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Trade Names:
Fosrenol
- Tablets, chewable 250 mg
- Tablets, chewable 500 mg

Mechanism of Action

Pharmacology

Inhibits GI absorption of phosphate by forming highly insoluble lanthanum phosphate complex with dietary phosphate released from food during digestion.

Pharmacokinetics

Absorption

Very low absorption (bioavailability less than 0.002%). C _max is 1 ng/mL.

Distribution

Highly bound to plasma proteins (more than 99%).

Metabolism

Not metabolized and not a substrate of CYP450.

Elimination

Elimination t _½ is 53 h.

Indications and Usage

Reduce serum phosphate in patients with end-stage renal disease.

Contraindications

None known.

Dosage and Administration

PO Initial dose is 750 to 1,500 mg/day divided and taken with meals. Titrate dose every 2 to 3 wk, generally in increments of 750 mg/day, until acceptable serum phosphate level is reached.

General Advice

• Have patient chew tablets completely before swallowing. Caution patient not to swallow intact tablets.
• In order to bind dietary phosphate efficiently, administer prescribed dose with or immediately after a meal.

Storage/Stability

Store tablets at controlled room temperature (59° to 86°F). Protect from moisture.

Drug Interactions

Do not take within 2 h of lanthanum.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Hypotension (at least 5%).

CNS

Headache (at least 5%).

EENT

Rhinitis (at least 5%).

GI

Abdominal pain, constipation, diarrhea, nausea, vomiting (at least 5%).

Metabolic-Nutritional

Hypercalcemia (at least 5%).

Respiratory

Bronchitis (at least 5%).

Miscellaneous

Dialysis graft occlusion or complication (at least 5%).

Precautions

Pregnancy

Category C .

Lactation

Undetermined.

Children

Not recommended.

Special Risk Patients

Use with caution in patients with acute peptic ulcer, ulcerative colitis, Crohn disease, or bowel obstruction because these populations were not included in clinical studies.

Patient Information

• Advise patient that medication does not replace diet changes and to continue to adhere to prescribed diet.
• Advise patient that dose may be adjusted periodically in order to achieve maximum benefit.
• Advise patient to take each dose with or immediately after a meal. Caution patient to chew tablets thoroughly before swallowing and not to swallow intact tablets.