Wes-Phos 250 Neutral Tablets
It is used to treat or prevent low phosphate levels.It is used to lower the urine's pH.
Drug Class
Electrolyte replacement, Urinary acidifier
Pharmacologic Class
Phosphate supplement, Electrolyte
Pregnancy Category
Category C
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination of potassium phosphate and sodium phosphate. It's used to replace low levels of phosphate in your body, which is an important mineral for bones and many body functions. It can also be used to make your urine more acidic, which helps prevent certain kidney stones.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with meals and at bedtime, or as directed by your doctor. Swallow your medication with a full glass of water.
Storing and Disposing of Your Medication
Keep your medication at room temperature, away from light and moisture. Avoid storing it in a bathroom. Store all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses to make up for a missed one.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with meals and at bedtime, or as directed by your doctor. Swallow your medication with a full glass of water.
Storing and Disposing of Your Medication
Keep your medication at room temperature, away from light and moisture. Avoid storing it in a bathroom. Store all medications in a safe location, out of reach of children and pets. Dispose of unused or expired medications properly. Do not flush them down the toilet or pour them down the drain unless instructed to do so. If you have questions about disposing of your medication, consult your pharmacist. You may also want to check if there are drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next dose, skip the missed dose and resume your regular schedule. Do not take two doses at the same time or take extra doses to make up for a missed one.
Lifestyle & Tips
- Take with food or immediately after meals to minimize stomach upset.
- Drink plenty of water throughout the day, especially if taking for kidney stones.
- Avoid antacids containing aluminum or magnesium, as they can interfere with this medication.
- Report any unusual symptoms like muscle cramps, numbness, or weakness to your doctor.
Available Forms & Alternatives
Available Strengths:
Dosing & Administration
Adult Dosing
Standard Dose:
1 to 2 tablets four times daily after meals and at bedtime
Dose Range:
1 - 2 mg
Condition-Specific Dosing:
hypophosphatemia:
Individualized based on serum phosphate levels and clinical condition. Typically 1-2 tablets 4 times daily.
urinary acidification:
1-2 tablets 4 times daily to maintain urinary pH below 6.0.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Dosing should be individualized based on weight, serum phosphate levels, and clinical condition. Consult a specialist.
Adolescent:
Dosing should be individualized based on weight, serum phosphate levels, and clinical condition. Typically similar to adult dosing but adjusted for weight.
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; monitor serum phosphate and electrolytes closely.
Moderate:
Significant dose reduction or contraindication. Monitor serum phosphate, calcium, and potassium frequently. Consider alternative therapies.
Severe:
Contraindicated due to risk of hyperphosphatemia and hypocalcemia.
Dialysis:
Contraindicated. Phosphate removal is managed by dialysis.
Hepatic Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
No specific adjustment needed.
Pharmacology
Mechanism of Action
Wes-Phos 250 Neutral Tablets provide a source of phosphate, potassium, and sodium. Phosphate is an essential intracellular anion involved in numerous physiological processes, including energy metabolism (ATP), bone mineralization, and cell membrane integrity. It also acts as a urinary acidifier, helping to prevent the formation of calcium stones in the urinary tract by increasing the solubility of calcium salts and inhibiting crystal formation.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 60-70% of oral phosphate is absorbed.
Tmax:
1-6 hours (variable)
FoodEffect:
Food may decrease the rate but not the extent of absorption.
Distribution:
Vd:
Not readily quantifiable; phosphate is widely distributed throughout the body, with approximately 85% in bone, 14% intracellular, and 1% extracellular.
ProteinBinding:
Negligible
CnssPenetration:
Limited
Elimination:
HalfLife:
Variable, depends on renal function and phosphate balance (typically 2-6 hours in healthy individuals).
Clearance:
Primarily renal filtration and tubular reabsorption.
ExcretionRoute:
Renal (urine)
Unchanged:
Nearly 100% (as phosphate ion)
Pharmacodynamics
OnsetOfAction:
Within hours for electrolyte effects.
PeakEffect:
Variable, depends on absorption and physiological response.
