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

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            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
              -
              500 mg chewable tablet
              Fosrenol oral
              -
              1,000 mg chewable tablet
              Fosrenol oral
              -
              750 mg powder
              Fosrenol oral
              -
              750 mg chewable tablet
              Fosrenol oral
              -
              750 mg powder
              Fosrenol oral
              -
              1,000 mg powder
              Fosrenol oral
              -
              1,000 mg powder
              lanthanum oral
              -
              500 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet
              lanthanum oral
              -
              750 mg chewable tablet
              lanthanum oral
              -
              1,000 mg chewable tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              lanthanum oral

              LANTHANUM CARBONATE POWDER - ORAL

              (LAN-tha-num KAR-bo-nate)

              COMMON BRAND NAME(S): Fosrenol

              USES: Lanthanum is used to lower high blood phosphate levels in people who are on dialysis due to severe kidney disease. Dialysis removes some phosphate from your blood, but it is difficult to remove enough to keep your phosphate levels balanced. Decreasing blood phosphate levels can help keep your bones strong, prevent unsafe buildup of minerals in your body, and may decrease the risk of heart disease and strokes that can result from high phosphate levels.Lanthanum is a natural mineral that works by binding to phosphate in the foods you eat. The phosphate then passes out of your body in your stool.

              HOW TO USE: Read the Medication Guide provided by your pharmacist before you start taking lanthanum and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth as directed by your doctor, usually with or right after meals. Sprinkle the powder on a small amount of applesauce or soft food and swallow the mixture right away. Do not open the powder packet until you are ready to use it. Do not store the drug/food mixture for future use. Lanthanum powder will not dissolve in liquid.Take this medication regularly to get the most benefit from it. The dosage is based on your medical condition, response to treatment, and laboratory test results.Lanthanum may stop some medications from working well if you take them at the same time. Ask your pharmacist if you need to separate the time that you take your other medications from the time that you take lanthanum. See also Drug Interactions section.

              SIDE EFFECTS: Nausea, vomiting, stomach pain, diarrhea, or constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: mental/mood changes, unusual muscle weakness/spasms, seizures.Rarely, a serious blockage of the bowels or a hole in the bowels may occur, which may sometimes require surgery or going to the hospital. Tell your doctor right away if you have: stomach/abdominal pain that is severe or doesn't stop, vomiting that doesn't stop, severe constipation, severe diarrhea, fever, chills.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking lanthanum, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestinal problems (such as ulcers, bowel blockage/surgery, cancer, constipation), diabetes.Before having an X-ray of your stomach/abdomen, tell X-ray personnel that you are taking this medication.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication is not recommended for children because it may affect the bones.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Lanthanum may stop some medications from working well if you take them at the same time. Ask your pharmacist for details because you may need to separate the times you take lanthanum by at least 2 hours from the times you take the following medications, among others: mycophenolate, thyroid medications (such as levothyroxine), tetracycline antibiotics (such as doxycycline, tetracycline), drugs that interact with antacids.Other medications (such as quinolone antibiotics including ciprofloxacin/levofloxacin) may require different separation time schedules. Talk with your doctor or pharmacist about how to schedule lanthanum and your other medications.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Your doctor may tell you to follow a special diet to help lower your blood phosphate levels. Follow the diet closely.Do not share this medication with others.Laboratory and/or medical tests (such as blood phosphate and calcium levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, skip the missed dose unless you have just eaten. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
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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.