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Lanthanum Carbonate

PubChem CID
168924
Structure
Lanthanum Carbonate_small.png
Lanthanum Carbonate_3D_Structure.png
Molecular Formula
Synonyms
  • Lanthanum Carbonate
  • Foznol
  • 587-26-8
  • Phosbloc
  • Lanthanum sesquicarbonate
Molecular Weight
457.84 g/mol
Computed by PubChem 2.2 (PubChem release 2021.10.14)
Dates
  • Create:
    2005-08-08
  • Modify:
    2025-01-18
Description
Lanthanum carbonate is a phosphate binder marketed under the trade name Fosrenol by Shire Pharmaceuticals. It is a large pill that requires thorough chewing to avoid choking and other gastrointestinal adverse effects. It is used to treat elevated phosphate levels, primarily in patients with chronic kidney disease, by binding to dietary phosphate and preventing its absorption in the intestine.
Lanthanum Carbonate is the carbonate salt of lanthanum, a silvery white metallic element of the lanthanoids family, with phosphate binding property. Lanthanum carbonate dissociates in gastric acid to release lanthanum ions, which then binds dietary phosphate. This agent inhibits the absorption of phosphate by forming highly insoluble lanthanum-phosphate complexes that reduce concentrations of serum phosphate and calcium phosphate.
See also: Lanthanum cation (3+) (has active moiety); Dilanthanum tricarbonate (annotation moved to).

1 Structures

1.1 2D Structure

Chemical Structure Depiction
Lanthanum Carbonate.png

1.2 3D Conformer

3D Conformer of Parent

2 Names and Identifiers

2.1 Computed Descriptors

2.1.1 IUPAC Name

lanthanum(3+);tricarbonate
Computed by Lexichem TK 2.7.0 (PubChem release 2021.10.14)

2.1.2 InChI

InChI=1S/3CH2O3.2La/c3*2-1(3)4;;/h3*(H2,2,3,4);;/q;;;2*+3/p-6
Computed by InChI 1.0.6 (PubChem release 2021.10.14)

2.1.3 InChIKey

NZPIUJUFIFZSPW-UHFFFAOYSA-H
Computed by InChI 1.0.6 (PubChem release 2021.10.14)

2.1.4 SMILES

C(=O)([O-])[O-].C(=O)([O-])[O-].C(=O)([O-])[O-].[La+3].[La+3]
Computed by OEChem 2.3.0 (PubChem release 2024.12.12)

2.2 Molecular Formula

C3La2O9
Computed by PubChem 2.2 (PubChem release 2021.10.14)

2.3 Other Identifiers

2.3.1 CAS

587-26-8
54451-24-0
183309-52-6

2.3.2 Deprecated CAS

14475-16-2

2.3.3 European Community (EC) Number

2.3.4 UNII

2.3.5 DrugBank ID

2.3.6 DSSTox Substance ID

2.3.7 NCI Thesaurus Code

2.3.8 RXCUI

2.3.9 Wikidata

2.3.10 Wikipedia

2.4 Synonyms

2.4.1 MeSH Entry Terms

  • Fosrenol
  • lanthanum carbonate
  • lantharenol

2.4.2 Depositor-Supplied Synonyms

3 Chemical and Physical Properties

3.1 Computed Properties

Property Name
Molecular Weight
Property Value
457.84 g/mol
Reference
Computed by PubChem 2.2 (PubChem release 2021.10.14)
Property Name
Hydrogen Bond Donor Count
Property Value
0
Reference
Computed by Cactvs 3.4.8.18 (PubChem release 2021.10.14)
Property Name
Hydrogen Bond Acceptor Count
Property Value
9
Reference
Computed by Cactvs 3.4.8.18 (PubChem release 2021.10.14)
Property Name
Rotatable Bond Count
Property Value
0
Reference
Computed by Cactvs 3.4.8.18 (PubChem release 2021.10.14)
Property Name
Exact Mass
Property Value
457.76696 Da
Reference
Computed by PubChem 2.2 (PubChem release 2021.10.14)
Property Name
Monoisotopic Mass
Property Value
457.76696 Da
Reference
Computed by PubChem 2.2 (PubChem release 2021.10.14)
Property Name
Topological Polar Surface Area
Property Value
190 Ų
Reference
Computed by Cactvs 3.4.8.18 (PubChem release 2021.10.14)
Property Name
Heavy Atom Count
Property Value
14
Reference
Computed by PubChem
Property Name
Formal Charge
Property Value
0
Reference
Computed by PubChem
Property Name
Complexity
Property Value
18.8
Reference
Computed by Cactvs 3.4.8.18 (PubChem release 2021.10.14)
Property Name
Isotope Atom Count
Property Value
0
Reference
Computed by PubChem
Property Name
Defined Atom Stereocenter Count
Property Value
0
Reference
Computed by PubChem
Property Name
Undefined Atom Stereocenter Count
Property Value
0
Reference
Computed by PubChem
Property Name
Defined Bond Stereocenter Count
Property Value
0
Reference
Computed by PubChem
Property Name
Undefined Bond Stereocenter Count
Property Value
0
Reference
Computed by PubChem
Property Name
Covalently-Bonded Unit Count
Property Value
5
Reference
Computed by PubChem
Property Name
Compound Is Canonicalized
Property Value
Yes
Reference
Computed by PubChem (release 2021.10.14)

