lanthanum carbonate hydrate: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
lanthanum carbonate hydrate: clinical details
Prescribing considerations
- Restricted to adults in the selected UK licences; paediatric safety and efficacy are not established.
- Assess gastrointestinal anatomy, motility, constipation, previous gastrointestinal surgery, ulceration, peritonitis and medicines that reduce gut motility.
- Review carefully where biliary flow is markedly reduced because absorbed lanthanum is principally eliminated through the liver and bile.
- Lanthanum may produce a radiopaque appearance on abdominal X-rays.
Contraindications and cautions
- Hypersensitivity to lanthanum carbonate hydrate or product excipients
- Hypophosphataemia
- Bowel obstruction
Monitoring
- Serum phosphate for effectiveness and detection of hypophosphataemia
- Serum calcium because hypocalcaemia can occur and the product contains no calcium
- Liver function where clinically appropriate, particularly with impaired biliary elimination
- TSH more closely when used with levothyroxine
- New constipation, abdominal pain or distension and other signs of gastrointestinal obstruction
Clinical pharmacology
Lanthanum carbonate dissociates in gastric acid; released lanthanum binds dietary phosphate to form poorly soluble lanthanum phosphate. Oral bioavailability is extremely low, it is not metabolised, and absorbed lanthanum is eliminated mainly in faeces through biliary and intestinal routes.
Formulation and product differences
- Chewable tablets must be chewed completely and may be crushed; swallowing them whole has been associated with serious gastrointestinal complications.
- Oral powder is intended for immediate mixing with a small amount of soft food and must not be dissolved in liquid or stored after mixing.
- The selected oral powder contains dextrates with glucose; excipients differ between products.
lanthanum carbonate hydrate preparations and strengths
Chewable tablet
Route: Oral
Strengths: 500 mg, 750 mg, 1000 mg
lanthanum carbonate hydrate interactions
Lanthanum can bind other medicines or alter their absorption. Ask a pharmacist how to separate them.
Ciprofloxacin and other oral fluoroquinolones
Lanthanum can substantially reduce antibiotic absorption, so they must not be taken together.
Tetracycline antibiotics, including doxycycline
Binding in the gut may reduce antibiotic absorption; separate administration is recommended.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.