Lanthanum carbonate.

Author(s): Joy MS, Kshirsagar A, Candiani C, Brooks T, Hudson JQ

Affiliation(s): School of Medicine, Division of Nephrology, University of North Carolina, Carolina Kidney Center, Chapel Hill, NC 27599-7155, USA. Melanie_Joy@med.unc.edu

Publication date & source: 2006-02, Ann Pharmacother., 40(2):234-40. Epub 2006 Jan 31.

Publication type: Review

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety profile of lanthanum carbonate, a phosphate binder for chronic kidney disease (CKD). DATA SOURCES: Information was selected from PubMed (1965-October 2005). All studies presented as scientific posters and abstracts from nephrology meetings from 1999 to 2005 were also included. STUDY SELECTION AND DATA EXTRACTION: All published articles regarding lanthanum carbonate were included. In addition, abstracts and presentations from scientific meeting symposia were also considered for inclusion. DATA SYNTHESIS: Lanthanum carbonate has been recently approved as non-calcium-based therapy for phosphate reduction in patients with stage 5 CKD requiring dialysis. The recommended dose is 250-500 mg with meals, for a maximum of 1500 mg daily. Clinical studies have shown short- and long-term safety with lanthanum carbonate administration. Adverse effects were primarily gastrointestinal in nature. Clinical trials have also shown reductions in serum phosphorus to target concentrations, reductions in associated calcium-phosphorus product, and minimal effects on serum calcium and parathyroid hormone concentrations. CONCLUSIONS: Lanthanum carbonate is an effective phosphate-binding agent without significant risk of hypercalcemia or worsening metabolic acidosis. Lanthanum carbonate is a safe and effective drug for reduction of elevated serum phosphorus levels associated with stage 5 CKD. The role of lanthanum carbonate relative to other phosphate-binding drugs, such as calcium salts and sevelamer, remains to be determined.