Lanthanum carbonate is a chemical compound with the formula La2(CO3)3. It is a salt that contains the lanthanum cation (La3+) and the carbonate anion (CO3^2-). Lanthanum itself is a rare earth element, and it is part of the lanthanide series on the periodic table. Lanthanum carbonate is one of the compounds that can be used to treat certain medical conditions, particularly those related to high levels of phosphate in the body.

Lanthanum carbonate is commonly used as a phosphate binder in the treatment of hyperphosphatemia in patients with chronic kidney disease. It works by binding to dietary phosphate in the digestive tract, preventing its absorption into the bloodstream. This can help lower the levels of phosphate in the blood, which is important in managing kidney disease, as high phosphate levels can lead to complications like bone problems and cardiovascular issues.

A non-absorbable medication called fosrenol (Lanthanum Carbonate) binds to food phosphate in the digestive system to produce insoluble complexes.

Lanthanum Carbonate (Fosrenol) Uses:

• To reduce the serum Phosphate levels:
  • It is recommended for the treatment of hyperphosphatemia in ESRD patients (end-stage renal disease).

Lanthanum Carbonate dosage in adults:

Fosrenol Dose in the treatment of Hyperphosphatemia (to reduce serum phosphate levels):

• Start with: 1,500 mg each day. Split this amount and take it with meals or right after.
• If needed, your doctor might increase your dose by 750 mg every 2 to 3 weeks to get the phosphate level in your blood below a certain point.
• Most people take between 1,500 to 3,000 mg each day.
• In some cases, doses can go up to 4,500 mg, but this is not common.

Lanthanum carbonate use in children:

The safety and efficacy of the drug in children are not established.

Fosrenol Pregnancy Risk Factor C

• Lanthanum Carbonate might have negative effects on baby animals when tested.
• We don't know if it affects how vitamins and nutrients are taken up in the body.
• Because of these unknowns, it's better not to use Lanthanum during pregnancy.

Use of lanthanum carbonate during breastfeeding

• We don't know if Lanthanum gets into breast milk.
• So, if giving it to a woman who's breastfeeding, think about the potential risk to the baby.

Lanthanum Carbonate dose in kidney disease:

Adjustment in the dose is not necessary.

Lanthanum Carbonate dose in liver disease:

The manufacturer has not provided any adjustments in the dose in patients with liver disease.

Common Side Effects of Lanthanum carbonate (Fosrenol):

• Gastrointestinal:
  • Diarrhea
  • Nausea
  • Vomiting

Less Common Side Effects of Lanthanum carbonate (Fosrenol):

• Endocrine & metabolic:
  • Hypocalcemia
• Gastrointestinal:
  • Abdominal pain

Contraindications to Lanthanum carbonate (Fosrenol):

• Certain bowel problems like blockage, hard stool that can't be passed, or the intestines not working right are issues to consider with Lanthanum Carbonate.
• In Canada, they also warn against using it if you're allergic to any part of the medicine or if your blood has very low phosphate levels.
• This specific warning isn't in the US label.

Warnings and precautions

Gastrointestinal obstruction:

• Some people have had serious problems in their digestive system, like blockages, intestines not moving food properly, holes in the intestines, or really hard stool.
• These issues sometimes needed surgery or a stay in the hospital.
• People who might be at higher risk include:
  • Those with digestive system problems (like diverticulitis, past surgeries, ulcers, or cancers).
  • Those with movement issues in their intestines (like constipation, slow-moving intestines, or diabetes-related stomach problems).
  • Those taking medicines that can make these effects worse.
• This can happen even if someone hasn't had any past digestive system problems.
• If someone has severe unexplained stomach issues, it might be best to stop taking Lanthanum Carbonate.

Obstructive biliary:

• Be careful when giving Lanthanum Carbonate to people with biliary obstruction.
• Biliary obstruction is a blockage in the tubes that carry bile from the liver to the intestines.
• People with this blockage might not get rid of Lanthanum from their body as easily.

Gastrointestinal disease and Lanthanum Carbonate:

• Be careful when giving Lanthanum Carbonate to people with certain stomach or intestine issues.
• This includes those with:
  • Active stomach ulcers
  • Ulcerative colitis
  • Crohn's disease.

Hepatic impairment

• Be careful when giving Lanthanum Carbonate to people with liver problems.
• People with liver problems might not get rid of Lanthanum from their body as easily.

Lanthanum carbonate: Drug Interaction

Monitor:

Testing for Calcium, Phosphorus, and Parathyroid Hormone (PTH) in chronic kidney disease (CKD):

• How often you test can depend on how severe the kidney disease is and if there are treatments for bone and mineral issues related to CKD.

CKD stage G3a to G3b:

• Test calcium and phosphate: Once every 6-12 months.
• Test PTH: Depends on the initial level and how fast CKD is getting worse.

CKD stage G4:

• Test calcium and phosphate: Once every 3-6 months.
• Test PTH: Once every 6-12 months.

CKD stage G5 and G5D:

• Test calcium and phosphate: Once every 1-3 months.
• Test PTH: Once every 3-6 months.

How to administer Lanthanum carbonate (Fosrenol)?

General:

• Take it with or right after eating.

Chewable Tablet:

• Make sure to chew the tablet fully before swallowing.
• Don't swallow the tablet whole.
• If needed, crush the tablet to make it easier to chew.
• Tablets that aren’t chewed well can cause serious stomach problems.

Oral Powder:

• Sprinkle the powder on a small amount of food like applesauce.
• Eat it right away.
• Don't mix with liquid.
• Don't save the mixture for later; use it immediately.

Mechanism of action of Lanthanum carbonate (Fosrenol):

• Once taken, it breaks down in the upper part of your stomach and intestines.
• It releases lanthanum ions.
• These ions grab onto phosphate from your food.
• This makes lanthanum-phosphate combos that your body can't absorb.
• The result? Less phosphate and calcium in your blood.

Absorption:

• Only a tiny bit (less than 0.002%) gets into your bloodstream.

Protein binding:

• It mostly sticks to proteins in the blood (over 99%).

Metabolism:

• It doesn't get broken down by the body.

Half-life:

• In the blood: 53 hours (about 2 days).
• In the bone: 2 to almost 4 years.

How it leaves your body:

• Mostly through poop.
• Very little (less than 2%) goes out in urine.

International Brands of Lanthanum carbonate:

• Fosrenol
• Fosbait
• Fosrenol
• Foznol
• Lantharex
• Lanthonate

Lanthanum carbonate Brand Names in Pakistan:

Not Available.