Oral Hyperphosphataemia in patients with chronic renal failure
Adult: In patients on haemodialysis or CAPD: Doses are expressed in mg of elemental lanthanum. As chewable tab or oral powder: Initially, 750-1,500 mg daily in divided doses. Dose is adjusted every 2-3 weeks until an acceptable serum phosphate level is achieved. Usual maintenance dose: 1,500-3,000 mg daily in divided doses. Dosage recommendations may vary between countries (refer to detailed local guidelines).
Oral Hyperphosphataemia in chronic kidney disease
Adult: In patients not on dialysis with a serum phosphate concentration of ≥1.78 mmol/L which cannot be controlled by a low-phosphate diet: Doses are expressed in mg of elemental lanthanum. As chewable tab or oral powder: Initially, 750-1,500 mg daily in divided doses. Dose is adjusted every 2-3 weeks until an acceptable serum phosphate level is achieved. Usual maintenance dose: 1,500-3,000 mg daily in divided doses. Dosage recommendations may vary between countries (refer to detailed local guidelines).
What are the brands available for Lanthanum carbonate in Hong Kong?
Patient with altered gastrointestinal anatomy (e.g. diverticular disease, peritonitis, history of gastrointestinal surgery, cancer and ulceration), hypomotility disorders (e.g. constipation, subileus, diabetic gastroparesis); biliary obstruction; active peptic ulcer, ulcerative colitis, Crohn's disease. Patients taking agents known to potentiate gastrointestinal obstruction. Some studies observed increasing lanthanum levels in bone biopsies of patients receiving treatment for up to 4.5 years. Lanthanum is reported to deposit into developing bone; clinical consequences on developing bones are not fully known. Hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Serious gastrointestinal obstruction, including gastrointestinal perforation, ileus, subileus, and faecal impaction; hypocalcaemia. Endocrine disorders: Hyperparathyroidism. Gastrointestinal disorders: Abdominal pain, diarrhoea, nausea, vomiting, constipation, dyspepsia, flatulence, taste alteration. Metabolism and nutrition disorders: Hyperglycaemia, hyperphosphataemia, hypophosphataemia. Nervous system disorders: Headache.
Monitor serum Ca, phosphorus, and PTH levels as clinically indicated; LFTs, particularly in patients with hepatic impairment. Closely monitor for signs and symptoms of gastrointestinal disorders (e.g. abdominal pain or distention, constipation).
May reduce the absorption or bioavailability of compounds known to interact with antacids, such as chloroquine, hydroxychloroquine, ketoconazole, quinolones (e.g. oral ciprofloxacin), ampicillin, tetracycline and levothyroxine; consider separating the administration of these drugs at least 2 hours before or after giving the lanthanum dose (dosing interval of interacting agents may vary between countries).
Lab Interference
May produce a radio-opaque appearance typical of an imaging agent on abdominal X-ray.
Action
Description: Mechanism of Action: Lanthanum carbonate is a phosphate binder that dissociates in the upper gastrointestinal tract to release trivalent lanthanum ions. These ions bind to dietary phosphates, forming insoluble lanthanum phosphate complexes which decrease phosphate absorption in the gastrointestinal tract. Consequently, the levels of serum phosphate and calcium are reduced. Pharmacokinetics: Absorption: Minimally absorbed from the gastrointestinal tract. Bioavailability: <0.002%. Distribution: Plasma protein binding: >99%. Metabolism: Not metabolised. Excretion: Mainly via faeces; urine (<2%). Elimination half-life: 53 hours (plasma); 2-3.6 years (bone).
Chemical Structure
Lanthanum carbonate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 168924, Lanthanum Carbonate. https://pubchem.ncbi.nlm.nih.gov/compound/Lanthanum-Carbonate. Accessed Nov. 26, 2024.
V03AE03 - lanthanum carbonate ; Belongs to the class of drugs used in the treatment of hyperkalemia and hyperphosphatemia.
References
Anon. Lanthanum Carbonate. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 31/10/2024.Brayfield A, Cadart C (eds). Lanthanum Carbonate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/10/2024.Fosrenol 500 mg, 750 mg, and 1,000 mg Chewable Tablets (Takeda Malaysia Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 31/10/2024.Fosrenol 750 mg Oral Powder (Takeda UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 31/10/2024.Fosrenol Chewable Tablet and Powder (Takeda Pharmaceuticals America, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 31/10/2024.Joint Formulary Committee. Lanthanum. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 31/10/2024.Lanthanum 1,000 mg Chewable Tablets (Mylan). MHRA. https://products.mhra.gov.uk. Accessed 31/10/2024.Lanthanum. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 31/10/2024.Takeda New Zealand Limited. Fosrenol 500 mg, 750 mg, and 1,000 mg Chewable Tablets data sheet 16 November 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 31/10/2024.Takeda New Zealand Limited. Fosrenol 750 mg and 1,000 mg Oral Powder data sheet 16 November 2022. Medsafe. http://www.medsafe.govt.nz. Accessed 31/10/2024.
Sign Out
