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Lanthanum

Also known as: Lanthanum carbonate, Fosrenol, C6H15La3O18

Overview

Lanthanum carbonate is a synthetic, non-naturally occurring compound primarily used as a phosphate binder in the management of hyperphosphatemia, a common complication in patients with chronic kidney disease (CKD), especially those undergoing dialysis. It functions by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption into the bloodstream and thereby reducing serum phosphate levels. Lanthanum carbonate is available in chewable tablet form, which enhances its effectiveness by ensuring thorough mixing with food during digestion. Research on lanthanum carbonate is mature, with numerous clinical trials and meta-analyses supporting its efficacy and safety. The available evidence is generally of high quality, providing robust data on its role in managing hyperphosphatemia and related complications in CKD patients. It is considered a first-line treatment option for controlling phosphate levels and preventing vascular calcification.

Benefits

Lanthanum carbonate effectively reduces serum phosphate levels in CKD patients, which is crucial for managing hyperphosphatemia. Studies indicate that it may also reduce vascular calcification and improve bone outcomes compared to calcium-based phosphate binders. A systematic review and meta-analysis of 11 trials involving 1,501 participants showed that lanthanum carbonate has a beneficial effect on bone outcomes and a lower incidence of hypercalcemia compared to calcium-based binders. These benefits can typically be observed within weeks to months of treatment initiation, depending on the dose and individual patient response. It is particularly beneficial for CKD patients at risk of vascular calcification and bone disease.

How it works

Lanthanum carbonate acts by binding to dietary phosphate within the gastrointestinal tract. This binding action prevents the absorption of phosphate into the bloodstream. Because lanthanum carbonate is not absorbed systemically, its effects are localized to the GI tract, where it forms insoluble lanthanum phosphate complexes that are then excreted in the feces. The primary target of lanthanum carbonate is dietary phosphate, and its mechanism of action primarily affects the gastrointestinal and renal systems by reducing phosphate absorption. This helps to maintain serum phosphate levels within the normal range, preventing complications associated with hyperphosphatemia.

Side effects

Lanthanum carbonate is generally considered safe for use in CKD patients, with a relatively favorable side effect profile compared to some other phosphate binders. The most common side effects, occurring in more than 5% of patients, are gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Uncommon side effects, affecting 1-5% of patients, include abdominal pain and dyspepsia. Serious adverse effects are rare, occurring in less than 1% of patients, but may include allergic reactions. Lanthanum carbonate should be used cautiously with other medications that affect the gastrointestinal tract. It is contraindicated in patients with acute gastrointestinal conditions or those who cannot swallow tablets whole. Use with caution in pregnant or breastfeeding women due to limited data. Patients should be monitored for persistent gastrointestinal symptoms, and the dosage should be adjusted accordingly.

Dosage

The typical starting dose of lanthanum carbonate is 250-500 mg per meal, adjusted based on serum phosphate levels, usually up to a maximum of 3000 mg per day. It is crucial to take lanthanum carbonate with meals to maximize phosphate binding. The medication is available in chewable tablets to facilitate use. Since lanthanum carbonate is not absorbed systemically, it acts locally in the GI tract. The dosage should be individualized based on the patient's response and serum phosphate levels, with regular monitoring to ensure optimal control. The maximum safe dose generally should not exceed 3000 mg per day.

FAQs

How should I take Lanthanum carbonate?

Take Lanthanum carbonate with meals to maximize its effectiveness in binding dietary phosphate. Chew the tablets thoroughly before swallowing to ensure proper action and optimal phosphate binding.

Is Lanthanum carbonate safe?

Lanthanum carbonate is generally safe but may cause gastrointestinal side effects such as nausea, vomiting, or diarrhea. Report any persistent or severe side effects to your healthcare provider.

When should I expect to see results?

You should expect to see a reduction in serum phosphate levels within a few weeks of starting Lanthanum carbonate, provided you take it consistently with meals as prescribed.

Does Lanthanum carbonate get absorbed into my bloodstream?

No, Lanthanum carbonate is not absorbed into the bloodstream. It works locally in the gastrointestinal tract to bind phosphate and is then excreted in the feces.

Research Sources

https://pubmed.ncbi.nlm.nih.gov/25399356/ – A systematic review and meta-analysis of 11 trials with 1,501 participants found that lanthanum carbonate reduces vascular calcification and has a beneficial effect on bone outcomes with a lower incidence of hypercalcemia compared to calcium-based binders. The study highlights the potential benefits of lanthanum carbonate in managing hyperphosphatemia and related complications in chronic kidney disease patients.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8491672/ – A systematic review and meta-analysis including 26 RCTs and 3 observational studies showed that lanthanum carbonate is effective in controlling serum phosphorus levels and reducing adverse effects compared to other phosphate binders. The study provides robust evidence supporting the efficacy and safety of lanthanum carbonate in managing hyperphosphatemia in CKD patients.
https://karger.com/bpu/article/52/7-8/609/854797/Comparative-Efficacy-and-Acceptability-of-12 – This systematic review and network meta-analysis of 94 trials with 14,459 participants highlights the importance of phosphate binders in CKD management. While not specifically focused on lanthanum carbonate, the study provides a broader context for understanding the role of different phosphate binders in controlling serum phosphorus levels.