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

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