Lanthanum carbonate
Phosphate binders
Phosphate binders
A calcium-free phosphate binder, chewed with meals, for high phosphate in end-stage kidney disease. It shows up on abdominal X-rays.
Quick facts
- Group
- Phosphate binders
- Target
- Dietary phosphate in the gut lumen (the drug acts locally and has no human receptor)
- Used for
- Lowering serum phosphate · Prevention of the mineral
- Key effects
- Nausea · Abdominal pain · Diarrhoea or constipation
- Monitor
- Serum phosphate and calcium · PTH
- ATC
- V03AE03
No doses: the clinician sets them by the current guideline.
Mechanism of action
In the acid of the stomach lanthanum carbonate releases lanthanum ions, which bind dietary phosphate tightly to form insoluble lanthanum phosphate. The complex is not absorbed and leaves in the stool, so less phosphate enters the blood and serum phosphate and the calcium-phosphate product fall.
- The chewed tablet releases lanthanum ions in the stomach
- Lanthanum binds phosphate from the meal
- Insoluble lanthanum phosphate leaves in the stool
- Serum phosphate and the calcium-phosphate product fall
Indications
- Lowering serum phosphate in end-stage kidney disease, with diet and dialysis Chronic kidney disease →
- Prevention of the mineral and bone disorder driven by high phosphate CKD-mineral and bone disorder (renal osteodystrophy) →
Adverse effects
Common
- Nausea, vomiting
- Abdominal pain, dyspepsia
- Diarrhoea or constipation
Contraindications
- Bowel obstruction, including ileus and faecal impaction
- Hypersensitivity to lanthanum carbonate or its ingredients
Key interactions
- Antacids with aluminium, magnesium or calcium
- Doses are separated by a few hours
- Fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin)
- Lower antibiotic absorption; the antibiotic is spaced from the binder
- Levothyroxine
- Lower absorption; doses are separated and TSH is watched
What is monitored
- Serum phosphate and calcium
- PTH
- Bowel habit and abdominal symptoms
- TSH in people on levothyroxine
Administration and safety
- Chewable tablets are chewed completely (or crushed) and never swallowed whole
- Taken with or right after meals
- The powder is sprinkled on a little soft food and taken at once, not mixed into liquid
- Radiology staff are told: the tablets are radio-opaque and can look like contrast on abdominal X-rays
Pregnancy and breastfeeding
Human data are insufficient; the label advises a non-lanthanum phosphate binder during pregnancy.
Nursing care
- Teach that the tablet must be chewed completely; swallowing it whole has caused obstruction
- Check that doses go with meals
- Watch for constipation, distension, severe abdominal pain or inability to pass gas
- Space quinolones, thyroid hormone and antacids as ordered
- Note lanthanum use on imaging requests
Pharmacokinetics
- Absorption
- Minimal; plasma levels are very low
- Distribution
- The small absorbed amount accumulates slowly in bone, liver and gut tissue with long use
- Metabolism
- Not metabolised
- Elimination
- Mainly in bile and stool, very little by the kidney
Test yourself
Think of the answer, then tap the question to see it.
What is the key administration rule for lanthanum chewable tablets?
They are chewed completely (or crushed) with or right after a meal; swallowing them whole has caused serious bowel complications.
Why should radiology know a patient takes lanthanum?
The tablets are radio-opaque and can look like contrast or foreign material on abdominal X-rays.
What is the main contraindication of lanthanum carbonate?
Bowel obstruction, including ileus and faecal impaction.
Connections
← Back to the class: Phosphate binders
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - LANTHANUM CARBONATE tablet, chewable (DailyMed (U.S. National Library of Medicine), 2026); Lanthanum: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.