LANTHANUM CARBONATE
Clinical safety rating: caution
Comprehensive clinical and safety monograph for LANTHANUM CARBONATE (LANTHANUM CARBONATE).
Lanthanum carbonate dissociates in the acidic gastric environment to release lanthanum ions, which bind to dietary phosphate in the gastrointestinal tract, forming insoluble lanthanum-phosphate complexes that are excreted in feces, reducing serum phosphate levels.
| Metabolism | Not metabolized; eliminated unchanged in feces |
| Excretion | Primarily fecal (>99%) as unabsorbed drug. Minimal renal elimination (<1%). |
| Half-life | Terminal half-life not clinically defined due to minimal systemic absorption; effectively acts locally in GI tract. |
| Protein binding | Negligible systemic absorption; binding to serum proteins not applicable. |
| Volume of Distribution | Negligible systemic absorption; Vd not clinically relevant. |
| Bioavailability | Minimal (<0.001%) oral absorption; acts locally. |
| Onset of Action | Immediate upon binding dietary phosphate in the GI tract; clinical effect on serum phosphate seen within 1-2 weeks. |
| Duration of Action | Duration of phosphate binding corresponds to GI transit time (~24-48 hours); sustained effect with regular dosing. |
| Molecular Weight | 457.84 |
Oral: 500-1000 mg three times daily with meals, titrated based on serum phosphate levels; maximum 3000 mg/day.
| Dosage form | TABLET, CHEWABLE |
| Renal impairment | No dose adjustment required for renal impairment; caution in severe renal disease due to accumulation of lanthanum. |
| Liver impairment | No dose adjustment recommended; not metabolized by liver. |
| Pediatric use | Safety and efficacy not established in pediatric patients; no recommended dose. |
| Geriatric use | No specific dose adjustment; use lowest effective dose and monitor serum phosphate and adverse effects. |
| 1st trimester | Lanthanum carbonate is not recommended during the first trimester due to the potential for fetal phosphate depletion and associated skeletal abnormalities. |
| 2nd trimester | Limited data; use only if benefit outweighs risk. May cause maternal-fetal phosphate imbalance. |
| 3rd trimester | Avoid in third trimester as it may cause fetal hypophosphatemia and skeletal demineralization. |
Clinical note
Comprehensive clinical and safety monograph for LANTHANUM CARBONATE (LANTHANUM CARBONATE).
| Placental transfer | Crosses the placenta in animal studies; human data insufficient. Degree likely limited due to high molecular weight and low solubility. |
| Breastfeeding | Excretion into human milk is unknown. Because of potential for phosphate depletion in the infant, caution is advised. Consider alternative treatment. |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to lanthanum carbonateHypophosphatemiaBowel obstructionActive gastrointestinal bleeding
| Precautions | Risk of gastrointestinal obstruction, impaction, or perforation; use with caution in patients with gastrointestinal motility disorders or history of GI surgery, Potential for aluminum toxicity if dialysate aluminum levels are high, Not recommended in patients with phenylketonuria due to excipients |
| Food/Dietary | Lanthanum carbonate binds dietary phosphate; therefore, it should be taken with food to be effective. No specific foods must be avoided, but high-phosphate foods (dairy, nuts, colas) may require dose adjustment. Avoid taking concurrently with oral medications that require absorption. |
Loading safety data…
| Lactation Rating | L4 (possibly hazardous) |
| Teratogenic Risk | Lanthanum carbonate is a non-absorbed phosphate binder. Systemic absorption is minimal (<0.0001%), and animal studies show no teratogenic effects at doses up to 20 times the human dose. However, because of potential maternal hypocalcemia and electrolyte disturbances, fetal risk cannot be excluded. In the first trimester, theoretical risk from maternal disturbances; second and third trimesters, possible effects from altered calcium-phosphorus metabolism. Use only if maternal benefit outweighs potential fetal risk. |
| Fetal Monitoring | Monitor serum calcium, phosphorus, and parathyroid hormone levels throughout pregnancy. Assess renal function and electrolyte balance. Fetal ultrasound to monitor growth and development if long-term use. |
| Fertility Effects | No known adverse effects on fertility in animal studies. In humans, no data available; theoretical risk from electrolyte disturbances could affect reproductive function. |
| Clinical Pearls | Lanthanum carbonate is a non-calcium, non-aluminum phosphate binder used in chronic kidney disease (CKD) patients on dialysis. It should be taken with or immediately after meals to maximize phosphate binding. Monitor serum phosphate levels; target 3.5-5.5 mg/dL. May cause gastrointestinal side effects (nausea, vomiting, abdominal pain). Avoid in patients with bowel obstruction or fecal impaction. Drug interactions: reduces absorption of oral bisphosphonates, fluoroquinolones, and tetracyclines; separate by at least 2 hours. |
| Patient Advice | Take this medication with meals or as directed by your healthcare provider. · Do not crush or chew tablets; swallow whole. · Common side effects include nausea, vomiting, and constipation. · Report severe stomach pain, bloating, or difficulty passing stool. · Separate lanthanum carbonate from antibiotics like ciprofloxacin or tetracycline by at least 2 hours. |