Lanthanum

Brand names: Fosrenol
Drug class: Antineoplastic Agents

Usage of Lanthanum

Hyperphosphatemia

Reduction of serum phosphorus in patients with end-stage renal disease (ESRD). Reductions in serum phosphorus concentrations are similar to those achieved with alternative phosphate binders (e.g., Calcium Salts, Sevelamer).

Risk of hypercalcemia apparently is less than with calcium (e.g., Calcium carbonate) salts.

Relate drugs

How to use Lanthanum

Administration

Oral Administration

Administer orally in divided doses with or immediately after meals (in order to bind dietary phosphates efficiently).

Chew tablets completely before swallowing; do not swallow intact tablets.

Dosage

Available as Lanthanum carbonate; dosage expressed in terms of lanthanum.

Adults

Hyperphosphatemia ESRD Oral

Initially, 750 mg–1.5 g daily.

Adjust dosage at 2- to 3-week intervals until serum phosphorus concentration is acceptable; generally titrated in increments of 750 mg daily in clinical studies.

Dosage of 1.5–3 g daily usually is required to reduce serum phosphorus concentrations to <6 mg/dL; dosages up to 3.75 g daily have been studied.

Monitor serum phosphorus concentrations as needed during titration and regularly thereafter.

Warnings

Contraindications

  • No known contraindications.

    • Warnings/Precautions

    General Precautions

    GI Disease

    Safety and efficacy not established in active peptic ulcer disease, ulcerative colitis, Crohn’s disease, or bowel obstruction; use with caution in patients with these disorders.

    Radiographic Examinations

    Abdominal radiographs performed in patients taking lanthanum may have the typical radiopaque appearance of a radiograph performed using an imaging agent.

    Chronic Use

    No differences in fracture or mortality rates were observed between patients receiving lanthanum and those receiving alternative therapy for up to 3 years in clinical studies; however, data are insufficient to conclude lanthanum has no effect on fracture or mortality rates beyond 3 years of use.

    Specific Populations

    Pregnancy

    Category C.

    Lactation

    Not known whether lanthanum is distributed into milk. Caution if used in nursing women.

    Pediatric Use

    Safety and efficacy not established in children <18 years of age.

    Deposited in developing bone (including the growth plate) of animals in long-term studies; although growth abnormalities in animals were not observed, the consequences of deposition in developing bone of pediatric patients are unknown.

    Geriatric Use

    No substantial differences in safety and efficacy relative to younger adults.

    Common Adverse Effects

    Nausea, vomiting, dialysis graft occlusion, abdominal pain.

    What other drugs will affect Lanthanum

    Not a substrate for CYP isoenzymes. Does not inhibit CYP isoenzymes 1A2, 2C9/10, 2C19, 2D6, or 3A4/5.

    Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

    Pharmacokinetic interaction unlikely.

    Drugs Known to Interact with Antacids

    Possible formation of insoluble complexes; do not administer such drugs within 2 hours of lanthanum dose.

    Specific Drugs

    Drug

    Interaction

    Citrate salts

    Lanthanum absorption not altered

    Digoxin

    No formation of insoluble complexes in vitro; digoxin absorption not altered

    Enalapril

    No formation of insoluble complexes in vitro

    Furosemide

    No formation of insoluble complexes in vitro

    Metoprolol

    No formation of insoluble complexes in vitro; metoprolol absorption not altered

    Phenytoin

    No formation of insoluble complexes in vitro

    Warfarin

    No formation of insoluble complexes in vitro; warfarin absorption not altered

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