Lanthanum carbonate
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Chewable tablet containing lanthanum carbonate hydrate equivalent to lanthanum 500mg.
Chewable tablet containing lanthanum carbonate hydrate equivalent to lanthanum 750mg.
Chewable tablet containing lanthanum carbonate hydrate equivalent to lanthanum 1000mg.
Oral powder containing lanthanum carbonate hydrate equivalent to lanthanum 750mg.
Oral powder containing lanthanum carbonate hydrate equivalent to lanthanum 1000mg.
Drugs List
Therapeutic Indications
Uses
Hyperphosphataemia in chronic renal failure patients on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD).
Chronic kidney disease not on dialysis with serum phosphate levels equal or greater than 1.78mmol/L.
Dosage
Adults
Control of serum phosphate levels have been demonstrated at a starting dose of 750mg per day divided between meals. Acceptable serum phosphate levels are usually achieved at doses of 1500 - 3000mg lanthanum per day. A maximum dose of 3750mg has been studied in a limited number of patients during clinical trials.
Serum phosphate levels should be monitored regularly and the dose of lanthanum carbonate titrated every 2-3 weeks until an acceptable serum phosphate level is reached. Once an acceptable level is reached, monitoring should continue.
Elderly
No dosage adjustment necessary (see 'Dosage; Adults' section)
Children
Not recommended.
The safety and efficacy in patients below 18 years has not been established.
Patients with Renal Impairment
Lanthanum carbonate is indicated for patients with renal impairment and no dose reduction is needed.
Hypocalcaemia may develop in patients with renal insufficiency. Serum calcium levels should be monitored regularly in patients with renal impairment. Appropriate supplements should be given.
Patients with Hepatic Impairment
The use of lanthanum carbonate in patients with hepatic impairment has not been studied. However, although lanthanum is not metabolised by liver enzymes, it is likely that it is excreted in the bile. Slower elimination of lanthanum resulting from conditions where there is a marked reduction of bile flow may lead to higher plasma levels and increased tissue deposition of lanthanum.
Lanthanum carbonate should therefore be used with caution in patients with hepatic impairment and liver function monitored regularly.
Additional Dosage Information
Treatment with lanthanum is as an adjunct to dietary control and patients should be advised to adhere to their recommended diets to control fluid and phosphate intake.
The chewable tablet and oral powder avoid the need to take additional fluid with the medication.
Administration
For oral use to be taken with or immediately after food, with the daily dose divided between meals.
Tablets must be chewed and not swallowed whole. To aid with chewing tablets may be crushed.
Oral powder must be mixed with a small quantity of soft food (e.g. apple sauce or other similar food product) and consumed immediately (within 15 minutes). Lanthanum carbonate oral powder is insoluble and must not be dissolved in liquid for administration.
Contraindications
Hypophosphataemia
Children under 18 years of age
Pregnancy (see 'Pregnancy' section)
Precautions and Warnings
Hepatic impairment - liver function should be monitored regularly (See Dosage - Hepatic Impairment).
Breastfeeding (see 'Lactation' section).
Caution is recommended when treating patients predisposed to gastrointestinal obstruction, ileus, subileus and perforation, for example patients with altered gastrointestinal anatomy (e.g. diverticular disease, peritonitis, history of gastrointestinal surgery, gastrointestinal cancer, gastrointestinal ulceration) and hypomotility disorders (e.g. constipation, diabetic gastroparesis).
Hypocalcaemia may develop in patients with renal insufficiency. Serum calcium levels should be monitored regularly in patients.
Monitor serum phosphate levels periodically. Discontinue if hypophosphataemia develops.
Lanthanum may increase gastric pH. It is recommended that it is treated pharmacologically as an antacid and that drugs where the absorption may be impaired by antacids should not be taken within 2 hours of lanthanum carbonate.
Clinical studies with the use of lanthanum carbonate beyond two years is currently limited. Treatment of patients with lanthanum carbonate for up to 6 years has not demonstrated a change in the benefit/risk profile. Accumulation of lanthanum carbonate has been seen in bone during prolonged treatment.
Lanthanum deposition in gastroduodenal mucosa, mainly after long term use, has been demonstrated endoscopically as whitish lesions of different shapes and sizes. Various pathological features have been identified in gastroduodenal mucosa with lanthanum deposition such as chronic or active inflammation, glandular atrophy, regenerative changes, foveolar hyperplasia, intestinal metaplasia and neoplasia.
Abdominal X-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of an imaging agent.
Oral powder contains glucose. Use with caution in glucose-galactose malabsorption syndrome.
Pregnancy and Lactation
Pregnancy
At the time of writing, there are no adequate data regarding the use of lanthanum carbonate in pregnant women. Lanthanum carbonate is not recommended for use during pregnancy.
One study in rats showed reproductive foetotoxicity and reduced pup weight at high doses. The potential risk for humans is unknown.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 - 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password at https://www.toxbase.org/
Lactation
It is not known whether lanthanum carbonate is excreted in breast milk and this has not been studied in animals.
The manufacturer recommends that a careful decision should be made whether to continue/discontinue breastfeeding or to continue/discontinue lanthanum carbonate, considering the potential benefit of breastfeeding to the infant and the potential benefit of therapy to the mother.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Effects on Ability to Drive and Operate Machinery
Lanthanum carbonate may cause dizziness and vertigo which may impair the ability to drive or operate machinery.
Counselling
Dizziness and vertigo have been reported as side effects. Advise patient that this may impair their ability to drive or operate machinery.
Advise patient not to take other medicines within two hours of dosing with lanthanum carbonate.
Advise patient that they should adhere to recommended diets in order to control phosphate and fluid intake.
Side Effects
Abdominal pain
Constipation
Diarrhoea
Dyspepsia
Flatulence
Nausea
Vomiting
Hypocalcaemia
Gastro-enteritis
Laryngitis
Eosinophilia
Hyperparathyroidism
Hypercalcaemia
Hyperglycaemia
Hyperphosphataemia
Hypophosphataemia
Anorexia
Increased appetite
Dizziness
Headache
Taste disturbances
Vertigo
Eructation
Indigestion
Irritable bowel syndrome(IBS)
Dry mouth
Oesophagitis
Stomatitis
Diarrhoea/loose stools
Tooth disorder
Gastro-intestinal symptoms
Alopecia
Urticaria
Pruritus
Erythematous rash
Increased sweating
Arthralgia
Myalgia
Osteoporosis
Asthenia
Chest pain
Fatigue
Malaise
Peripheral oedema
Pain
Thirst
Gamma glutamyl transferase (GGT) increased
Increase of liver transaminases
Increase in alkaline phosphatase
Weight loss
Increase in blood aluminium
Transient QT changes
Lanthanum accumulation in the bones
Ileus
Subileus
Intestinal obstruction
Intestinal perforation
Effects on Laboratory Tests
May appear in abdominal X-rays with a radio-opacity similar to that of an imaging agent.
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( https://www.toxbase.org/ ) or if this is unavailable at the backup site ( https://www.TOXBASEbackup.org/ ).
Shelf Life and Storage
No special storage requirements.
Further Information
Last Full Review Date: June 2012
Reference Sources
British National Formulary, 63rd Edition (2012) Pharmaceutical Press, London.
Summary of Product Characteristics: Fosrenol 500mg, 750mg & 1000mg chewable tablets. Takeda UK Ltd. Revised January 2022.
Summary of Product Characteristics: Fosrenol 750mg oral powder. Takeda UK Ltd. Revised January 2022.
Summary of Product Characteristics: Fosrenol 1000mg oral powder. Takeda UK Ltd. Revised January 2022.
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
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