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Vol. 28. Issue. S5.October 2008
Pages 3-143
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Vol. 28. Issue. S5.October 2008
Pages 3-143
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Lanthanum carbonate in clinical practice
Carbonato de lantano en la práctica clínica
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V. Torregrosa Prats
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Abstract
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El lantano es un elemento que pertenece al grupo denominado «tierras raras». Por su baja solubilidad el carbonato de lantano se ha estudiado ampliamente como captor intestinal de fósforo. Los resultados de diferentes ensayos clínicos demuestran que es un captor de fósforo eficaz en monoterapia y bien tolerado. El fósforo se controla en aproximadamente el 70% de pacientes a los 5 años sin provocar hipercalcemia. Como únicos efectos adversos destacables, se ha constatado un reducido porcentaje de molestias gastrointestinales (6%). El carbonato de lantano no altera valores séricos de vitaminas liposolubles ni afecta la farmacocinética de digoxina, warfarina, furosemida, fenitoína, IECA¿s o betabloqueantes. Sí altera la farmacocinética del ciprofloxacino (quinolonas en general), tetraciclinas y doxiciclina. En España, el carbonato de lantano (Fosrenol®) se presenta en comprimidos masticables de 500 mg, 750 mg y 1.000 mg, que no deben ingerirse sin masticar para no perder eficacia. La dosis de inicio recomendada por la OMS es de 2.250 mg/día que equivale a un comprimido de 750 mg en cada comida. El carbonato de lantano, o el fosfato de lantano, pueden visualizarse claramente en una radiografía simple de abdomen en pacientes que lo hayan ingerido recientemente. En resumen, es un captor de fósforo ampliamente estudiado, potente, que ofrece la posibilidad de mejorar el control del fósforo sérico en pacientes con enfermedad renal crónica, sin efectos secundarios relevantes. El hecho de que se presente en comprimidos masticables y que se reduzca significativamente el número de comprimidos diarios necesarios, probablemente facilitará un mejor cumplimiento por parte de los pacientes.
Lanthanum is an element belonging to the group called rare earths. Due to its low solubility, lanthanum carbonate has been widely studied as an intestinal phosphate binder. The results of different clinical trials show that it is an effective and well-tolerated phosphate binder used in monotherapy. Serum phosphate levels are controlled in approximately 70% of patients at 5 years without causing hypercalcemia. The only significant adverse effects observed are a low percentage of gastrointestinal disturbances (6%). Lanthanum carbonate does not alter serum values of liposoluble vitamins or affect the pharmacokinetics of digoxin, warfarin, furosemide, phenytoin, ACE inhibitors or beta-blockers. However, it does alter the pharmacokinetics of ciprofloxacin (quinolones in general), tetracyclines and doxycycline. Lanthanum carbonate (Fosrenol®) is available in Spain as 500 mg, 750 mg, and 1,000 mg chewable tablets, which should not be swallowed without chewing to avoid loss of efficacy. The initial dose recommended by the WHO is 2,250 mg/day, which is equivalent to one 750 mg at each meal. Lanthanum carbonate or lanthanum phosphate can be clearly visualized on a plain x-ray of the abdomen in patients who have recently ingested it. In summary, lanthanum carbonate is a widely studied potent phosphate binder, which offers the possibility of improving control of serum phosphate in patients with chronic kidney disease, without significant side effects. The fact that it is available as chewable tablets and that the number of daily tablets required has been significantly reduced will probably facilitate better patient compliance.
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Nefrología (English Edition)

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