3.2 Experimental Properties

3.2.1 Physical Description

Dry Powder; Other Solid

3.2.2 Color / Form

White powder
Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 15th Edition. John Wiley & Sons, Inc. New York, NY 2007., p. 739

3.2.3 Solubility

Practically insoluble.
FDA Label
Soluble in acids
Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 15th Edition. John Wiley & Sons, Inc. New York, NY 2007., p. 739
Practically insoluble in water
Thomson Health Care Inc.; Physicians' Desk Reference 63 ed., Montvale, NJ 2009, p. 3027

3.2.4 Density

2.6
Lewis, R.J. Sr.; Hawley's Condensed Chemical Dictionary 15th Edition. John Wiley & Sons, Inc. New York, NY 2007., p. 739

3.3 Chemical Classes

3.3.1 Drugs

3.3.1.1 Human Drugs
Breast Feeding; Lactation
Human drug -> Prescription; Active ingredient (LANTHANUM CARBONATE)
Human drug -> Prescription; Discontinued

5 Chemical Vendors

6 Drug and Medication Information

6.1 Drug Indication

Lanthanum carbonate is indicated to reduce serum phosphate in patients with end-stage renal disease (ESRD).

6.2 Drug Classes

Breast Feeding; Lactation

6.3 FDA Medication Guides

Drug
Active Ingredient
LANTHANUM CARBONATE
Form;Route
POWDER;ORAL
Company
TAKEDA PHARMS USA
Date
08/29/2024
Drug
Active Ingredient
LANTHANUM CARBONATE
Form;Route
TABLET, CHEWABLE;ORAL
Company
TAKEDA PHARMS USA
Date
08/29/2024

6.4 FDA Approved Drugs

6.5 FDA Orange Book

6.6 FDA National Drug Code Directory

6.7 Drug Labels

Drug and label
Active ingredient and drug

6.8 Clinical Trials

6.8.1 ClinicalTrials.gov

6.8.2 EU Clinical Trials Register

6.8.3 NIPH Clinical Trials Search of Japan

6.9 Therapeutic Uses

Lanthanum; Kidney Failure, Chronic
National Library of Medicine's Medical Subject Headings online file (MeSH, 2009)
Lanthanum carbonate is indicated to reduce serum phosphate in patients with end stage renal disease. /Included in US product label/
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132

6.10 Drug Warnings

Adverse effects reported in 5% or more of patients receiving lanthanum carbonate and more frequently than with placebo include nausea, vomiting, dialysis graft occlusion, and abdominal pain.
American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2755
Patients with acute peptic ulcer, ulcerative colitis, Crohn's disease or bowel obstruction were not included in lanthanum carbonate clinical studies. Caution should be used in patients with these conditions.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
While growth abnormalities were not identified in long-term animal studies, lanthanum was deposited into developing bone including growth plate. The consequences of such deposition in developing bone in pediatric patients are unknown. Therefore, the use of lanthanum carbonate in this population is not recommended.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
/Patients taking lanthanum carbonate should be advised of the/ importance of taking lanthanum carbonate with or immediately after meals.
American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2755
For more Drug Warnings (Complete) data for Lanthanum Carbonate (9 total), please visit the HSDB record page.

6.11 Drug Tolerance

In clinical trials, daily doses up to 4718 mg/day of lanthanum were well tolerated in healthy adults when administered with food, with the exception of GI symptoms.
Fosrenol Product Insert, Shire US Inc. Available from, as of 8/28/2009. www.pdr.net

7 Pharmacology and Biochemistry

7.1 Pharmacodynamics

In vitro studies have shown that lanthanum binds phosphate in the physiologically relevant pH range of 3 to 7 - in simulated gastric fluid, lanthanum binds approximately 97% of the available phosphate at pH 3-5 and 67% at pH 7, when lanthanum is present in a two-fold molar excess to phosphate. Bile acids have not been shown to affect the phosphate binding affinity of lanthanum. In order to bind dietary phosphate, lanthanum carbonate must be administered with or immediately after meals. In comparison to [sevelemer], another common phosphate binder, lanthanum carbonate is more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia.

