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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for LANTHANUM CARBONATE (LANTHANUM CARBONATE).
| Breastfeeding | No data on excretion in human milk. Due to negligible systemic absorption, excretion into breast milk is expected to be minimal. M/P ratio is unknown. Consider benefit of breastfeeding versus risk of infant exposure, although the risk is likely low. |
| 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. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to lanthanum carbonate or any component of the formulation","Hypophosphatemia"]
| 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"] |
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| 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. |