Lanthanum Carbonate

Pronunciation: LAN-tha-num KAR-bo-nate
Class: Phosphate binder

Trade Names

Fosrenol
- Tablets, chewable, oral 500 mg
- Tablets, chewable, oral 750 mg
- Tablets, chewable, oral 1,000 mg

Pharmacology

Inhibits GI absorption of phosphate by forming highly insoluble lanthanum phosphate complex with dietary phosphate released from food during digestion.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

Pharmacokinetics

Absorption

Very low absorption (bioavailability less than 0.002%). C max is 1 ng/mL.

Distribution

Highly bound to plasma proteins (more than 99%).

Metabolism

Not metabolized.

Elimination

Elimination half-life is 53 h.

Special Populations

Renal Function Impairment

No data available.

Hepatic Function Impairment

No data available.

Indications and Usage

Reducing serum phosphate in patients with end-stage renal disease.

Contraindications

Bowel obstruction, ileus, fecal impaction.

Dosage and Administration

Adults

PO Initial dosage is 1,500 mg/day divided and taken with or immediately after meals. Titrate dose every 2 to 3 wk, generally in increments of 750 mg/day, until acceptable serum phosphate level is reached. Usual total daily dose is between 1,500 and 3,000 mg/day.

General Advice

  • Have patient chew tablets completely before swallowing. Caution patient not to swallow intact tablets. Tablets may be crushed to aid in chewing.
  • In order to bind dietary phosphate efficiently, administer prescribed dose with or immediately after a meal.

Storage/Stability

Store between 59° and 86°F. Protect from moisture.

Drug Interactions

Compounds known to interact with antacids (eg, ACE inhibitors [eg, captopril], ampicillin, antimalarials, HMG-CoA reductase inhibitors [eg, simvastatin], tetracyclines, thyroid hormones [eg, levothyroxine])

Lanthanum coadministration may decrease the bioavailability of these agents. Do not take within 2 h of lanthanum.

Quinolones (eg, ciprofloxacin)

Lanthanum coadministration may decrease the bioavailability of oral quinolone antibiotics. Give oral quinolones at least 1 h before or 4 h after lanthanum. When giving quinolones for short courses, consider eliminating the doses of lanthanum that would be normally scheduled near the time of quinolone intake to improve quinolone absorption.

Adverse Reactions

GI

Nausea (11%); vomiting (9%); abdominal pain (5%); constipation, dyspepsia (postmarketing).

Miscellaneous

Allergic skin reactions, hypophosphatemia, tooth injury (postmarketing).

Precautions

Monitor

Monitor serum phosphate levels as needed during dose titration and on a regular basis thereafter.


Pregnancy

Category C . Not recommended for use during pregnancy.

Lactation

Undetermined.

Children

Safety and efficacy not established.

Diagnostic tests

Patients taking lanthanum may have a radio-opaque appearance typical of an imaging agent during abdominal x-rays.

GI effects

GI obstruction, ileus, and fecal impaction have been reported, some requiring surgery or hospitalization.

Overdosage

Symptoms

Headache, nausea, vomiting.

Patient Information

  • Advise patient to take each dose with or immediately after food and to chew or crush tablets completely before swallowing. Caution patient not to swallow intact tablets.
  • Advise patients who are taking an oral medication where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy to separate the dosing of lanthanum from the affected drug by several hours.
  • Instruct patients to notify health care provider that they are taking lanthanum prior to an abdominal x-ray.

Copyright © 2009 Wolters Kluwer Health.

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