DurationOfAction:
Variable, depends on renal function and dietary intake.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain, cramps, or spasms
+ Weakness
+ Shakiness
+ Change in balance
+ Abnormal heartbeat
+ Seizures
+ Loss of appetite
+ Severe upset stomach or vomiting
A fast heartbeat
Severe headache
Seizures
Dizziness or fainting
Abnormal sensations, such as burning, numbness, or tingling
Shortness of breath, sudden weight gain, or swelling in the arms or legs
Feeling extremely tired or weak
Bone or joint pain
Feeling of heaviness in the arms or legs
Decreased urine output
Unusual thirst
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they persist, contact your doctor or seek medical attention:
Diarrhea
Stomach pain
Upset stomach
* Vomiting
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of electrolyte problems, including:
+ Mood changes
+ Confusion
+ Muscle pain, cramps, or spasms
+ Weakness
+ Shakiness
+ Change in balance
+ Abnormal heartbeat
+ Seizures
+ Loss of appetite
+ Severe upset stomach or vomiting
A fast heartbeat
Severe headache
Seizures
Dizziness or fainting
Abnormal sensations, such as burning, numbness, or tingling
Shortness of breath, sudden weight gain, or swelling in the arms or legs
Feeling extremely tired or weak
Bone or joint pain
Feeling of heaviness in the arms or legs
Decreased urine output
Unusual thirst
Other Possible Side Effects
Like all medications, this drug can cause side effects. Many people may not experience any side effects or may only have mild ones. If you are bothered by any of the following side effects or if they persist, contact your doctor or seek medical attention:
Diarrhea
Stomach pain
Upset stomach
* Vomiting
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe diarrhea or stomach pain
- Muscle cramps or spasms
- Numbness or tingling in hands or feet
- Unusual tiredness or weakness
- Irregular heartbeat
- Shortness of breath
- Swelling in ankles or feet
- Signs of kidney problems (e.g., decreased urination)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Kidney disease
+ High phosphate levels
+ Infected phosphate stones
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* All your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Kidney disease
+ High phosphate levels
+ Infected phosphate stones
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, tell your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
* All your health problems
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Regular blood tests and other laboratory evaluations should be conducted as directed by your doctor to monitor your condition.
If you are currently using a salt substitute containing potassium, a potassium-sparing diuretic, or any potassium-based product, consult with your doctor to discuss potential interactions. Additionally, individuals with a history of kidney stones should be aware that they may pass existing stones when initiating this medication, and therefore, should discuss this with their doctor.
To avoid potential interactions, do not take antacids containing aluminum, magnesium, or calcium while taking this drug. It is also crucial to notify your doctor if you are pregnant, planning to become pregnant, or are breastfeeding, as this will require a discussion about the potential benefits and risks of the medication to both you and your baby.
If you are currently using a salt substitute containing potassium, a potassium-sparing diuretic, or any potassium-based product, consult with your doctor to discuss potential interactions. Additionally, individuals with a history of kidney stones should be aware that they may pass existing stones when initiating this medication, and therefore, should discuss this with their doctor.
To avoid potential interactions, do not take antacids containing aluminum, magnesium, or calcium while taking this drug. It is also crucial to notify your doctor if you are pregnant, planning to become pregnant, or are breastfeeding, as this will require a discussion about the potential benefits and risks of the medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Severe diarrhea
- Nausea, vomiting
- Abdominal pain
- Muscle weakness or paralysis
- Numbness or tingling
- Seizures
- Irregular heartbeat (bradycardia, asystole)
- Low blood pressure
- Signs of hypocalcemia (tetany, spasms)
- Signs of hyperkalemia (cardiac arrhythmias)
What to Do:
Seek immediate medical attention. Call 911 or Poison Control at 1-800-222-1222. Treatment may involve intravenous calcium, glucose/insulin, sodium bicarbonate, or dialysis depending on the severity of electrolyte imbalances.
Drug Interactions
Contraindicated Interactions
- Aluminum-containing antacids (e.g., aluminum hydroxide, aluminum carbonate) - form insoluble complexes with phosphate, reducing absorption.
- Magnesium-containing antacids/laxatives (e.g., magnesium hydroxide, magnesium citrate) - may increase risk of hypermagnesemia.
- Calcium-containing products (e.g., calcium carbonate, calcium acetate) - may form insoluble complexes with phosphate, reducing absorption and increasing risk of ectopic calcification in hyperphosphatemia.
Major Interactions
- Potassium-sparing diuretics (e.g., spironolactone, amiloride, triamterene) - increased risk of hyperkalemia due to potassium content.
- ACE inhibitors (e.g., lisinopril, enalapril) - increased risk of hyperkalemia.
- Angiotensin Receptor Blockers (ARBs) (e.g., valsartan, losartan) - increased risk of hyperkalemia.
- NSAIDs (e.g., ibuprofen, naproxen) - may impair renal function, increasing risk of hyperkalemia and hyperphosphatemia.
Moderate Interactions
- Corticosteroids (e.g., prednisone, dexamethasone) - may increase urinary phosphate excretion, potentially counteracting phosphate supplementation.
- Thiazide diuretics (e.g., hydrochlorothiazide) - may decrease urinary calcium excretion, potentially increasing risk of calcium stone formation if used for urinary acidification.
- Vitamin D analogs (e.g., calcitriol, paricalcitol) - may increase phosphate absorption and serum phosphate levels.
Minor Interactions
- Sucralfate - contains aluminum, may bind phosphate.
Monitoring
Baseline Monitoring
Serum Phosphate
Rationale: To establish baseline levels and guide dosing for hypophosphatemia.
Timing: Prior to initiation of therapy.
Serum Calcium
Rationale: To assess for hypocalcemia risk, as phosphate administration can lower calcium.
Timing: Prior to initiation of therapy.
Serum Potassium
Rationale: To assess for hyperkalemia risk due to potassium content.
Timing: Prior to initiation of therapy.
Renal Function (BUN, Creatinine, eGFR)
Rationale: Essential for safe use, as phosphates are renally eliminated and renal impairment increases risk of toxicity.
Timing: Prior to initiation of therapy.
