Lanthanum
NOTE: Referenced from Lexi-Comp - View References below**
Dosing:
Reduction of serum phosphorous: Oral: Initial: 1500 mg/day divided and taken with meals; typical increases of 750 mg/day every 2-3 weeks are suggested as needed to reduce the serum phosphate level <6 mg/dL; usual dosage range: 1500-3000 mg; doses of up to 4500 mg have been evaluated
Use: Labeled Indications
Reduction of serum phosphate in patients with stage 5 chronic kidney disease (end-stage renal disease [ESRD]; kidney failure: GFR <15 mL/minute/1.73 m2 or dialysis)
Administration: Oral
Administer with or immediately after meals; tablet should be chewed completely prior to swallowing; do not swallow whole. Tablet may be crushed to aid in chewing.
Storage
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from moisture.
Contraindications
Bowel obstruction, fecal impaction, ileus
Warnings/Precautions
Disease-related concerns:
• Gastrointestinal disease: Gastrointestinal (GI) obstruction may occur in patients with altered gastrointestinal anatomy, hypomotility disorders (including constipation, ileus, and diabetes), or concomitant medications (eg, calcium channel blockers); may also occur without history of GI disease. Use with caution in patients with active peptic ulcer, ulcerative colitis, or Crohn's disease.
Dosage form specific issues:
• Tablet: Chew thoroughly to decrease risk of adverse GI effects; do not swallow whole.
Other warnings/precautions:
• Abdominal x-rays: May have a radiopaque appearance in patients taking lanthanum
Adverse Reactions
Reported in short-term (4-6 weeks) trials:
>10%: Gastrointestinal: Nausea (11%)
1% to 10%: Gastrointestinal: Vomiting (9%), abdominal pain (5%)
Postmarketing and/or case reports: Allergic skin reactions, bowel obstruction, constipation, dyspepsia, fecal impaction, hypophosphatemia, ileus
Drug Interactions
ACE Inhibitors: Lanthanum may decrease the serum concentration of ACE Inhibitors. Management: Administer angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. Exceptions: Enalaprilat. Risk D: Consider therapy modification
Ampicillin: Lanthanum may decrease the serum concentration of Ampicillin. Management: Administer oral ampicillin at least two hours before or after lanthanum. Risk D: Consider therapy modification
Chloroquine: Lanthanum may decrease the serum concentration of Chloroquine. Management: Administer chloroquine at least two hours before or after lanthanum. Risk D: Consider therapy modification
HMG-CoA Reductase Inhibitors: May decrease the serum concentration of Lanthanum. Management: Administer HMG-CoA reductase inhibitors at least two hours before or after lanthanum. Risk D: Consider therapy modification
Quinolone Antibiotics: Lanthanum may decrease the serum concentration of Quinolone Antibiotics. Management: Administer oral quinolone antibiotics at least two hours before or after lanthanum. Exceptions: Gemifloxacin; Lomefloxacin. Risk D: Consider therapy modification
Tetracycline Derivatives: Lanthanum may decrease the serum concentration of Tetracycline Derivatives. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Risk D: Consider therapy modification
Thyroid Products: Lanthanum may decrease the serum concentration of Thyroid Products. Management: Administer oral thyroid products at least two hours before or after lanthanum. Risk D: Consider therapy modification
Monitoring Parameters
Serum calcium and phosphorus: Frequency of measurement may be dependent upon the presence and magnitude of abnormalities, the rate of progression of CKD, and the use of treatments for CKD-mineral and bone disorders (KDIGO, 2009): CKD stage 5 and 5D: Every 1-3 months
Reference Range
Corrected total serum calcium (K/DOQI, 2003): CKD stage 5: 2.1-2.37 mmol/L; KDIGO guidelines recommend maintaining normal ranges for CKD stage 5 and 5D (KDIGO, 2009)
Phosphorus (K/DOQI, 2003): CKD stage 5 (including those treated with dialysis): 1.13-1.78 mmol/L; KDIGO guidelines recommend maintaining normal ranges for CKD stage 5 and lowering elevated phosphorus levels toward the normal range for CKD stage 5D (KDIGO, 2009)
Patient Education
Chew tablets prior to swallowing. Ensure patient's adherence to medicine. You may experience nausea, vomiting, and abdominal pain. Report persistent nausea or vomiting.
