Dosing and uses of Fosrenol (lanthanum carbonate)
Adult dosage forms and strengths
chewable tablet
- 500mg
- 750mg
- 1000mg
oral powder
- 750mg
- 1000mg
Reduction of Serum Phosphate in ESRD Patients
Initial: 750-1500 mg/day PO in divided doses
Titrate by 750 mg increments q2-3Weeks until acceptable serum phosphate level attained
Doses up to 4500 mg were evaluated in clinical trials; most patients required a total daily dose between 1500-3000 mg to reduce plasma phosphate levels to <6.0 mg/dL
Administration
Take with or immediately after meals
Chewable tablet: Chew or crush tablet completely; do not swallow whole
Oral powder
- Sprinkle oral powder on a small quantity of applesauce or other similar food and consume immediately
- Do not open until ready to use
- Do not store oral powder for future use once mixed with food
- Oral powder is insoluble, do not attempt to dissolve in liquid for administration
- Consider using the oral powder formulation in patients with poor dentition, or who have difficulty chewing tablets
Pediatric dosage forms and strengths
Not recommended
Fosrenol (lanthanum carbonate) adverse (side) effects
1-10%
Abdominal pain
Constipation
Dialysis graft complication/occlusion
Diarrhea
Headache
Hypertension
Nausea
Vomiting
<1%
Bronchitis
Hypercalcemia
Rhinitis
Postmarketing Reports
Dyspepsia
Allergic skin reactions
Hypophosphatemia
Hypocalcemia
Tooth injury
Intestinal perforation
Intestinal obstruction
Ileus
Subileus
Warnings
Contraindications
Bowel obstruction
Ileus
Fecal impaction
Cautions
Use with caution in PUD, Crohn's disease, ulcerative colitis, bowel obstruction
Serious cases of gastrointestinal obstruction, ileus, subileus, gastrointestinal perforation and fecal impaction reported; risk factors for gastrointestinal obstruction and gastrointestinal perforation in patients taking chewable tablets include altered gastrointestinal anatomy (e.g., diverticular disease, peritonitis, history of gastrointestinal surgery, gastrointestinal colon cancer, gastrointestinal ulceration), hypomotility disorders (e.g., constipation, ileus, subileus, diabetic gastroparesis) and concomitant medications (e.g., calcium channel blockers); cases were reported in patients with no history of gastrointestinal disease; advise patients prescribed chewable tablets to chew tablet completely to reduce risk of serious adverse gastrointestinal events
Has radio-opaque properties and therefore may give the appearance typical of an imaging agent during abdominal X-ray procedures
Chewable tablets should be chewed completely to reduce the risk of serious adverse gastrointestinal events
Pregnancy, lactation
Pregnancy and lactation
Pregnancy category: C
Lactation: use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Fosrenol (lanthanum carbonate)
Mechanism of action
Lanthanum forms strong complexes with PO4 that inhibits GI absorption and results in a decrease of serum phosphate and calcium levels
Pharmacokinetics
Half-Life, elimination: 53 hr (plasma); 2-3.6 years (bond)
Peak Plasma: 1 ng/mL
Bioavailability: 0.002%
Protein bound: 99%
Metabolism: Not metabolized
Excretion: Predominantly feces
