Fosrenol (Lanthanum Carbonate) is a non-absorbable medicine that forms insoluble complexes with dietary phosphate in the gastrointestinal tract.

Lanthanum Carbonate (Fosrenol) Uses:

• To reduce the serum Phosphate levels:

  • It is indicated in the treatment of hyperphosphatemia in patients with ESRD (end-stage renal disease).

Lanthanum Carbonate dosage in Adults:

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

• Lanthanum Carbonate 1,500 mg orally daily in divided doses with meals or immediately after a meal.
• The dose is increased in increments of 750 mg daily every 2 to 3 weeks to achieve the target serum phosphate level of less than 6 mg/dL (1.92 mmol/L)
• The usual dose ranges from 1,500 to 3,000 mg daily.
• A maximum dose of up to 4,500 mg per day has been evaluated.

Lanthanum carbonate use in children:

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

Fosrenol Pregnancy Risk Factor C

• Pregnancy is not recommended for Lanthanum Carbonate. Studies on animal reproduction have shown that a negative effect on fetal health has been observed.
• Its effects on the absorption and utilization of vitamins and nutrients are not known.

Use of lanthanum carbonate during breastfeeding

• It is unknown if the drug will be excreted into breastmilk.
• It is important to consider the possibility of drug exposure for infants.

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):

• Bowel obstruction
• Impaction of the fecal feces
• Ileus
• Hypophosphatemia
• Allergy reactions to any component of the drug or the drug itself

Warnings and precautions

• Gastrointestinal obstruction:
  • Patients with certain risk factors are more likely to experience serious gastrointestinal adverse effects from the use of lanthanum Carbonate.
  • These are some of the risk factors for adverse events related to GI.
    • Peritonitis, diverticular diseases, GI ulcers and a history GI surgery or cancers can all alter GI anatomy.
    • Disorders that affect the GI motility, such as constipation, diabetes, ileus and hypothyroidism, include diabetic gastroparesis and constipation.
    • Medications that reduce GI motility such as opioids andtricyclic anti-depressants.
  • These serious gastrointestinal issues could include:
    • Obstructive GI
    • Impaction of the fecal feces
    • Perforation of the GI
    • Ileus and subileus
  • Patients with unrelated GI-related adverse reactions should stop taking medication.
• Obstructive biliary:
  • The drug's elimination may be reduced in patients suffering from biliary obstruction and biliary disease. These patients should use caution when using the drug.
  • Hepatic impairment
    • Patients with severe liver disease may have difficulty eliminating the drug.
    • Patients with liver disease should use it with caution.

Lanthanum carbonate: Drug Interaction

Monitor:

• Serum calcium, phosphorus, and parathyroid hormone levels (PTH) as indicated.
• The frequency of monitoring depends on the stage of the kidney disease, the severity of the disease, associated complications (the level of pre-treatment phosphate and calcium levels), and the use of treatment for kidney disease-mineral and bone disorder

  • CKD stage G3a to G3b:

    • Monitor serum calcium and phosphate levels every 6 to 12 months.
    • PTH monitoring depends on the baseline PTH level and progression of CKD

  • CKD stage G4:

    • Monitor serum calcium and phosphate levels every 3 - 6 months
    • Monitor PTH levels every 6 - 12 months.

  • CKD stage G5 and G5D:

    • Monitor serum calcium and phosphate levels every 1 to 3 months
    • Monitor PTH levels every 3 to 6 months.

How to administer Lanthanum carbonate (Fosrenol)?

It should be administered with meals or immediately after a meal.

Chewable tablet:

• The chewable tablets should not be swallowed whole and chewed completely before it is swallowed.
• It can also be crushed to be easily chewed. Serious gastrointestinal side effects may occur if the tablet is not completely chewed.

Oral powder:

• The powder should be sprinkled over food or applesauce (but not liquid) and immediately administered.
• The mixture should not be stored for future use.

Mechanism of action of Lanthanum carbonate (Fosrenol):

• It blocks the absorption of dietary potassium by binding to it, making insoluble complexes with lanthanum-phosphate.
• It first forms lanthanum, carbonate, and then complexes with calcium and phosphates, decreasing both serum and total phosphate levels.

Absorption: <0.002%

Protein binding: >99% Metabolism: It is not metabolized The half-life elimination in the plasma is 53 hours and in the bones is 2-3.6 years

Excretion: Feces primarily; urine <2%

International Brands of Lanthanum carbonate:

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

Lanthanum carbonate Brand Names in Pakistan:

No Brands Available in Pakistan.