Dosage Forms
Tablet, chewable, oral:
Fosrenol®: 500 mg, 750 mg, 1000 mg
Mechanism of Action
Disassociates in the upper gastrointestinal tract to lanthanum ions (La3+) which bind to dietary phosphate resulting in insoluble lanthanum phosphate complexes and a net decrease in serum phosphate and calcium levels.
Pharmacodynamics/Kinetics
Absorption: <0.002%
Protein binding: >99%
Metabolism: Not metabolized
Half-life elimination: Plasma: 53 hours; Bone: 2-3.6 years
Excretion: Feces primarily; urine <2%
Mental Health: Effects on Psychiatric Treatment
GI side effects are common; concurrent use with SSRIs, lithium, or valproic acid may produce additive GI effects; may bind with gabapentin; separate administration by at least 2 hours
Dosing:
Reduction of serum phosphorous: Oral: Initial: 1500 mg/day divided and taken with meals; typical increases of 750 mg/day every 2-3 weeks are suggested as needed to reduce the serum phosphate level <6 mg/dL; usual dosage range: 1500-3000 mg; doses of up to 4500 mg have been evaluated
Use: Labeled Indications
Reduction of serum phosphate in patients with stage 5 chronic kidney disease (end-stage renal disease [ESRD]; kidney failure: GFR <15 mL/minute/1.73 m2 or dialysis)
Administration: Oral
Administer with or immediately after meals; tablet should be chewed completely prior to swallowing; do not swallow whole. Tablet may be crushed to aid in chewing.
Storage
Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Protect from moisture.
Contraindications
Bowel obstruction, fecal impaction, ileus
Warnings/Precautions
Disease-related concerns:
• Gastrointestinal disease: Gastrointestinal (GI) obstruction may occur in patients with altered gastrointestinal anatomy, hypomotility disorders (including constipation, ileus, and diabetes), or concomitant medications (eg, calcium channel blockers); may also occur without history of GI disease. Use with caution in patients with active peptic ulcer, ulcerative colitis, or Crohn's disease.
Dosage form specific issues:
• Tablet: Chew thoroughly to decrease risk of adverse GI effects; do not swallow whole.
Other warnings/precautions:
• Abdominal x-rays: May have a radiopaque appearance in patients taking lanthanum
Adverse Reactions
Reported in short-term (4-6 weeks) trials:
>10%: Gastrointestinal: Nausea (11%)
1% to 10%: Gastrointestinal: Vomiting (9%), abdominal pain (5%)
Postmarketing and/or case reports: Allergic skin reactions, bowel obstruction, constipation, dyspepsia, fecal impaction, hypophosphatemia, ileus
Drug Interactions
ACE Inhibitors: Lanthanum may decrease the serum concentration of ACE Inhibitors. Management: Administer angiotensin-converting enzyme inhibitors at least two hours before or after lanthanum. Exceptions: Enalaprilat. Risk D: Consider therapy modification
Ampicillin: Lanthanum may decrease the serum concentration of Ampicillin. Management: Administer oral ampicillin at least two hours before or after lanthanum. Risk D: Consider therapy modification
Chloroquine: Lanthanum may decrease the serum concentration of Chloroquine. Management: Administer chloroquine at least two hours before or after lanthanum. Risk D: Consider therapy modification
HMG-CoA Reductase Inhibitors: May decrease the serum concentration of Lanthanum. Management: Administer HMG-CoA reductase inhibitors at least two hours before or after lanthanum. Risk D: Consider therapy modification
Quinolone Antibiotics: Lanthanum may decrease the serum concentration of Quinolone Antibiotics. Management: Administer oral quinolone antibiotics at least two hours before or after lanthanum. Exceptions: Gemifloxacin; Lomefloxacin. Risk D: Consider therapy modification
