lanthanum carbonate (Rx)

Brand and Other Names:Fosrenol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

chewable tablet

  • 500mg
  • 750mg
  • 1000mg

oral powder

  • 750mg
  • 1000mg

Reduction of Serum Phosphate in ESRD Patients

Initial: 750-1500 mg/day PO in divided doses

Titrate by 750 mg increments q2-3Weeks until acceptable serum phosphate level attained

Doses up to 4500 mg were evaluated in clinical trials; most patients required a total daily dose between 1500-3000 mg to reduce plasma phosphate levels to <6.0 mg/dL

Administration

Take with or immediately after meals

Chewable tablet: Chew or crush tablet completely; do not swallow whole

Oral powder

  • Sprinkle oral powder on a small quantity of applesauce or other similar food and consume immediately
  • Do not open until ready to use
  • Do not store oral powder for future use once mixed with food
  • Oral powder is insoluble, do not attempt to dissolve in liquid for administration
  • Consider using the oral powder formulation in patients with poor dentition, or who have difficulty chewing tablets

Not recommended

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Interactions

Interaction Checker

and lanthanum carbonate

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (2)

            • potassium phosphates, IV

              lanthanum carbonate decreases effects of potassium phosphates, IV by cation binding in GI tract. Contraindicated. Lanthanum carbonate decreases serum phosphate concentration by binding dietary phosphate.

            • sodium phosphates, IV

              lanthanum carbonate decreases effects of sodium phosphates, IV by cation binding in GI tract. Contraindicated. Lanthanum carbonate decreases serum phosphate concentration by binding dietary phosphate.

            Serious - Use Alternative (2)

            • captopril

              lanthanum carbonate decreases levels of captopril by cation binding in GI tract. Avoid or Use Alternate Drug. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • erdafitinib

              lanthanum carbonate, erdafitinib. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.

            Monitor Closely (36)

            • aluminum hydroxide

              lanthanum carbonate, aluminum hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • ampicillin

              lanthanum carbonate decreases levels of ampicillin by cation binding in GI tract. Use Caution/Monitor. Administer ampicillin at least 2 hr before or after lanthanum. Interaction applies to oral ampicillin.

            • atorvastatin

              lanthanum carbonate decreases levels of atorvastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • benazepril

              lanthanum carbonate decreases levels of benazepril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • calcium carbonate

              lanthanum carbonate, calcium carbonate. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • chloroquine

              lanthanum carbonate decreases levels of chloroquine by cation binding in GI tract. Use Caution/Monitor. Administer chlorquine at least 2 hr before or after lanthanum.

            • ciprofloxacin

              lanthanum carbonate decreases levels of ciprofloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

            • demeclocycline

              lanthanum carbonate decreases levels of demeclocycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • doxycycline

              lanthanum carbonate decreases levels of doxycycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • enalapril

              lanthanum carbonate decreases levels of enalapril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • fluvastatin

              lanthanum carbonate decreases levels of fluvastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • fosinopril

              lanthanum carbonate decreases levels of fosinopril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • levofloxacin

              lanthanum carbonate decreases levels of levofloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

            • levothyroxine

              lanthanum carbonate decreases levels of levothyroxine by cation binding in GI tract. Use Caution/Monitor. Administer oral thyroid products at least 2 hr before or after lanthanum. Interaction applies only to oral thyroid products only. .

            • liothyronine

              lanthanum carbonate decreases levels of liothyronine by cation binding in GI tract. Use Caution/Monitor. Administer oral thyroid products at least 2 hr before or after lanthanum. Interaction applies only to oral thyroid products only. .

            • liotrix

              lanthanum carbonate decreases levels of liotrix by cation binding in GI tract. Use Caution/Monitor. Administer oral thyroid products at least 2 hr before or after lanthanum. Interaction applies only to oral thyroid products only. .

            • lisinopril

              lanthanum carbonate decreases levels of lisinopril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • lovastatin

              lanthanum carbonate decreases levels of lovastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • magnesium hydroxide

              lanthanum carbonate, magnesium hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • minocycline

              lanthanum carbonate decreases levels of minocycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • moexipril

              lanthanum carbonate decreases levels of moexipril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • moxifloxacin

              lanthanum carbonate decreases levels of moxifloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

            • ofloxacin

              lanthanum carbonate decreases levels of ofloxacin by cation binding in GI tract. Use Caution/Monitor. Administer oral quinolone antibiotics at least 1 hr before or 4 hr after lanthanum. Interaction applies only to oral quinolones.

            • perindopril

              lanthanum carbonate decreases levels of perindopril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • pitavastatin

              lanthanum carbonate decreases levels of pitavastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • pravastatin

              lanthanum carbonate decreases levels of pravastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • quinapril

              lanthanum carbonate decreases levels of quinapril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • ramipril

              lanthanum carbonate decreases levels of ramipril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            • red yeast rice

              lanthanum carbonate decreases levels of red yeast rice by cation binding in GI tract. Use Caution/Monitor. Administer red yeast rice at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • rosuvastatin

              lanthanum carbonate decreases levels of rosuvastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • simvastatin

              lanthanum carbonate decreases levels of simvastatin by cation binding in GI tract. Use Caution/Monitor. Administer statin at least 2 hr before or 2 hr after lanthanum. Monitor serum concentrations.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of lanthanum carbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of lanthanum carbonate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • tetracycline

              lanthanum carbonate decreases levels of tetracycline by cation binding in GI tract. Use Caution/Monitor. Administer oral tetracycline antibiotics at least 2 hr before or after lanthanum. Interaction applies only to oral tetracyclines.

