
Safety and efficacy of oral formulation have not been established. 0.64 mmol/kg (Max: 45 mmol/dose) IV is FDA-approved single maximum dosage; however, single maximum doses of 1 mmol/kg/dose (Usual Adult Max: 50 mmol/dose) IV have been used; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
-Children
Safety and efficacy of oral formulation have not been established. 0.64 mmol/kg (Max: 45 mmol/dose) IV is FDA-approved single maximum dosage; however, single maximum doses of 1 mmol/kg/dose (Usual Adult Max: 50 mmol/dose) IV have been used; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
-Infants
Safety and efficacy of oral formulation have not been established. 0.64 mmol/kg IV is FDA-approved single maximum dosage; however, single maximum doses of 1 mmol/kg/dose IV have been used; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
-Neonates
Safety and efficacy of oral formulation have not been established. 0.64 mmol/kg IV is FDA-approved single maximum dosage; individualize dosage based on indication, phosphate serum concentrations, and other clinical parameters.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Patients with Renal Impairment Dosing
Specific guidelines for dosage adjustments in renal impairment are not available; however, dosage adjustments are necessary. Potassium and phosphorus are significantly excreted by the kidneys and the risk of adverse reactions is higher in patients with renal impairment. In end-stage renal disease (ESRD), phosphorous levels are often elevated, leading to the need for phosphate-binding versus phosphate replacement.
eGFR 30 to 60 mL/minute/1.73 m2: Start at the low end of the dosage range.
eGFR less than 30 mL/minute/1.73 m2: Use of potassium phosphate is contraindicated.
*non-FDA-approved indication
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Acetaminophen; Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Acetaminophen; Aspirin: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Acetaminophen; Aspirin; Diphenhydramine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Alendronate; Cholecalciferol: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Aluminum Hydroxide: (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present.
Aluminum Hydroxide; Magnesium Carbonate: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present.
Aluminum Hydroxide; Magnesium Hydroxide: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products. (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present.
Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of aluminum-containing antacids (e.g., aluminum hydroxide). If the patient requires treatment with aluminum-containing antacids, it may be wise to separate the administration of phosphorus salts from the antacid. In some instances the administration of an aluminum hydroxide product is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of these drugs in these settings, assuming hypophosphatemia is not present.
Amiloride: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Amiloride; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Amlodipine; Benazepril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Amlodipine; Olmesartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Amlodipine; Valsartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Angiotensin II receptor antagonists: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Angiotensin-converting enzyme inhibitors: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Aspirin, ASA: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Butalbital; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Caffeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Carisoprodol; Codeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Dipyridamole: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Omeprazole: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Aspirin, ASA; Oxycodone: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Azilsartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Azilsartan; Chlorthalidone: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Benazepril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Benazepril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Bismuth Subsalicylate: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Bismuth Subsalicylate; Metronidazole; Tetracycline: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Burosumab: (Contraindicated) Oral phosphates are contraindicated in patients receiving burosumab; discontinue potassium phosphate 1 week prior to initiation of burosumab.
Butalbital; Aspirin; Caffeine; Codeine: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Calcifediol: (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Calcitriol: (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Calcium Acetate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Carbonate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Carbonate; Simethicone: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Chloride: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium Gluconate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Calcium; Vitamin D: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Candesartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Candesartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Captopril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Captopril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Chlorpheniramine; Pseudoephedrine: (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Chromium: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Cod Liver Oil: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Colestipol: (Moderate) Colestipol may interfere with the oral absorption of phosphorus salts. According to the manufacturer, administer other drugs at least 1 hour before or at least 4-6 hours after the administration of colestipol. The manufacturer also recommends that the interval between the administration of colestipol and other drugs should be as long as possible.
Cyclosporine: (Major) Avoid coadministration of potassium phosphate and cyclosporine as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Diflunisal: (Moderate) Agents that acidify the urine, like phosphate salts, should be avoided in patients receiving high-dose salicylates. Urine acidifying agents may increase renal tubular reabsorption of salicylic acid and possibly increase salicylic acid levels.
Digoxin: (Major) Avoid coadministration of potassium phosphate and digoxin as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Doxercalciferol: (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Enalapril, Enalaprilat: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Enalapril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Eplerenone: (Contraindicated) Eplerenone should not be used concomitantly with potassium supplements (including dietary salt substitutes containing potassium) because of the increased risk of developing hyperkalemia. The use of eplerenone in hypertensive patients treated with these medications is contraindicated. When medically necessary to replace losses, use potassium phosphates cautiously with eplerenone, as both drugs increase serum potassium concentrations. Those at risk for hyperkalemia include elderly patients or patients with impaired renal function. Patients at risk for hyperkalemia include elderly patients or patients with impaired renal function. Patients should have serum potassium and other electrolyte concentration determinations at periodic intervals.
Eprosartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Eprosartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Erdafitinib: (Major) Avoid coadministration of potassium phosphate with erdafitinib before the initial dose increase period (days 14 to 21) which is based on serum phosphate levels. Potassium phosphate increases serum phosphate levels. Erdafitinib causes hyperphosphatemia as a consequence of FGFR inhibition. Changes in serum phosphate levels by potassium phosphate may interfere with the determination of this initial dose increase and may cause additive hyperphosphatemia.
Ferric Maltol: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Finerenone: (Moderate) Monitor serum potassium concentrations closely if finerenone and potassium supplements are used together. Concomitant use may increase the risk of hyperkalemia.
Food: (Moderate) Foods containing oxalates (found in vegetables like rhubarb, tomatoes, celery, and spinach; as well as berries, beans, nuts and chocolate) or phytates (found in bran and whole-grain cereals) may reduce the absorption of phosphorus by forming complexes with the phosphorus salt.
Fosinopril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Fosinopril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Hydrochlorothiazide, HCTZ; Moexipril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Intrauterine Copper Contraceptive: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphorus salts by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Irbesartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Irbesartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Iron Salts: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Iron Salts: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Iron: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Lisinopril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Lisinopril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Losartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Losartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Magnesium Hydroxide: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products.
Magnesium Salts: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products.
Magnesium: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products.
Moexipril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Nebivolol; Valsartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Olmesartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Olmesartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Paricalcitol: (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Penicillin G: (Moderate) Use potassium phosphates cautiously with high-doses of IV potassium penicillin G, as both drugs increase serum potassium concentrations. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Patients should have serum potassium concentration determinations at periodic intervals.
Perindopril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Perindopril; Amlodipine: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Potassium-sparing diuretics: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Pyridoxine, Vitamin B6: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Quinapril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Quinapril; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Ramipril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Sacubitril; Valsartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Sevelamer: (Contraindicated) Pharmacologically, sevelamer decreases serum phosphate concentrations. Therefore, phosphate salts would be expected to counteract the pharmacological benefits of sevelamer. It would be illogical to administer phosphate or phosphorus salts to patients who require sevelamer.
Sodium Ferric Gluconate Complex; ferric pyrophosphate citrate: (Moderate) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of phosphates by as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Moderate) Phosphate may bind magnesium salts and magnesium-containing antacids (e.g., magnesium carbonate, magnesium hydroxide) may limit phosphorus absorption or phosphorus may limit magnesium absorption. If the patient requires magnesium supplements or a magnesium-containing antacid, it may be wise to separate the administration of phosphates from magnesium-containing products.
Sparsentan: (Moderate) Monitor potassium during concomitant use of sparsentan and potassium phosphate. Concomitant use increases the risk for hyperkalemia.
Spironolactone: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Spironolactone; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Sucralfate: (Moderate) Serum phosphorus should be checked routinely in patients treated chronically with sucralfate; sucralfate may cause hypophosphatemia and some patients may require phosphorus repletion. This nutrient interaction should be considered in patients receiving phosphates for dietary supplementation. It appears that sucralfate chelates phosphorus in the gut, forming nonabsorbable complexes. Because of sucralfate's therapeutic effect, this interaction may not be prevented by separating times of oral administration.
Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole: (Moderate) Use potassium phosphate cautiously with trimethoprim (especially high dose), as both drugs increase serum potassium concentrations. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Monitor serum potassium concentrations at periodic intervals.
Tacrolimus: (Major) Avoid coadministration of potassium phosphate and tacrolimus as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Telmisartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Telmisartan; Amlodipine: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Telmisartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Trandolapril: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Trandolapril; Verapamil: (Major) Avoid coadministration of potassium phosphate and angiotensin-converting enzyme inhibitors as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Triamterene: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Triamterene; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and potassium-sparing diuretics as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Trientine: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses.
Trimethoprim: (Moderate) Use potassium phosphate cautiously with trimethoprim (especially high dose), as both drugs increase serum potassium concentrations. Concurrent use can cause hyperkalemia, especially in elderly patients or patients with impaired renal function. Monitor serum potassium concentrations at periodic intervals.
Valsartan: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Valsartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of potassium phosphate and angiotensin II receptor antagonists as concurrent use may increase the risk of severe and potentially fatal hyperkalemia, particularly in high-risk patients (renal impairment, cardiac disease, adrenal insufficiency). If concomitant use is necessary, closely monitor serum potassium concentrations.