7.2 FDA Pharmacological Classification

Non-Proprietary Name
LANTHANUM CARBONATE
Pharmacological Classes
Phosphate Binder [EPC]; Phosphate Chelating Activity [MoA]

7.3 ATC Code

V - Various

V03 - All other therapeutic products

V03A - All other therapeutic products

V03AE - Drugs for treatment of hyperkalemia and hyperphosphatemia

V03AE03 - Lanthanum carbonate

7.4 Absorption, Distribution and Excretion

Absorption
The bioavailability of lanthanum carbonate following oral administration is exceedingly low (<0.002%), with a mean Cmax of 1.0 ng/mL and average serum concentration of 0.6 ng/mL. The timing of food intake relative to lanthanum administration (during and 30 minutes after food intake) has a negligible effect on the systemic level of lanthanum.
Route of Elimination
No information is available regarding the mass balance of lanthanum in humans after oral administration. In rats and dogs, the mean recovery of lanthanum after an oral dose was about 99% and 94%, respectively, and was essentially all from feces. Biliary excretion is the predominant route of elimination for circulating lanthanum in rats.
Clearance
In healthy volunteers administered intravenous lanthanum as the soluble chloride salt (120 μg), renal clearance was less than 2% of total plasma clearance.
Lanthanum is minimally absorbed from the GI tract following oral administration; bioavailability is less than 0.002%. In patients receiving therapeutic dosages of lanthanum for up to 2 years, mean plasma concentrations of the drug remained low (ie, 1.1 ng/mL or less).
American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2755
Following single or multiple dose oral administration of lanthanum carbonate to healthy subjects, the concentration of lanthanum in plasma was very low. Following oral administration in ESRD patients, the mean lanthanum Cmax was 1.0 ng/mL. During long-term administration (52 weeks) in ESRD patients, the mean lanthanum concentration in plasma was approximately 0.6 ng/mL. There was minimal increase in plasma lanthanum concentrations with increasing doses within the therapeutic dose range. The effect of food on the bioavailability of lanthanum carbonate has not been evaluated, but the timing of food intake relative to lanthanum administration (during and 30 minutes after food intake) has a negligible effect on the systemic level of lanthanum
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
In vitro, lanthanum is highly bound (>99%) to human plasma proteins, including human serum albumin, alpha1-acid glycoprotein, and transferrin. Binding to erythrocytes in vivo is negligible in rats.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
In studies in mice, rats and dogs, lanthanum concentrations in many tissues increased over time and were several orders of magnitude higher than plasma concentrations (particularly in the GI tract, bone and liver). Steady state tissue concentrations in bone and liver were achieved in dogs between 4 and 26 weeks. Relatively high levels of lanthanum remained in these tissues for longer than 6 months after cessation of dosing in dogs. There is no evidence from animal studies that lanthanum crosses the blood-brain barrier.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
For more Absorption, Distribution and Excretion (Complete) data for Lanthanum Carbonate (13 total), please visit the HSDB record page.

7.5 Metabolism / Metabolites

Lanthanum does not undergo metabolism.
Lanthanum is not metabolized and is not a substrate of CYP450. In vitro metabolic inhibition studies showed that lanthanum at concentrations of 10 and 40 ug/mL does not have relevant inhibitory effects on any of the CYP450 isoenzymes tested (1A2, 2C9/10, 2C19, 2D6, and 3A4/5).
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132

7.6 Biological Half-Life

The elimination half-life of lanthanum in patients undergoing dialysis was 53 hours following discontinuation of therapy.
Lanthanum was cleared from plasma following discontinuation of therapy with an elimination half-life 53 hours.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
... Estimates of elimination half-life from bone ranged from 2.0 to 3.6 years.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132

7.7 Mechanism of Action

Lanthanum carbonate is a phosphate binder that reduces absorption of phosphate by forming insoluble lanthanum phosphate complexes that pass through the gastrointestinal (GI) tract unabsorbed. Both serum phosphate and calcium phosphate product are reduced as a consequence of the reduced dietary phosphate absorption.
Lanthanum carbonate dissociates in the acid environment of the upper GI tract to release lanthanum ions that bind dietary phosphate released from food during digestion. Lanthanum carbonate inhibits absorption of phosphate by forming highly insoluble lanthanum phosphate complexes, consequently reducing both serum phosphate and calcium phosphate product.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
The carbonate salt of lanthanum is practically insoluble in water but dissociates in the acidic environment of the upper GI tract to release trivalent lanthanum ions, which bind dietary phosphates released during digestion, thereby forming highly insoluble lanthanum phosphate complexes. Consequently, phosphate absorption, serum phosphorus concentrations, and serum calcium times phosphorus product (Ca X P) are reduced. Lanthanum ions have a high affinity for phosphate; in vitro studies indicate that when lanthanum is present at pH 3-5 (pH corresponding to that of gastric fluid) in twofold molar excess to phosphates, the drug binds about 97% of available phosphates.
American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2755

