lanthanum

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:

Hypersensitivity;
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, 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)

Assessment ⬆ ⬇

Assess for GI adverse reactions (GI obstruction, ileus, subileus, GI 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:

Implementation ⬆ ⬇

Do not confuse lanthanum carbonate with lithium carbonate.
Divide total daily dose and administer with meals.
May bind with other orally administered drugs; consider separating the administration of other oral medications.
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 ⬆ ⬇

Educate patient on reason for lanthanum and side effects. Instruct patient to take lanthanum as directed. Do not swallow intact tablets. Do not premix future powder doses, open packet in advance, or attempt to mix with liquids. Discuss need to separate the administration of other oral medications with health care provider. Advise patient to read Patient Information 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 GI disease.
Rep: May cause fetal harm. Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.