            • thyroid desiccated

              lanthanum carbonate decreases levels of thyroid desiccated by cation binding in GI tract. Use Caution/Monitor. Administer oral thyroid products at least 2 hr before or after lanthanum. Interaction applies only to oral thyroid products only. .

            • trandolapril

              lanthanum carbonate decreases levels of trandolapril by cation binding in GI tract. Use Caution/Monitor. Administer ACE inhibitor at least 2 hr before or after lanthanum.

            Minor (0)

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              Adverse Effects

              1-10%

              Abdominal pain

              Constipation

              Dialysis graft complication/occlusion

              Diarrhea

              Headache

              Hypertension

              Nausea

              Vomiting

              <1%

              Bronchitis

              Hypercalcemia

              Rhinitis

              Postmarketing Reports

              Dyspepsia

              Allergic skin reactions

              Hypophosphatemia

              Hypocalcemia

              Tooth injury

              Intestinal perforation

              Intestinal obstruction

              Ileus

              Subileus

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              Warnings

              Contraindications

              Bowel obstruction

              Ileus

              Fecal impaction

              Cautions

              Use with caution in PUD, Crohn's disease, ulcerative colitis, bowel obstruction

              Has radio-opaque properties and therefore may give the appearance typical of an imaging agent during abdominal X-ray procedures

              Chewable tablets should be chewed completely to reduce the risk of serious adverse gastrointestinal events

              Gastrointestinal adverse effects

              • Serious cases of gastrointestinal obstruction, ileus, subileus, gastrointestinal perforation and fecal impaction reported
              • Risk factors for gastrointestinal obstruction and gastrointestinal perforation in patients taking chewable tablets include altered gastrointestinal anatomy (eg, diverticular disease, peritonitis, history of gastrointestinal surgery, gastrointestinal colon cancer, gastrointestinal ulceration), hypomotility disorders (e.g., constipation, ileus, subileus, diabetic gastroparesis) and concomitant medications (e.g., calcium channel blockers);
              • Cases were reported in patients with no history of gastrointestinal disease; advise patients prescribed chewable tablets to chew tablet completely to reduce risk of serious adverse gastrointestinal events; consider discontinuing therapy in patients without another explanation for severe gastrointestinal symptoms
              • During treatment, physicians and patients should remain vigilant for signs and symptoms of gastrointestinal disorders, especially constipation and abdominal pain/distention, which may indicate bowel obstruction, ileus, or subileus
              • Treatment should be re-evaluated in patients who develop severe constipation or other severe gastrointestinal signs and symptoms
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              Pregnancy & Lactation

              Pregnancy

              Available data from case reports in pregnant women are insufficient to identify a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes; use a non-lanthanum containing phosphate binder in a pregnant woman

              Animal data

              • In animal reproduction studies, oral administration to pregnant rats and rabbits during organogenesis at doses 3 and 2.5 times, respectively, the maximum recommended human dose (MRHD), resulted in no adverse developmental effects
              • In rabbits, lanthanum carbonate doses 5 times the MRHD was associated with maternal toxicity and resulted in increased post-implantation loss, reduced fetal weights, and delayed fetal ossification
              • Deposition of lanthanum into developing bone, including growth plate, was observed in juvenile animals in long-term animal studies with lanthanum carbonate

              Lactation

              There are no data on presence of drug in human milk, effects on breastfed infant, or on milk production; deposition of lanthanum into developing bone, including growth plate, was observed in juvenile animals in long-term animal studies with lanthanum carbonate; use a non-lanthanum containing phosphate binder in a lactating woman

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Lanthanum forms strong complexes with PO4 that inhibits GI absorption and results in a decrease of serum phosphate and calcium levels

              Pharmacokinetics

              Half-Life, elimination: 53 hr (plasma); 2-3.6 years (bond)

              Peak Plasma: 1 ng/mL

              Bioavailability: 0.002%

              Protein bound: 99%

              Metabolism: Not metabolized

              Excretion: Predominantly feces

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Fosrenol oral
              -
              1,000 mg powder
              Fosrenol oral
              -
              750 mg powder
              Fosrenol oral
              -
              1,000 mg chewable tablet
              Fosrenol oral
              -
              750 mg chewable tablet
              Fosrenol oral
              -
              500 mg chewable tablet
              Fosrenol oral
              -
              1,000 mg powder
              Fosrenol oral
              -
              750 mg powder
              lanthanum oral
              -
              750 mg chewable tablet
              lanthanum oral
              -
              500 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet
              lanthanum oral
              -
              750 mg chewable tablet
              lanthanum oral
              -
              500 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet
              lanthanum oral
              -
              750 mg chewable tablet
              lanthanum oral
              -
              500 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet

              Copyright © 2010 First DataBank, Inc.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.