8 Use and Manufacturing

8.1 Uses

THERAPEUTIC CATEGORY: Treatment of hyperphosphatemia
O'Neil, M.J. (ed.). The Merck Index - An Encyclopedia of Chemicals, Drugs, and Biologicals. Whitehouse Station, NJ: Merck and Co., Inc., 2006., p. 930
MEDICATION

8.1.1 Use Classification

Human Drugs -> FDA Approved Drug Products with Therapeutic Equivalence Evaluations (Orange Book) -> Active Ingredients

8.1.2 Industry Uses

  • Catalyst
  • Intermediate

8.2 Formulations / Preparations

Formulations: (AHFS, 2009)

Table: Formulations: (AHFS, 2009)

Route of administration
Oral
Dosage Form
Tablets, chewable
Strength
250 mg (of lanthanum)
Brand (Manufacturer)
Fosrenol (Shire)
Route of administration
Oral
Dosage Form
Tablets, chewable
Strength
500 mg (of lanthanum)
Brand (Manufacturer)
Fosrenol (Shire)
Route of administration
Oral
Dosage Form
Tablets, chewable
Strength
750 mg (of lanthanum)
Brand (Manufacturer)
Fosrenol (Shire)
Route of administration
Oral
Dosage Form
Tablets, chewable
Strength
1 g (of lanthanum)
Brand (Manufacturer)
Fosrenol (Shire)

American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2756

8.3 U.S. Production

Aggregated Product Volume

2019: <1,000,000 lb

2018: <1,000,000 lb

2017: <1,000,000 lb

2016: <1,000,000 lb

Production volumes for non-confidential chemicals reported under the Inventory Update Rule.
Year
1986
Production Range (pounds)
10 thousand - 500 thousand
Year
1990
Production Range (pounds)
No Reports
Year
1994
Production Range (pounds)
No Reports
Year
1998
Production Range (pounds)
>1 million - 10 million
Year
2002
Production Range (pounds)
10 thousand - 500 thousand
US EPA; Non-confidential Production Volume Information Submitted by Companies for Chemicals Under the 1986-2002 Inventory Update Rule (IUR). Carbonic acid, lanthanum(3+) salt (3:2) (587-26-8). Available from, as of July 29, 2009: https://www.epa.gov/oppt/iur/tools/data/2002-vol.html
Production volumes for non-confidential chemicals reported under the Inventory Update Rule.
Year
2006
Aggregated National Production Volume
1 to <10 million lbs
US EPA; Non-Confidential 2006 Inventory Update Reporting. National Chemical Information. Carbonic acid, lanthanum(3+) salt (3:2) (587-26-8). Available from, as of July 29, 2009: https://cfpub.epa.gov/iursearch/index.cfm?s=chem&err=t

8.4 General Manufacturing Information

Industry Processing Sectors
  • Petroleum Refineries
  • All Other Basic Inorganic Chemical Manufacturing
  • Petrochemical Manufacturing
EPA TSCA Commercial Activity Status
Carbonic acid, lanthanum(3+) salt (3:2): ACTIVE

9 Safety and Hazards

9.1 Hazards Identification

9.1.1 GHS Classification

1 of 2
View All
Note
Pictograms displayed are for 93.6% (44 of 47) of reports that indicate hazard statements. This chemical does not meet GHS hazard criteria for 6.4% (3 of 47) of reports.
Pictogram(s)
Irritant
Signal
Warning
GHS Hazard Statements

H315 (93.6%): Causes skin irritation [Warning Skin corrosion/irritation]

H319 (93.6%): Causes serious eye irritation [Warning Serious eye damage/eye irritation]

H335 (93.6%): May cause respiratory irritation [Warning Specific target organ toxicity, single exposure; Respiratory tract irritation]

Precautionary Statement Codes

P261, P264, P264+P265, P271, P280, P302+P352, P304+P340, P305+P351+P338, P319, P321, P332+P317, P337+P317, P362+P364, P403+P233, P405, and P501

(The corresponding statement to each P-code can be found at the GHS Classification page.)

ECHA C&L Notifications Summary

Aggregated GHS information provided per 47 reports by companies from 5 notifications to the ECHA C&L Inventory. Each notification may be associated with multiple companies.

