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Lanthanum

Pronunciation

(LAN tha num)

Index Terms

  • Lanthanum Carbonate

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Packet, Oral:

Fosrenol: 750 mg (10 ea, 90 ea); 1000 mg (10 ea, 90 ea)

Tablet Chewable, Oral:

Fosrenol: 500 mg, 750 mg, 1000 mg

Brand Names: U.S.

  • Fosrenol

Pharmacologic Category

  • Phosphate Binder

Pharmacology

Disassociates in the upper gastrointestinal tract to lanthanum ions (La3+) which bind to dietary phosphate resulting in insoluble lanthanum phosphate complexes and a net decrease in serum phosphate and calcium levels.

Absorption

<0.002%

Metabolism

Not metabolized

Excretion

Feces primarily; urine <2%

Half-Life Elimination

Plasma: 53 hours; Bone: 2-3.6 years

Protein Binding

>99%

Use: Labeled Indications

Reduction of serum phosphorous: Reduction of serum phosphate in patients with end-stage renal disease (ESRD)

Contraindications

Bowel obstruction, fecal impaction, ileus

Canadian labeling: Additional contraindications (not in U.S. labeling): Hypersensitivity to lanthanum carbonate or any component of the formulation; hypophosphatemia

Dosing: Adult

Reduction of serum phosphorous: Oral: Initial: 1,500 mg daily (US labeling) or 750 to 1,500 mg daily (Canadian labeling) divided and taken with or immediately after meals; typical increases of 750 mg daily every 2 to 3 weeks are suggested as needed to reduce the serum phosphate level <6 mg/dL (1.92 mmol/L); usual dosage range: 1,500 to 3,000 mg daily; doses of up to 4,500 mg have been evaluated

Dosing: Geriatric

Refer to adult dosing.

Dosing: Renal Impairment

No dosage adjustment necessary.

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer’s labeling.

Administration

Administer with or immediately after meals.

Chewable tablet: Tablet should be chewed completely prior to swallowing; do not swallow whole. Tablet may be crushed to aid in chewing.

Oral powder: Sprinkle powder on a small quantity of applesauce or other similar food (not liquid) and administer immediately. Do not store for future use.

Dietary Considerations

Take with or immediately after meals.

Storage

Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from moisture. Do not open oral powder until ready to use.

Drug Interactions

ACE Inhibitors: Lanthanum may decrease the serum concentration of ACE Inhibitors. Management: Administer angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. Exceptions: Enalaprilat. Consider therapy modification

Ampicillin: Lanthanum may decrease the serum concentration of Ampicillin. Management: Administer oral ampicillin at least two hours before or after lanthanum. Consider therapy modification

Chloroquine: Lanthanum may decrease the serum concentration of Chloroquine. Management: Administer chloroquine at least two hours before or after lanthanum. Consider therapy modification

Halofantrine: Lanthanum may decrease the serum concentration of Halofantrine. Management: Administer halofantrine at least two hours before or after lanthanum. Consider therapy modification

HMG-CoA Reductase Inhibitors: May decrease the serum concentration of Lanthanum. Management: Administer HMG-CoA reductase inhibitors at least two hours before or after lanthanum. Consider therapy modification

Quinolone Antibiotics: Lanthanum may decrease the serum concentration of Quinolone Antibiotics. Management: Administer oral quinolone antibiotics at least two hours before or after lanthanum. Exceptions: Gemifloxacin; LevoFLOXacin (Oral Inhalation); Lomefloxacin. Consider therapy modification

Tetracycline Derivatives: Lanthanum may decrease the serum concentration of Tetracycline Derivatives. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Consider therapy modification

Thyroid Products: Lanthanum may decrease the serum concentration of Thyroid Products. Management: Administer oral thyroid products at least two hours before or after lanthanum. Consider therapy modification

Test Interactions

Abdominal x-rays may have a radiopaque appearance.

Adverse Reactions

>10%:

Gastrointestinal: Diarrhea (oral powder: ≤18%; chewable tablets: ≤7%), nausea (oral powder: ≤18%; chewable tablet: ≤11%), vomiting (oral powder: ≤18%; chewable tablets: ≤9%)

1% to 10%:

Endocrine & metabolic: Hypocalcemia (5%)

Gastrointestinal: Abdominal pain (chewable tablet: 5%)

<1% (Limited to important or life-threatening): Allergic skin reaction, constipation, dyspepsia, fecal impaction, gastrointestinal perforation, hypophosphatemia, intestinal obstruction (including ileus and subileus), intestinal perforation, subileus accidental injury (tooth injury with chewable tablets)

Warnings/Precautions

Concerns related to adverse effects:

• Gastrointestinal obstruction: Serious gastrointestinal (GI) obstruction, ileus, subileus, GI perforation, and fecal impaction have been reported, some requiring surgery or hospitalization. Risk factors include patients with altered GI anatomy (eg, diverticular disease, peritonitis, history of GI surgery, GI cancer, GI ulceration), hypomotility disorders (eg, constipation, ileus, subileus, diabetic gastroparesis), or concomitant medications (eg, calcium channel blockers); may also occur in patients without history of GI disease.

Disease-related concerns:

• Biliary obstruction: Use with caution in patients with biliary obstruction (elimination of lanthanum may be reduced in these patients).

• Gastrointestinal disease: Use with caution in patients with active peptic ulcer, ulcerative colitis, or Crohn disease.

• Hepatic impairment: Use with caution in patients with hepatic impairment (elimination of lanthanum may be reduced in these patients).

Dosage form specific issues:

• Tablet: Chew thoroughly to decrease risk of serious adverse GI effects; do not swallow whole.

Other warnings/precautions:

• Abdominal x-rays: May have a radiopaque appearance in patients taking lanthanum.

• Bone deposition: Rising lanthanum levels were observed in bone biopsies of patients treated for up to 4.5 years (Fosrenol Canadian product monograph 2015). Lanthanum deposits into developing bone, including growth plates; consequences on developing bone are not known. Use in children is not recommended.

Monitoring Parameters

Serum calcium and phosphorus: Frequency of measurement may be dependent upon the presence and magnitude of abnormalities, the rate of progression of CKD, and the use of treatments for CKD-mineral and bone disorders (KDIGO 2009): CKD stage 5 and 5D: Every 1-3 months

Pregnancy Risk Factor

C

Pregnancy Considerations

Adverse effects have been observed in some animal reproduction studies. The effect on absorption of vitamins and nutrients has not been studied. Lanthanum is not recommended for use during pregnancy.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Have patient report immediately to prescriber severe nausea, severe vomiting, severe abdominal pain, severe constipation, or severe diarrhea (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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