Makindo Medical Notes

💊 Lanthanum carbonate is a non-calcium, non-aluminium phosphate binder used to control serum phosphate in patients with chronic kidney disease (CKD). It reduces the risk of vascular calcification compared to calcium-based binders.

📖 About

• Always check the BNF link here for up-to-date prescribing guidance.
• Used when dietary phosphate restriction alone is insufficient.

⚙️ Mode of Action

• Lanthanum binds dietary phosphate in the gastrointestinal tract, forming insoluble complexes that are excreted in faeces, thereby lowering serum phosphate.

🎯 Indications

• Hyperphosphataemia in patients with CKD on haemodialysis or CAPD (continuous ambulatory peritoneal dialysis).
• Hyperphosphataemia in CKD patients not on dialysis with serum phosphate >1.78 mmol/L despite low-phosphate diet.

💊 Dose

• Initial: 1.5–3 g daily in divided doses with or immediately after meals.
• Adjust every 2–3 weeks according to serum phosphate levels.
• Maximum dose often limited by gastrointestinal tolerance rather than efficacy.

⚠️ Interactions

• Lanthanum decreases absorption of Ciprofloxacin — give ciprofloxacin at least 2 hours before or after lanthanum.
• Minimal systemic absorption; few drug–drug interactions compared to aluminium/calcium binders.

🚫 Contraindications

• Gastrointestinal obstruction, ileus, or severe bowel disease (risk of complications).

🤒 Side Effects

• GI upset most common: constipation, diarrhoea, abdominal pain, nausea, vomiting.
• Headache, dizziness, electrolyte disturbances (rare).
• Lanthanum is minimally absorbed, so systemic toxicity is rare.

💡 Pearls

• Preferred over aluminium-based binders (avoids aluminium toxicity) and calcium-based binders (less vascular calcification risk).
• Chewable tablets must be chewed thoroughly to be effective.
• Monitor serum phosphate and calcium regularly in CKD patients.
• Part of “mineral bone disorder” management in CKD, alongside vitamin D analogues and parathyroid hormone control.

📚 References

• Lanthanum in the BNF
• National Kidney Foundation – Phosphate Control