炭酸ランタン
炭酸ランタンは、主に末期腎疾患（ESRD）患者の高リン血症を管理するために使用される経口リン吸着剤です。 食事によるリン制限は慢性腎臓病（CKD）管理の基本ですが、食事療法だけでは不十分な場合や患者が療法食を拒否する場合にリン吸着剤が適応となります。 > **臨床のポイント：** カルシウムベースの吸着剤（高カルシウム血症を引き起こす可能性がある）やアルミニウムベースの吸着剤（長期使用でアルミニウム中毒のリスクがある）とは異なり、ランタンはカルシウムもアルミニウムも含んでいないため、獣医療における高リン血症の長期管理において魅力的な選択肢となります。
作用機序: Lanthanum carbonate acts locally in the gastrointestinal tract. * It dissociates in the acidic environment of the upper GI tract (stomach) to release **lanthanum ions (La³⁺)**. * These ions bind to dietary phosphate → forming highly insoluble **lanthanum phosphate complexes**. * These complexes cannot cross the intestinal mucosa and are subsequently eliminated in the feces, thereby reducing net intestinal absorption of phosphorus.
動物種別の用量
- Phosphate binder · 200 mg (total dose) PO (on/in food) 2-3 times daily. · PO · 2-3 times daily · Anecdotally appears safe and effective.
- Phosphate binder (using Renalzin) · 2 mLs (400 mg) applied in the cat's food, once or twice daily depending on the cat's feeding regimen. · PO · once or twice daily
- Chronic kidney disease (Hyperphosphataemia) · 400-800 mg/cat/day · PO · divided according to feeding schedule (give some with every meal) · Chronic · Recommended starting dose is 400 mg per day. It is important to give some with every meal.
- Chronic kidney disease (Hyperphosphataemia) · 100 mg/kg/day · PO · divided between meals · Chronic · Dose adjustments should be based on serum phosphate levels monitored at 4-6 week intervals.
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Patients with non-intact GI tract (e.g., GI ulcers, colitis) - use with caution due to increased risk of systemic absorption
- Acute renal crisis (patients should be stabilized first)
有害事象
- Vomiting
- Nausea
- Inappetence
- None known according to the monograph
- Gastrointestinal upset (nausea, vomiting, diarrhea, or constipation) may occur (Clinical Pearl)
薬物相互作用
- Allopurinol · Potential decreased absorption; separate dosing by 2 hours
- Chloroquine · Potential decreased absorption; separate dosing by 2 hours
- Corticosteroids · Potential decreased absorption; separate dosing by 2 hours
- Digoxin · Potential decreased absorption; separate dosing by 2 hours
- Ethambutol · Potential decreased absorption; separate dosing by 2 hours
- Fluoroquinolones · Potential decreased absorption; separate dosing by 2 hours
- H-2 Antagonists (ranitidine, famotidine) · Potential decreased absorption; separate dosing by 2 hours
- Iron Salts · Potential decreased absorption; separate dosing by 2 hours
- Isoniazid · Potential decreased absorption; separate dosing by 2 hours
- Penicillamine · Potential decreased absorption; separate dosing by 2 hours
- Phenothiazines · Potential decreased absorption; separate dosing by 2 hours
- Tetracyclines · Potential decreased absorption; separate dosing by 2 hours
- Thyroid Hormones · Potential decreased absorption; separate dosing by 2 hours
モニタリング
- Serum phosphorous
- Serum potassium
- Serum calcium
- Serum bicarbonate
- Serum chloride
- Serum phosphate levels (at 4-6 week intervals to adjust dosage and achieve target concentrations)
- Renal parameters (BUN, Creatinine, SDMA)
- Serum calcium levels
過量投与
No specific information located, but acute overdose is likely tolerated with potential for GI effects. Only supportive treatment should be required. In cats, oral dosages up to 1 gram/kg were tolerated, but repeated vomiting occurred at 2 grams/kg.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。