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FORMULARY FORUM

Lanthanum Carbonate

Associate Professor, School of Medicine, Division of Nephrology, University of North Carolina; Carolina Kidney Center, Chapel Hill, NC

Abhijit Kshirsagar, MD

Assistant Professor, School of Medicine, Division of Nephrology, University of North Carolina; Carolina Kidney Center

Corina Candiani, MD

Research Associate, School of Medicine, Division of Nephrology, University of North Carolina; Carolina Kidney Center

Tyson Brooks, PharmD

Pharmacy Practice Resident, Methodist University Hospital, Memphis, TN

Joanna Q Hudson, PharmD BCPS

Associate Professor, College of Pharmacy, University of Tennessee, Memphis

Reprints: Dr. Joy, University of North Carolina, School of Medicine, Division of Nephrology, Carolina Kidney Center, CB #7155, 7005 Burnett Womack Bldg., Chapel Hill, NC 27599-7155, fax 919/966-4251, Melanie_Joy{at}med.unc.edu

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.

Key Words: chronic kidney failure, lanthanum carbonateA

Published Online, January 31, 2006. www.theannals.com, DOI 10.1345/aph.1G224

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