Fosrenol หรือ Lanthanum carbonate เป็ นยากลุม ่ Phosphate-Binding Agents มีขอ

้ บ่งใช้ในการรักษาภาวะ
hyperphosphatemia ในผูป้ ่ วย end stage renal disease

Phosphate-Binding Agents ประกอบด้วย

Agent Strength Relative Starting Titration Usual Adverse Effects Warnings

Phosphorus Dose Dose
Binding
Capacity*
Aluminum Content per 1.5 --- Short- 1425 to Neurotoxicity, Do not use
Hydroxide tablet term use 2850 effects on bone concurrently wi
varies only mg/day mineralization citrate-based
products;
absorption is
variable
Calcium Acetate 667 mg 1 1334 mg Every 2 to 2001 to Hypercalcemia, Contraindicate
(25% ORALLY 3 weeks 2668 mg extraskeletal with
elemental with each with each calcification, PTH hypercalcemia
calcium, meal meal suppression, GI dose reduction
169 mg) adverse effects discontinuatio
Calcium Carbonate 500 mg 1 --- --- 3000 to (nausea, vomiting) may be require
(40% 6000 in
elemental mg/day hypercalcemia
calcium,
200 mg)
Lanthanum 500 mg, 2 1500 mg Every 2 to 1500 to Abdominal pain, Contraindicate
Carbonate 750 mg, ORALLY per 3 weeks; 3000 bowel obstruction, with bowel
1000 mg day in usual mg/day fecal impaction, obstruction, ileu
divided increment: GI obstruction, or fecal impactio
doses with 750 hypocalcemia, potential
or mg/day nausea, vomiting accumulation i
immediately bone/other tiss
after meals
Magnesium Magnesium 1.7 1 to 3 tablets --- OTC: 3 GI adverse Do not use Rx
Carbonate/Calcium carbonate ORALLY tablets 3 effects; potential strength in
Carbonate 300 with meals times/day hypermagnesemia hypermagnesem
mg/Calcium with or in renal
carbonate meals; Rx: dysfunction no
250 mg; 1 to 2 requiring dialys
Magnesium tablets 3 reduce calcium
carbonate times/day dose in
400 hypercalcemia
mg/Calcium
carbonate
200 mg
Niacin/ 500 mg, N/A Niacin ER, Every 1 to 375 to Myopathy, Contraindicated
Niacinamide 750 mg, 375 to 400 4 1500 increased serum active liver
1000 mg; mg/day; weeks**** mg/day**** glucose, disease or
OTC: Niacinamide, thrombocytopenia unexplained
varies 500 mg/day or decrease in transaminase
divided twice platelet count, elevation, activ
daily**** increased PUD, or arteria
prothrombin time, bleeding; cautio
cough, flushing, in renal
diarrhea, nausea, impairment,
rash, vomiting unstable angin
acute MI, histo
of liver disease
substantial
alcohol intake
Sevelamer 800 mg, 0.75 By 800 mg 7200 mg Bowel obstruction; Contraindicated
Carbonate 2400 mg phosphorus per meal daily bowel perforation, bowel obstructio
level: 5.5 to every 2 fecal impaction, consider
less than 7.5 weeks ileus, abdominal suspension
mg/dL, 800 pain, constipation, formulation if
mg ORALLY diarrhea, history of
3 times dyspepsia, swallowing
daily; 7.5 flatulence, disorders; moni
mg/dL or nausea, vomiting vitamin D, E, K
greater, folic acid,
 1600 mg bicarbonate, an
ORALLY 3 chloride levels
times daily; may require
take with calcium
meals*** supplementatio
Sevelamer 400 mg, 0.75 By 1 tablet 2400 mg hypocalcemia
Hydrochloride 800 mg phosphorus per meal per meal occurs
level: 5.5 to at 2-week
less than 7.5 intervals
mg/dL, 800
mg ORALLY
3 times
daily; 7.5 to
less than 9
mg/dL, 1200
to 1600 mg
ORALLY 3
times daily;
9 mg/dL or
greater,
1600 mg
ORALLY 3
times daily;
take with
meals***
Sucroferric 500 mg N/A 500 mg 500 1500 to Diarrhea, No
Oxyhydroxide ORALLY 3 mg/day in 2000 mg discolored feces, contraindication
times daily 1-week daily nausea per manufactur
 with meals intervals monitor iron
hemostasis in a
risk patients
KEY: CKD=chronic kidney disease; FDA=Food and Drug Administration; GI=gastrointestinal; MI=myocardial infarction; OTC=
PTH=parathyroid hormone; PUD=peptic ulcer disease; RPBC=relative phosphate binding coefficient; Rx=prescription
* Based on gram of compound (ie, salt form) or elemental product as listed in the manufacturer information; interpret as relativ
does not reflect chemical binding capacity of compound on a molar basis. Use RPBC in combination with available drug stren
dose of the phosphate binder that would be equivalent to the index, calcium carbonate. Example: one 800-mg (0.8 g) tablet o
carbonate would be equivalent to 0.6 g of calcium carbonate (ie: 0.75 x 0.8).
** Guidelines recommend restricting dose of calcium-based phosphate binders and/or dose of calcitriol or vitamin D analogs i
recurrent or persistent hypercalcemia; reduction in calcium dose in cases of arterial calcification, adynamic bone disease, or c
decreased serum PTH levels is also suggested.
*** The provided sevelamer doses are based on initiation in patients who are not currently receiving a phosphate binder; see
specific dosing when switching from current phosphate binder therapy.
**** Niacin does not have an FDA indication for this use. Starting doses, titration periods, range of doses used, significant adv
place in therapy are from He et al 2013 meta-analysis of niacin or niacinamide added to current therapy in patients receiving d
manufacturer of niacin extended-release recommends starting doses of 500 mg at bedtime to reduce severity of adverse effe
dose titration by no more than 500 mg every 4 weeks; maximum recommended dose is 2000 mg/day.