From the Guidelines
Lanthanum carbonate is a phosphate binder medication primarily used to treat hyperphosphatemia in patients with chronic kidney disease, particularly in those with progressive or persistent hyperphosphatemia, as indicated by the 2017 clinical practice guideline update 1. The use of lanthanum carbonate is supported by studies that suggest phosphate-lowering therapies may only be indicated in the event of progressive or persistent hyperphosphatemia, and not for prevention, as noted in the 2018 study published in the Annals of Internal Medicine 1. Some key points to consider when using lanthanum carbonate include:
- It is a calcium-free phosphate-binding agent, which may be beneficial compared to calcium-based agents in treating hyperphosphatemia, as suggested by the results of additional randomized controlled trials (RCTs) with hard end points 1.
- The medication works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption into the bloodstream, which is crucial for patients with kidney failure who cannot adequately excrete phosphate.
- Regular monitoring of serum phosphate levels is necessary to ensure effective dosing and to minimize the risk of adverse effects.
- Common side effects include nausea, vomiting, and abdominal pain, but lanthanum carbonate does not contain calcium or aluminum, reducing the risk of hypercalcemia or aluminum toxicity.
- The typical starting dose is 750-1500 mg daily divided into multiple doses, taken with meals, and can be titrated up to 3000 mg daily based on phosphate levels, although the exact dosing may vary depending on the patient's specific needs and response to treatment.
From the FDA Drug Label
The FDA drug label does not provide sufficient information to answer the question about the use of Lanthanum carbonate (lanthanum). The FDA drug label does not answer the question.
From the Research
Use of Lanthanum Carbonate
- Lanthanum carbonate is used as a phosphate binder to control serum phosphate levels in patients with chronic kidney disease (CKD) stages 3,4, and 5, including those undergoing dialysis 2, 3, 4, 5, 6.
- It is effective in reducing serum phosphate levels and is generally well-tolerated in patients with CKD 2, 3, 4, 5, 6.
- Lanthanum carbonate has been shown to be a highly effective phosphate binder in pre-clinical studies and has been compared to other phosphate binders such as sevelamer carbonate in clinical studies 2, 3, 4.
Mechanism of Action
- Lanthanum carbonate works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble complexes that are then excreted in the feces 5.
- This mechanism of action reduces the absorption of phosphate into the bloodstream, thereby lowering serum phosphate levels 5.
Efficacy and Safety
- Clinical studies have demonstrated the efficacy and safety of lanthanum carbonate in reducing serum phosphate levels in patients with CKD 2, 3, 4, 5, 6.
- Lanthanum carbonate has been associated with a lower risk of hypercalcemia and improved nutritional status compared to other phosphate binders 5.
- Common adverse effects of lanthanum carbonate include nausea, alkaline gastric reflux, and gastrointestinal obstruction 5.