Lanthanum carbonate is a non-calcium, non-aluminum phosphate binder indicated for the reduction of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis. It is a chewable tablet that binds dietary phosphate in the upper gastrointestinal tract, forming insoluble lanthanum phosphate complexes that are excreted in feces, thereby reducing serum phosphate and calcium-phosphate product.
Adult: Initial: 500 mg (one tablet) chewed with or immediately after each meal. Titrate based on serum phosphate levels. Usual therapeutic dose: 1500-3000 mg per day, divided and administered with meals. Doses up to 3750 mg/day have been used.
Note: CHEW TABLETS COMPLETELY BEFORE SWALLOWING. Do not swallow whole. Must be taken WITH or IMMEDIATELY AFTER food to bind dietary phosphate effectively. If a meal is missed, the corresponding dose should be omitted. Tablets can be crushed for patients with chewing difficulties. Maintain adequate interval (at least 2 hours) from other oral medications (especially tetracyclines, quinolones, levothyroxine) to prevent binding and reduced absorption.
Lanthanum carbonate dissociates in the acidic environment of the stomach, releasing lanthanum ions (La3+). These trivalent cations bind directly to dietary phosphate anions (PO4^3-) present in ingested food, forming highly insoluble lanthanum phosphate complexes (LaPO4). This complex is not absorbed and is excreted in the feces, thereby preventing the absorption of dietary phosphate and lowering serum phosphate levels.
Pregnancy: Category C. Animal studies have shown fetal toxicity. There are no adequate and well-controlled studies in pregnant women. Use only if the potential benefit justifies the potential risk to the fetus. Hyperphosphatemia in pregnancy is rare.
Driving: No known effects. Unlikely to impair ability to drive or operate machinery.
| Tetracycline antibiotics (Doxycycline, Tetracycline) | Lanthanum binds to tetracycline in GI tract, significantly reducing its absorption. | Major |
| Fluoroquinolone antibiotics (Ciprofloxacin, Levofloxacin) | Lanthanum binds to quinolones, reducing their absorption and efficacy. | Major |
| Levothyroxine | Lanthanum may bind to levothyroxine, reducing its absorption. | Major |
| ACE Inhibitors (e.g., Enalapril) | No direct interaction, but both can cause nausea/vomiting; additive GI effects possible. | Moderate |