lanthanum

Therapeutic Classification: hypophosphatemics

Pharmacologic Classification: phosphate binders

Indications ⬆ ⬇

REMS

Hyperphosphatemia in end-stage kidney disease.

Action ⬆ ⬇

Dissociates in the upper GI tract forming lanthanate ions, which form an insoluble complex with phosphate.

Therapeutic effects:

Decreased serum phosphate levels.

Pharmacokinetics ⬆ ⬇

Absorption: Negligible absorption.

Distribution: Stays within the GI tract.

Metabolism/Excretion: Eliminated almost entirely in feces.

Half-Life: 53 hr (in plasma).

Time/Action Profile ⬆ ⬇

(effect on phosphate levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–3 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Bowel obstruction;
Ileus;
Fecal impaction;
OB: Pregnancy;
Lactation: Lactation;
Pedi: Use in children not recommended (potential negative effect on developing bone).

Use Cautiously in:

Patients with risk factors for GI obstruction or perforation, including history of GI surgery, colon cancer, or GI ulceration, diverticular disease, peritonitis, constipation, ileus, diabetic gastroparesis, or taking medications that cause constipation.

Adv. Reactions/Side Effects ⬆ ⬇

F and E: hypocalcemia

GI: nausea, vomiting, diarrhea, fecal impaction, GI obstruction, GI perforation, ileus

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of fluoroquinolones, tetracyclines, and levothyroxine; administer ≥1 hr before or 3 hr after lanthanum.

Route/Dosage ⬆ ⬇

PO (Adults ): 1500 mg/day in divided doses; may be titrated upward every 2–3 wk in increments of 750 mg/day up to 4500 mg/day (usual range 1500–3000 mg/day).

Availability ⬆ ⬇

(Generic available)

Chewable tablets: 250 mg; 500 mg; 750 mg; 1000 mg
Oral powder: 750 mg/pkt; 1000 mg/pkt

Assessment ⬆ ⬇

Assess for GI adverse reactions (gastrointestinal obstruction, ileus, subileus, gastrointestinal perforation, fecal impaction). May require discontinuation of therapy in patients without another explanation for severe GI symptoms.
Assess for nausea and vomiting during therapy.

Lab Test Considerations:

Monitor serum phosphate levels prior to and periodically during therapy.

Implementation ⬆ ⬇

Do not confuse lanthanum carbonate with lithium carbonate.
Divide total daily dose and administer with meals.
PO: Administer with or immediately after meals. Tablets should be crushed or chewed completely before swallowing; intact tablets should not be swallowed.
- Sprinkle powder on small quantity of applesauce or other similar food; consume immediately. Consider powder formulation for patients with poor dentition or who have difficulty chewing tablets.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take lanthanum as directed. Advise patient to read Medication Guide before starting therapy and with each Rx refill in case of changes.
Advise patient to take antacids or thyroid medicine (levothyroxine), 2 hr before or after lanthanum carbonate and antibiotics 1 hr before or 4 hr after lanthanum carbonate.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
Advise patient to notify health care professional of medication regimen before an abdominal x-ray or if they have a history of gastrointestinal disease.
Rep: May cause fetal harm. Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.

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Pronunciation ⬇

Classifications ⬆ ⬇