Urinary pH (if for urinary acidification)
Rationale: To establish baseline and guide dosing for desired urinary pH.
Timing: Prior to initiation of therapy.
Routine Monitoring
Serum Phosphate
Frequency: Daily initially for severe hypophosphatemia, then 2-3 times weekly or as clinically indicated for maintenance.
Target: 2.5-4.5 mg/dL (adults)
Action Threshold: Below target: consider dose increase; Above target (>4.5 mg/dL): consider dose reduction/hold.
Serum Calcium
Frequency: Daily initially, then 2-3 times weekly or as clinically indicated.
Target: 8.5-10.5 mg/dL (total calcium)
Action Threshold: Below target (<8.5 mg/dL): consider calcium supplementation or dose reduction of phosphate; Above target: investigate.
Serum Potassium
Frequency: Daily initially, then 2-3 times weekly or as clinically indicated.
Target: 3.5-5.0 mEq/L
Action Threshold: Above target (>5.0 mEq/L): consider dose reduction/hold, investigate other sources of potassium.
Renal Function (BUN, Creatinine)
Frequency: Weekly or as clinically indicated, especially with dose changes or worsening renal function.
Target: Within normal limits for patient's baseline.
Action Threshold: Significant increase: re-evaluate phosphate dosing, consider contraindication.
Urinary pH (if for urinary acidification)
Frequency: Daily or several times weekly, as needed to achieve target.
Target: <6.0
Action Threshold: Above target: consider dose increase; Below target (too acidic): consider dose reduction.
Symptom Monitoring
- Symptoms of hyperphosphatemia (e.g., nausea, vomiting, diarrhea, lethargy, seizures, ectopic calcification)
- Symptoms of hypocalcemia (e.g., muscle cramps, tetany, paresthesias, Chvostek's sign, Trousseau's sign)
- Symptoms of hyperkalemia (e.g., muscle weakness, paresthesias, fatigue, cardiac arrhythmias)
- Symptoms of gastrointestinal upset (e.g., abdominal discomfort, diarrhea, nausea)
Special Patient Groups
Pregnancy
Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks. Use only if clearly needed and the benefit outweighs the potential risk to the fetus. Close monitoring of electrolyte levels is crucial.
Trimester-Specific Risks:
First Trimester:
Potential for electrolyte imbalances affecting fetal development, though data is limited.
Second Trimester:
Continued risk of maternal electrolyte imbalances (hyperphosphatemia, hypocalcemia, hyperkalemia) which could indirectly affect fetal well-being.
Third Trimester:
Increased risk of electrolyte disturbances, especially in mothers with pre-existing renal impairment or preeclampsia. Close monitoring is essential.
Lactation
Phosphate, potassium, and sodium are natural components of breast milk. While generally considered safe at therapeutic doses, caution is advised. Monitor the infant for signs of electrolyte imbalance (e.g., diarrhea, lethargy). The benefits of breastfeeding should be weighed against the potential risks.
Infant Risk:
L3 (Moderate risk - compatible with monitoring). Risk of electrolyte imbalance in the infant, particularly if maternal doses are high or infant has renal impairment.
Pediatric Use
Use with caution. Dosing must be carefully individualized based on weight, age, and serum electrolyte levels. Children, especially infants, are more susceptible to electrolyte imbalances. Close monitoring of serum phosphate, calcium, and potassium is essential. Renal function should be assessed.
Geriatric Use
Use with caution. Elderly patients are more likely to have age-related decline in renal function, which increases the risk of hyperphosphatemia, hyperkalemia, and hypocalcemia. Close monitoring of renal function and serum electrolytes is critical. Start with lower doses and titrate carefully.
Clinical Information
Clinical Pearls
- Wes-Phos 250 Neutral Tablets contain 250 mg (8 mmol) of phosphorus, 278 mg (7.125 mEq) of potassium, and 164 mg (7.125 mEq) of sodium per tablet. Be mindful of the potassium and sodium load, especially in patients with cardiac or renal conditions.
- Always take with food or immediately after meals to minimize gastrointestinal irritation and improve tolerability.
- This product is contraindicated in patients with severe renal impairment, hyperphosphatemia, hyperkalemia, or hypernatremia.
- Regular monitoring of serum phosphate, calcium, potassium, and renal function is crucial, especially during initiation and dose adjustments.
- For urinary acidification, monitor urinary pH regularly to ensure the desired effect and avoid excessive acidification.
- Educate patients about symptoms of electrolyte imbalances (hyperphosphatemia, hypocalcemia, hyperkalemia) and when to seek medical attention.
Alternative Therapies
- Oral sodium phosphate solutions (e.g., Fleet Phospho-Soda - generally for bowel prep, not chronic use)
- Oral potassium phosphate solutions
- Intravenous phosphate replacement (for severe hypophosphatemia)
- Dietary phosphate sources (e.g., dairy products, meat, nuts, legumes)
- For urinary acidification: Ascorbic acid, cranberry extract (less potent)
Cost & Coverage
Average Cost:
$30 - $80 per 100 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 2 or Tier 3 (often covered by most plans)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.