Reported as not meeting GHS hazard criteria per 3 of 47 reports by companies. For more detailed information, please visit ECHA C&L website.

There are 4 notifications provided by 44 of 47 reports by companies with hazard statement code(s).

Information may vary between notifications depending on impurities, additives, and other factors. The percentage value in parenthesis indicates the notified classification ratio from companies that provide hazard codes. Only hazard codes with percentage values above 10% are shown.

9.1.2 Hazard Classes and Categories

Skin Irrit. 2 (93.6%)

Eye Irrit. 2 (93.6%)

STOT SE 3 (93.6%)

9.2 Accidental Release Measures

9.2.1 Disposal Methods

SRP: At the time of review, criteria for land treatment or burial (sanitary landfill) disposal practices are subject to significant revision. Prior to implementing land disposal of waste residue (including waste sludge), consult with environmental regulatory agencies for guidance on acceptable disposal practices.

9.3 Handling and Storage

9.3.1 Storage Conditions

Store at 25 °C (77 °F): excursions permitted to 15-30 °C (59-86 °F)
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132

9.4 Regulatory Information

9.4.1 FDA Requirements

The Approved Drug Products with Therapeutic Equivalence Evaluations List identifies currently marketed prescription drug products, incl lanthanum carbonate, approved on the basis of safety and effectiveness by FDA under sections 505 of the Federal Food, Drug, and Cosmetic Act.
DHHS/FDA; Electronic Orange Book-Approved Drug Products with Therapeutic Equivalence Evaluations. Available from, as of July 9, 2009: https://www.accessdata.fda.gov/scripts/cder/ob/docs/queryai.cfm

10 Toxicity

10.1 Toxicological Information

10.1.1 Drug Induced Liver Injury

Compound
lanthanum carbonate
DILI Annotation
No-DILI-Concern
Label Section
No match
References

M Chen, V Vijay, Q Shi, Z Liu, H Fang, W Tong. FDA-Approved Drug Labeling for the Study of Drug-Induced Liver Injury, Drug Discovery Today, 16(15-16):697-703, 2011. PMID:21624500 DOI:10.1016/j.drudis.2011.05.007

M Chen, A Suzuki, S Thakkar, K Yu, C Hu, W Tong. DILIrank: the largest reference drug list ranked by the risk for developing drug-induced liver injury in humans. Drug Discov Today 2016, 21(4): 648-653. PMID:26948801 DOI:10.1016/j.drudis.2016.02.015

10.1.2 Effects During Pregnancy and Lactation

◉ Summary of Use during Lactation

No information is available on the use of lanthanum carbonate during breastfeeding in humans. In animal studies, lanthanum was deposited in the bones of juvenile animals. Lanthanum carbonate should not be used in nursing mothers. An alternate drug is recommended.

◉ Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

◉ Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

10.1.3 Interactions

Drugs known to interact with antacids should not be administered within 2 hours of a lanthanum carbonate dose. Potential pharmacokinetic interaction (insoluble complex formation).
American Society of Health System Pharmacists; AHFS Drug Information 2009. Bethesda, MD. (2009), p. 2755
... Twelve patients randomly received in a crossover manner a single oral dose of ciprofloxacin 750 mg alone and plus lanthanum carbonate 1 g three times daily with meals for six doses, with a washout interval of 7 to 14 d. Serial blood and urine samples were collected for 24 hr after ciprofloxacin administration, and ciprofloxacin concentrations were determined using reverse-phase HPLC. Pharmacokinetic parameters of ciprofloxacin were calculated by noncompartmental methods, and the effect of lanthanum on ciprofloxacin pharmacokinetic parameters was assessed using ANOVA. Lanthanum decreased (P < 0.001) the mean ciprofloxacin area under the plasma concentration-time curve by 54% and the maximum plasma concentration by 56%. The 24-hr urinary recovery of ciprofloxacin was reduced by 52% by lanthanum (P < 0.001). No statistically significant differences in ciprofloxacin time to maximum plasma concentration, elimination half-life, and renal clearance occurred between the two arms. Lanthanum carbonate significantly reduces the systemic exposure to orally administered ciprofloxacin. Concomitant administration of both drugs should be avoided to prevent possible suboptimal response to ciprofloxacin.
How PP et al; Clin J Am Soc Nephrol 2 (6): 1235-40 (2007).

