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

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 and Phosex (discontinued)

• Osvaren 435mg/235mg tablets and Phosex 1g tablets have been discontinued. Existing patients should be switched to an alternative phosphate binder containing calcium acetate, advice should be sought from the renal team regarding a suitable alternative and dosing.
• Renacet tablets remain available (drug entry above). For those switched to Renacet, tablets should be taken at mealtimes, with no requirement for additional monitoring after the switch, aside from standard follow up.
  • 950mg calcium acetate equivalent to 240.5mg calcium.
    
• Osvaren 435mg/235mg tablets:
  • 435mg calcium acetate equivalent to 110mg calcium
  • 235mg magnesium carbonate, heavy, equivalent to 60mg magnesium.
• Phosex 1g tablets: stocks are expected to be exhausted by late May 2025
  • 1g calcium acetate equivalent to 250mg calcium.

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, within its marketing authorisation, for treating X-linked hypophosphataemia (XLH) with radiographic evidence of bone disease in children aged 1 year and over, and in young people with growing bones, only if the company provides it according to the commercial arrangement (October 2018, updated April 2025).
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).