9.5.2.1 Phosphate supplements

Phosphate-Sandoz

(Sodium acid phosphate anhydrous)

• Effervescent tablets 1.936g (£19.39 = 100 tablets)

Indication

• Vitamin D-resistant hypophosphataemic osteomalacia

Dose

• 4–6 tablets daily; child under 5 years 2–3 tablets daily

Notes

1. Medicines Supply Notification (22 December 2023): Phosphate Sandoz (sodium dihydrogen phosphate anhydrous 1.936g) effervescent tablets
   1. Phosphate Sandoz effervescent tablets are in limited supply until late March 2024.
   2. For further information, refer to the notification.

Mixed phosphates

• Solution 0.5 mmol/ml (unlicensed preparation)

Phosphates

• IV infusion 500ml

Potassium phosphates

• Injection 17.42% 10ml (unlicensed preparation)

9.5.2.2 Phosphate-binding agents

Calcium

Drugs used not listed here:

• Calcium carbonate, see section 9.5.1 Calcium and magnesium

Phosex

(Calcium acetate)

• Tablets 1g (£19.79 = 180 tablets)
• Tablets 500mg (unlicensed preparation)

Indications

• Hyperphosphataemia

Dose

• Initially 1 tablet 3 times daily with meals, adjusted according to serum-phosphate concentration (usual dose 4–6 tablets daily); maximum 12 tablets daily

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Renacet

(Calcium acetate)

• Tablets 475mg, 950mg (£14.95 = 200 x 475mg tablets)

Indications

• Hyperphosphataemia

Dose

• 475–950mg, to be taken with breakfast and with snacks, 0.95–2.85g, to be taken with main meals and 0.95–1.9g, to be taken with supper, dose to be adjusted according to serum-phosphate concentration; maximum 6.65g per day.

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Osvaren

(calcium acetate with magnesium carbonate)

• Tablets (435mg + 235mg) (£24.00 = 180 tablets)

Indications

• Hyperphosphataemia

Dose

• Initially 1 tablet 3 times daily with meals, adjusted according to serum-phosphate concentration (usual dose 3–10 tablets daily); maximum 12 tablets daily

Notes

1. Prescribe by brand (to aid identification where products contain multiple ingredients, or to prevent confusion where multiple brands contain similar ingredients)

Lanthanum carbonate

• Chewable tablets 500mg, 750mg, 1g (£182.60 = 90 x 750mg tablets)

Indications

• Hyperphosphataemia

Dose

• Usual dose range 1.5–3g daily in divided doses with or immediately after meals, adjusted according to serum-phosphate concentration every 2–3 weeks

Sevelamer hydrochloride

• Renagel tablets 800mg (£167.04 = 180 tablets)

Indications

• Hyperphosphataemia

Dose

• Initially 2.4–4.8g daily in 3 divided doses with meals, adjusted according to serum-phosphate concentration (usual dose range 2.4–12g daily in 3 divided doses)

Sevelamer carbonate

• Tablets 800mg (£31.38 = 180 tablets)

Indications

• Hyperphosphataemia

Dose

• Usual dose approximately 6g daily in 3 divided doses

Notes

1. Sevelamer carbonate is not interchangeable with sevelamer hydrochloride. When prescribing please include the correct salt.
2. Sevelamer carbonate is licensed for both dialysis and non-dialysis patients.

Sucroferric oxyhydroxide

• Chewable tablets 500mg

Indications

• Hyperphosphataemia in adult patients with chronic kidney disease on haemodialysis or peritoneal dialysis (NHS England commissioned)

Notes

1. Tablets must be chewed or crushed, not swallowed whole

9.5.2.3 Burosumab

Burosumab

• Solution for injection vials 10mg/1ml, 20mg/1ml, 30mg/1ml

Notes

1. NICE HST8: Burosumab (Crysvita) is recommended for treating X-linked hypophosphataemia (XLH) with radiographic evidence of bone disease in children aged 1 year and over, and young people with growing bones (October 2018) (NHS England commissioned).
2. NICE TA993: Burosumab (Crysvita) is recommended, within its marketing authorisation, as an option for treating X-linked hypophosphataemia (XLH) in adults, only if the company provides it according to the commercial arrangement (August 2024).