10.1.4 Antidote and Emergency Treatment

/SRP:/ Immediate first aid: Ensure that adequate decontamination has been carried out. If patient is not breathing, start artificial respiration, preferably with a demand valve resuscitator, bag-valve-mask device, or pocket mask, as trained. Perform CPR if necessary. Immediately flush contaminated eyes with gently flowing water. Do not induce vomiting. If vomiting occurs, lean patient forward or place on the left side (head-down position, if possible) to maintain an open airway and prevent aspiration. Keep patient quiet and maintain normal body temperature. Obtain medical attention. /Poisons A and B/
Currance, P.L. Clements, B., Bronstein, A.C. (Eds).; Emergency Care For Hazardous Materials Exposure. 3Rd edition, Elsevier Mosby, St. Louis, MO 2005, p. 160
/SRP:/ Basic treatment: Establish a patent airway (oropharyngeal or nasopharyngeal airway, if needed). Suction if necessary. Watch for signs of respiratory insufficiency and assist ventilations if needed. Administer oxygen by nonrebreather mask at 10 to 15 L/min. Monitor for pulmonary edema and treat if necessary ... . Monitor for shock and treat if necessary ... . Anticipate seizures and treat if necessary ... . For eye contamination, flush eyes immediately with water. Irrigate each eye continuously with 0.9% saline (NS) during transport ... . Do not use emetics. For ingestion, rinse mouth and administer 5 mL/kg up to 200 mL of water for dilution if the patient can swallow, has a strong gag reflex, and does not drool ... . Cover skin burns with dry sterile dressings after decontamination ... . /Poisons A and B/
Currance, P.L. Clements, B., Bronstein, A.C. (Eds).; Emergency Care For Hazardous Materials Exposure. 3Rd edition, Elsevier Mosby, St. Louis, MO 2005, p. 160
/SRP:/ Advanced treatment: Consider orotracheal or nasotracheal intubation for airway control in the patient who is unconscious, has severe pulmonary edema, or is in severe respiratory distress. Positive-pressure ventilation techniques with a bag valve mask device may be beneficial. Consider drug therapy for pulmonary edema ... . Consider administering a beta agonist such as albuterol for severe bronchospasm ... . Monitor cardiac rhythm and treat arrhythmias as necessary ... . Start IV administration of D5W /SRP: "To keep open", minimal flow rate/. Use 0.9% saline (NS) or lactated Ringer's if signs of hypovolemia are present. For hypotension with signs of hypovolemia, administer fluid cautiously. Watch for signs of fluid overload ... . Treat seizures with diazepam or lorazepam ... . Use proparacaine hydrochloride to assist eye irrigation ... . /Poisons A and B/
Currance, P.L. Clements, B., Bronstein, A.C. (Eds).; Emergency Care For Hazardous Materials Exposure. 3Rd edition, Elsevier Mosby, St. Louis, MO 2005, p. 160-1

10.1.5 Human Toxicity Excerpts

/CASE REPORTS/ A 75-year-old woman was admitted with febrile confusion and abdominal pain. She was taking medications that included lanthanum carbonate. Examination, biology, a cerebral scan, and a review of her medications could not explain the confusion. The plain film of the abdomen revealed multiple diffuse calcium-like deposits throughout the digestive tract. The plasma levels of lanthanum were higher than normal. The confusion resolved after discontinuation of the lanthanum carbonate. This case raises the problem of the potential role played by lanthanum tablet residue in the genesis or aggravation of diverticular flare-up and the problem of the potential permeability of the blood-brain barrier with lanthanum use in case of its digestive accumulation, leading to increased serum concentrations.
Muller C et al; Nephrol Dial Transplant 24 (10): 3245-7 (2009).
/CASE REPORTS/ ... A 77-year-old man was admitted to a hospital for renal failure caused by complete obstructive ureterolithiasis in the solitary kidney. Hemodialysis was indicated due to elevated renal parameters (urea 28.0 mmol/L, serum creatinine 1079 umol/L, phosphorus 2.45 mmol/L). Treatment with lanthanum carbonate was started in order to normalize serum phosphate levels. Surgical treatment of ureteral obstruction was necessary but the patient presented with hemodynamically significant supraventricular tachycardia. The ECG proved atrial flutter that was the indication to electrical cardioversion by cardiologists. Therefore, transesophageal echocardiography had to be carried out to exclude intracardial thrombi; these were not detected. The echocardiography also demonstrated an inexplicable finding on the thoracic aorta, and thus, computed tomography of the aorta was performed. The CT scan did not reveal any significant pathology of the aorta. However, a high-contrast substance of unknown origin and significance was captured in the stomach. /Investigators/ performed an X-ray of lanthanum pills in a vial and detected the radio-opacity of lanthanum itself, even without calcium and phosphate. This confirmed our suspicion that the high-contrast metallic-like substance in the stomach was a tablet of lanthanum. ...
Pafcugova J et al; Nephrol Dial Transplant 23 (5): 1776-7 (2008).
/EPIDEMIOLOGY STUDIES/ A specified subset of data from four Phase III clinical trials and subsequent extension studies is presented, in order to assess the effects of lanthanum carbonate on the liver. Hepatic biochemical tests for alanine transaminase, aspartate aminotransferase, alkaline phosphatase and bilirubin were performed. Adverse events classified as "liver and biliary system events" were recorded. In the four initial clinical trials, lanthanum carbonate was not associated with any adverse changes in transaminases or bilirubin. The incidence and nature of adverse events associated with the liver during lanthanum carbonate treatment was similar to that in the comparator groups. For patients who enrolled into the subsequent long-term follow-up study (up to 6 years of treatment), changes in transaminases were not clinically relevant and mean values were similar to those observed in the earlier trials. Overall, there was no increase in the incidence of adverse events associated with the liver reported after up to 6 years of treatment when compared with the results of the initial studies. There was no evidence of adverse effects of lanthanum carbonate on the liver in patients who received treatment for up to 6 years.
Hutchison AJ et al; Clin Nephrol 71 (3): 286-95 (2009).