Vitamin D analogs: (Major) High intake of phosphates concomitantly with vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Vitamin D: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia. (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue.
Vitamin D: (Major) High intake of phosphates concomitantly with vitamin D or vitamin D analogs may lead to hyperphosphatemia. Dose adjustment of vitamin D or vitamin D analogs may be necessary during coadministration with phosphorus salts. Additionally, serum calcium concentrations should be monitored frequently. Monitor more frequently in patients with a history of hypercalcemia.
Zinc Salts: (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Zinc: (Minor) It has been reported that high intakes of phosphates, such as are found in dietary supplements or food additives, can interfere with absorption of trace nutrients such as iron, copper, and zinc. The magnitude of the effect may be small, and the interactions require further study to judge clinical significance. The theorized mechanism is the formation of insoluble complexes within the gut. Until more data are available, it may be helpful to separate administration times of potassium phosphate; sodium phosphateby as much as possible from the oral administration of iron (e.g., iron salts or polysaccharide-iron complex), copper salts, or zinc salts to limit any potential interactions.
Potassium phosphate contains the salts of potassium and phosphate and has varying functions.
Phosphorus homeostasis
Phosphorus has numerous functions in the human body. In addition to its well-known role as a structural component of teeth and bone, phosphorus also serves as a buffer in intracellular and renal tubular fluids, and is an essential element of nucleic acids, phospholipid cell membranes, and phosphoproteins. Phospholipids present in cell membranes serve as regulators of solute transport into and out of cells. Phosphoproteins are required for mitochondrial function. Other functions of phosphorus include regulation of the intermediary metabolism of carbohydrates, fats, and proteins; regulation of enzymatic reactions including glycolysis, ammoniagenesis, 1-hydroxylation of 25-hydroxyvitamin D; and regulation of the oxygen-carrying capacity of hemoglobin.
Phosphorus is present in high-energy adenosine triphosphate (ATP) bonds, which fuel a variety of physiological processes, including muscle contractions, neurologic function, and electrolyte transport, as well as other important biochemical reactions. Intracellular inorganic phosphate serves as the phosphorus source from which ATP is resynthesized. The prime determinant of intracellular inorganic phosphate is extracellular inorganic phosphate.
The relationship between phosphorus and calcium is a reciprocal one and is regulated partially by parathyroid hormone. Parathyroid hormone decreases the reabsorption of phosphate by the kidney, thereby lowering phosphate levels. The hormone stimulates an increase in calcium levels by increasing bone resorption, gut calcium absorption, and reabsorption of calcium in renal tubules. When serum phosphorus levels are high, serum calcium levels are generally low, and vice versa.
Potassium homeostasis
Potassium is the primary intracellular cation. It plays a major role in muscle and nerve cell electrodynamics. Its concentration inside the cell (roughly 150 to 160 mEq/L) is 25 to 35 times greater than extracellular concentrations.
Urinary acidification
Phosphates are excreted at the distal renal tubule where hydrogen ion is exchanged for sodium ion causing a decrease in urine pH.
Potassium phosphate is administered intravenously or orally. The primary route of phosphate excretion is renal. More than 80% of an administered dose is excreted by the kidneys. Fecal excretion accounts for the remainder. Normal plasma concentrations of phosphorus are between 2.5 and 4.5 mg/dL in adults. In pediatric patients, normal plasma concentrations of phosphorus are higher than adults due to the demands of physical growth and vary by age.
-Neonates: 4.8 to 8.2 mg/dL
-Children 1 to 3 years: 3.8 to 6.5 mg/dL
-Children 4 to 11 years: 3.7 to 5.6 mg/dL
-Children and Adolescents 12 to 15 years: 2.9 to 5.4 mg/dL
-Adolescents 16 years and older: 2.7 to 4.7 mg/dL
-Route-Specific Pharmacokinetics
Oral Route
Following oral administration, phosphate is absorbed via an active, energy-dependent process. In general, in adults, about two thirds of orally administered phosphate is absorbed from the bowel. Due to the formation of insoluble complexes, foods or drugs containing large amounts of calcium or aluminum decrease the amount of phosphate absorbed. The absorption of phosphate is most favorable when phosphate and calcium are administered in equal amounts (as in milk). Phosphate absorption is also stimulated by vitamin D.
-Special Populations
Renal Impairment
Phosphorus excretion is significantly reduced in patients with renal impairment and end-stage renal disease, resulting in elevated phosphorus serum concentrations.