Adult Dosing

To reduce serum phosphate in patients with end-stage renal disease

• Initial dose 1500 mg/day PO in divided doses
• Titrate the dose q2-3 wks in increments of 750 mg/day, until an acceptable serum phosphate level is reached; usual range: 1500 mg - 3000 mg/day
• Max: 3750 mg/day
• Note: Tablets to be taken with or immediately after food. Chew tablets completely before swallowing; tablets may be crushed to aid in chewing

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

• To reduce serum phosphate in patients with end-stage renal disease (ESRD)

• Hypersensitivity to any of the ingredients of the product
• Bowel obstruction, ileus, and fecal impaction

• N/A

Renal Dose Adjustment

• Renal impairment: No dose adjustments

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

See Supplemental Patient Information

• Serious cases of GI obstruction, ileus, and fecal impaction have been reported in association with lanthanum, some indicating surgery or hospitalization
• Abdominal x-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of an imaging agent

Cautions: Use cautiously in

• Hepatic impairment
• Acute peptic ulcer disease
• Crohn's disease
• Bowel obstruction
• Ulcerative colitis

Supplemental Patient Information

• Advise patients to take the tablets with or immediately after meals
• Advise patients to chew or to crush the tablet completely before swallowing to reduce the risk of adverse gastrointestinal events
• Inform patients that lanthanum may affect the bioavailability of an oral drug if taken together causing significant effect on the safety and efficacy of that drug; hence, advise patients to administer the drug at least one hour before or three hours after lanthanum
• Instruct patients to promptly report their physician regarding lanthanum use prior to an abdominal x-ray

Fosrenol interacts with :

	Cytomel
	Levo-T
	Levothroid
	Levothyroxine
	Levoxyl
	Liothyronine
	Liotrix
	Synthroid
	Thyroid USP
	Thyrolar
	Thyrolar-0.25
	Thyrolar-0.5
	Thyrolar-1
	Thyrolar-2
	Thyrolar-3
	Tirosint
	Triostat
	Unithroid

Pregnancy Category:C

Breastfeeding: Safety unknown. As per manufacturer's data, it is not known whether lanthanum is excreted in breast milk. As many drugs are excreted in human milk, caution must be exercised if administered to a nursing woman.

• GI: Nausea, vomiting, abdominal pain, diarrhea
• CNS: Headache
• MISC: Dialysis graft occlusion

• Phosphate binder; it reduces absorption of phosphate by forming highly insoluble lanthanum phosphate complexes, consequently reducing both serum phosphate and calcium phosphate levels
• Not metabolized; CYP450: None
• Excretion: Feces 94-99% (unchanged); urine <2%
• Half-life: 53 hrs

US Trade Name(s)

• Fosrenol

US Availability

Fosrenol

• CHEW TABS: 250, 500, 750, 1000 mg

Canadian Trade Name(s)

• Fosrenol

Canadian Availability

Fosrenol

• CHEW TABS: 250, 500, 750, 1000 mg

UK Trade Name(s)

• Fosrenol

UK Availability

Fosrenol

• CHEW TABS: 500, 750, 1000 mg

Australian Trade Name(s)

• Fosrenol

Australian Availability

Fosrenol

• CHEW TABS: 500, 750, 1000 mg

Endocrine/Metabolic

Phosphate Binders

Pricing data from www.DrugStore.com in U.S.A.

• Fosrenol 500 MG CHEW [Bottle] (SHIRE US INC.)
  45 mg = $359.98
  135 mg = $1059.98
• Fosrenol 1000 MG CHEW [Bottle] (SHIRE US INC.)
  90 mg = $679.97
  180 mg = $1339.94

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

• Fosrenol 1000 MG Chewable Tablet (Shire US Manufacturing Inc.)
• Fosrenol 500 MG Chewable Tablet (Shire US Manufacturing Inc.)
• Fosrenol 750 MG Chewable Tablet (Shire US Manufacturing Inc.)