LANTHANUM CARBONATE
| LANTHANUM CARBONATE (lan-tha'num) Fosrenol Classifications: electrolyte and water balance agent; phosphate binder; Therapeutic: phosphate binder Prototype: Sevelamer hydrochloride Pregnancy Category: C |
Availability
250 mg, 500 mg, 750 mg, 1g chewable tablets
Action
Lanthanum is used for the management of hyperphosphatemia in end-stage renal disease; it is a calcium/aluminum-free phosphate binding agent. Has a higher affinity for binding to phosphate than calcium or aluminum. Low systemic absorption minimizes the risk of aluminum intoxication and hypercalcemia. Lanthanum decreases phosphate absorption from the diet. Dietary phosphate bound to lanthanum carbonate is excreted in the feces.
Therapeutic Effect
Lowers serum phosphate.
Uses
Reduce serum phosphate levels in patients with end-stage renal disease.
Contraindications
Prior hypersensitivity to lanthanum carbonate; pregnancy (category C); children <18 y.
Cautious Use
Bowel obstruction, Crohn's disease, acute peptic ulcer, ulcerative colitis; lactation.
Route & Dosage
| Hyperphosphatemia Adult: PO 250–500 mg t.i.d. with or immediately after meals; may titrate up every 2–3 wk in increments of 750 mg/d to achieve acceptable serum phosphate levels (max: 3750 mg/d) |
Administration
Oral- Give with or immediately after a meal.
- Tablets must be chewed completely before swallowing. Whole tablets should not be swallowed.
- Store at 15°–30° C (59°–86° F).
Adverse Effects (≥1%)
CNS: Headache. CV: Hypotension. GI: Nausea, vomiting, diarrhea, abdominal pain, constipation. Respiratory: Bronchitis, rhinitis. Other: Dialysis graft occlusion.Pharmacokinetics
Absorption: Minimal from GI tract. Metabolism: Not metabolized. Elimination: In feces. Half-Life: 53 h.Nursing Implications
Assessment & Drug Effects
- Monitor for dialysis graft occlusion, as lanthanum therapy may increase occlusion risk.
- Lab tests: serum phosphate levels during dosage titration and regularly throughout treatment; periodic serum calcium, bicarbonate, and chloride.
Patient & Family Education
- Chew chewable tablets completely, then swallow.
- Report promptly any of the following: headache, drowsiness, dizziness, fainting, confusion, irritability, nausea, vomiting, or loss of appetite.
Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; 
Canadian drug name; 
Prototype drug