Tetracycline Derivatives: Lanthanum may decrease the serum concentration of Tetracycline Derivatives. Management: Administer oral tetracycline antibiotics at least two hours before or after lanthanum. Risk D: Consider therapy modification
Thyroid Products: Lanthanum may decrease the serum concentration of Thyroid Products. Management: Administer oral thyroid products at least two hours before or after lanthanum. Risk D: Consider therapy modification
Monitoring Parameters
Serum calcium and phosphorus: Frequency of measurement may be dependent upon the presence and magnitude of abnormalities, the rate of progression of CKD, and the use of treatments for CKD-mineral and bone disorders (KDIGO, 2009): CKD stage 5 and 5D: Every 1-3 months
Reference Range
Corrected total serum calcium (K/DOQI, 2003): CKD stage 5: 2.1-2.37 mmol/L; KDIGO guidelines recommend maintaining normal ranges for CKD stage 5 and 5D (KDIGO, 2009)
Phosphorus (K/DOQI, 2003): CKD stage 5 (including those treated with dialysis): 1.13-1.78 mmol/L; KDIGO guidelines recommend maintaining normal ranges for CKD stage 5 and lowering elevated phosphorus levels toward the normal range for CKD stage 5D (KDIGO, 2009)
Patient Education
Chew tablets prior to swallowing. Ensure patient's adherence to medicine. You may experience nausea, vomiting, and abdominal pain. Report persistent nausea or vomiting.
Dosage Forms
Tablet, chewable, oral:
Fosrenol®: 500 mg, 750 mg, 1000 mg
Mechanism of Action
Disassociates in the upper gastrointestinal tract to lanthanum ions (La3+) which bind to dietary phosphate resulting in insoluble lanthanum phosphate complexes and a net decrease in serum phosphate and calcium levels.
Pharmacodynamics/Kinetics
Absorption: <0.002%
Protein binding: >99%
Metabolism: Not metabolized
Half-life elimination: Plasma: 53 hours; Bone: 2-3.6 years
Excretion: Feces primarily; urine <2%
Mental Health: Effects on Psychiatric Treatment
GI side effects are common; concurrent use with SSRIs, lithium, or valproic acid may produce additive GI effects; may bind with gabapentin; separate administration by at least 2 hours
References
Behets GJ, Verberckmoes SC, D'Haese PC, et al, “Lanthanum Carbonate: A New Phosphate Binder,” Curr Opin Nephrol Hypertens, 2004, 13:403-9.[PubMed 15199290]
“K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Guideline 13: Treatment of Bone Disease in Chronic Kidney Disease.” Available at http://www.kidney.org/professionals/KDOQI/guidelines_bone/index.htm
“K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Kidney Disease Outcome Quality Initiative.” Available athttp://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm[PubMed 11774095]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group, "KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)," Kidney Int Suppl, 2009, 76(S113):1-130.[PubMed 19644521]
Behets GJ, Verberckmoes SC, D'Haese PC, et al, “Lanthanum Carbonate: A New Phosphate Binder,” Curr Opin Nephrol Hypertens, 2004, 13:403-9.[PubMed 15199290]
“K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Guideline 13: Treatment of Bone Disease in Chronic Kidney Disease.” Available at http://www.kidney.org/professionals/KDOQI/guidelines_bone/index.htm
“K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Kidney Disease Outcome Quality Initiative.” Available athttp://www.kidney.org/professionals/KDOQI/guidelines_ckd/toc.htm[PubMed 11774095]
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group, "KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)," Kidney Int Suppl, 2009, 76(S113):1-130.[PubMed 19644521]