10.1.6 Non-Human Toxicity Excerpts

/LABORATORY ANIMALS: Subchronic or Prechronic Exposure/ ... The aim of this study was to determine whether long-term lanthanum exposure results in persistent alternations in nervous system function. Wistar rats were exposed to lanthanum chloride (LaCl(3)) through oral administration at 0, 0.1, 2 and 40mg/kg concentration from 4 weeks through 6 months of age. Morris water maze test showed that lanthanum exposure at 40mg/kg could significantly impair the behavioral performance. To fully investigate the neurotoxicological consequence of lanthanum exposure, brain elemental distributions and neurochemicals were also investigated. The distributions of brain elements such as Ca, Fe and Zn were significantly altered after lanthanum exposure. Moreover, 40mg/kg LaCl(3) significantly inhibited the activity of Ca(2+)-ATPase; the function of the central cholinergic system was also noticeably disturbed and the contents of some monoamines neurotransmitters were significantly decreased. These findings indicate that chronic exposure to lanthanum could possibly impair the learning ability and this deficit may be possibly attributed to the disturbance of the homeostasis of trace elements, enzymes and neurotransmitter systems in brain. ... /Lanthanum chloride/
Feng L et al; Toxicol Lett 165 (2): 112-20 (2006).
/LABORATORY ANIMALS: Chronic Exposure or Carcinogenicity/ Oral administration of lanthanum carbonate to rats for up to 104 weeks, at doses up to 1500 mg of the salt per kg/day (2.5 times the maximum recommended daily human dose (MRHD) on a mg/sq m basis) revealed no evidence of carcinogenic potential.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
/LABORATORY ANIMALS: Chronic Exposure or Carcinogenicity/ In the mouse, oral administration of lanthanum carbonate for up to 99 weeks, at a dose of 1500 mg/kg/day was associated with an increased incidence of glandular stomach adenomas in male mice.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
/LABORATORY ANIMALS: Developmental or Reproductive Toxicity/ Lanthanum carbonate, at doses up to 2000 mg/kg/day, did not affect fertility or mating performance of male or female rats. In pregnant rats, oral administration of lanthanum carbonate at doses as high as 2000 mg/kg/day resulted in no evidence of harm to the fetus.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132
For more Non-Human Toxicity Excerpts (Complete) data for Lanthanum Carbonate (8 total), please visit the HSDB record page.

10.1.7 Populations at Special Risk

While growth abnormalities were not identified in long-term animal studies, lanthanum was deposited into developing bone including growth plate. The consequences of such deposition in developing bone in pediatric patients are unknown. Therefore, the use of lanthanum carbonate in this population is not recommended.
US Natl Inst Health; DailyMed. Current Medication Information for Fosrenol (Lanthanum carbonate) (January 2006). Available from, as of June 17, 2009: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=3132

10.1.8 Protein Binding

_In vitro_, lanthanum is highly bound (>99%) to human plasma proteins, including human serum albumin, α1-acid glycoprotein, and transferrin.

11 Associated Disorders and Diseases

12 Literature

12.1 Consolidated References

12.2 NLM Curated PubMed Citations

12.3 Springer Nature References

12.4 Chemical Co-Occurrences in Literature

12.5 Chemical-Gene Co-Occurrences in Literature

12.6 Chemical-Disease Co-Occurrences in Literature

13 Patents

13.1 Depositor-Supplied Patent Identifiers

13.2 WIPO PATENTSCOPE

13.3 FDA Orange Book Patents

13.4 Chemical Co-Occurrences in Patents

13.5 Chemical-Disease Co-Occurrences in Patents

13.6 Chemical-Gene Co-Occurrences in Patents

14 Interactions and Pathways

14.1 Drug-Drug Interactions

14.2 Drug-Food Interactions

Take with food.

