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.
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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 OralInitially, 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
Warnings/Precautions
General Precautions
GI DiseaseSafety 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 ExaminationsAbdominal radiographs performed in patients taking lanthanum may have the typical radiopaque appearance of a radiograph performed using an imaging agent.
Chronic UseNo 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
PregnancyCategory C.
LactationNot known whether lanthanum is distributed into milk. Caution if used in nursing women.
Pediatric UseSafety 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 UseNo 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
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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