15 Classification

15.1 MeSH Tree

15.2 NCI Thesaurus Tree

15.3 WHO ATC Classification System

15.4 ChemIDplus

15.5 UN GHS Classification

15.6 NORMAN Suspect List Exchange Classification

15.7 EPA DSSTox Classification

15.8 EPA TSCA and CDR Classification

15.9 EPA Substance Registry Services Tree

15.10 MolGenie Organic Chemistry Ontology

16 Information Sources

  1. ChemIDplus
    ChemIDplus Chemical Information Classification
    https://pubchem.ncbi.nlm.nih.gov/source/ChemIDplus
  2. DrugBank
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    Carbonic acid, lanthanum(3+) salt (3:2)
    https://www.epa.gov/chemical-data-reporting
  4. EPA Chemicals under the TSCA
    Carbonic acid, lanthanum(3+) salt (3:2)
    https://www.epa.gov/chemicals-under-tsca
    EPA TSCA Classification
    https://www.epa.gov/tsca-inventory
  5. EPA DSSTox
    CompTox Chemicals Dashboard Chemical Lists
    https://comptox.epa.gov/dashboard/chemical-lists/
  6. European Chemicals Agency (ECHA)
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  7. FDA Global Substance Registration System (GSRS)
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    https://www.fda.gov/about-fda/about-website/website-policies#linking
  8. Hazardous Substances Data Bank (HSDB)
  9. ClinicalTrials.gov
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  10. Comparative Toxicogenomics Database (CTD)
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    http://ctdbase.org/about/legal.jsp
  11. Therapeutic Target Database (TTD)
  12. DailyMed
  13. Drug Induced Liver Injury Rank (DILIrank) Dataset
    LICENSE
    Unless otherwise noted, the contents of the FDA website (www.fda.gov), both text and graphics, are not copyrighted. They are in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from FDA. Credit to the U.S. Food and Drug Administration as the source is appreciated but not required.
    https://www.fda.gov/about-fda/about-website/website-policies#linking
  14. NCI Thesaurus (NCIt)
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    https://www.cancer.gov/policies/copyright-reuse
  15. Drugs and Lactation Database (LactMed)
  16. Drugs@FDA
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    Unless otherwise noted, the contents of the FDA website (www.fda.gov), both text and graphics, are not copyrighted. They are in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from FDA. Credit to the U.S. Food and Drug Administration as the source is appreciated but not required.
    https://www.fda.gov/about-fda/about-website/website-policies#linking
  17. EU Clinical Trials Register
  18. FDA Medication Guides
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    Unless otherwise noted, the contents of the FDA website (www.fda.gov), both text and graphics, are not copyrighted. They are in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from FDA. Credit to the U.S. Food and Drug Administration as the source is appreciated but not required.
    https://www.fda.gov/about-fda/about-website/website-policies#linking
  19. FDA Orange Book
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    https://www.fda.gov/about-fda/about-website/website-policies#linking
  20. National Drug Code (NDC) Directory
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    https://www.fda.gov/about-fda/about-website/website-policies#linking
  21. NIPH Clinical Trials Search of Japan
  22. NLM RxNorm Terminology
    LICENSE
    The RxNorm Terminology is created by the National Library of Medicine (NLM) and is in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from NLM. Credit to the U.S. National Library of Medicine as the source is appreciated but not required. The full RxNorm dataset requires a free license.
    https://www.nlm.nih.gov/research/umls/rxnorm/docs/termsofservice.html
  23. Springer Nature
  24. WHO Anatomical Therapeutic Chemical (ATC) Classification
    LICENSE
    Use of all or parts of the material requires reference to the WHO Collaborating Centre for Drug Statistics Methodology. Copying and distribution for commercial purposes is not allowed. Changing or manipulating the material is not allowed.
    https://www.whocc.no/copyright_disclaimer/
  25. Wikidata
  26. Wikipedia
  27. PubChem
  28. Medical Subject Headings (MeSH)
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    https://www.nlm.nih.gov/copyright.html
  29. GHS Classification (UNECE)
  30. NORMAN Suspect List Exchange
    LICENSE
    Data: CC-BY 4.0; Code (hosted by ECI, LCSB): Artistic-2.0
    https://creativecommons.org/licenses/by/4.0/
    NORMAN Suspect List Exchange Classification
    https://www.norman-network.com/nds/SLE/
  31. EPA Substance Registry Services
  32. MolGenie
    MolGenie Organic Chemistry Ontology
    https://github.com/MolGenie/ontology/
  33. PATENTSCOPE (WIPO)
  34. NCBI
CONTENTS