The effect of sevelamer carbonate and lanthanum carbonate on the pharmacokinetics of oral calcitriol

Abstract

Background: Lanthanum carbonate and sevelamer carbonate are non-calcium-based phosphate binders used to manage hyperphosphataemia in patients with chronic kidney disease (CKD). Patients with CKD may require intravenous or oral active vitamin D. We investigated the effects of lanthanum carbonate and sevelamer carbonate on the bioavailability of oral calcitriol.

Methods: This was a three-period, crossover study in healthy volunteers. Forty-one individuals were randomized to one of six possible sequences, each consisting of three treatment periods separated by washouts. The treatments were calcitriol (1 μg at lunch), calcitriol with lanthanum carbonate (3000 mg/day) and calcitriol with sevelamer carbonate (7200 mg/day). Serum calcitriol levels were assessed at baseline and throughout the study.

Results: Co-administration of lanthanum carbonate with calcitriol had no significant effect on area under the curve over 48 h (AUC(0-48)) for serum exogenous calcitriol [least-squares (LS) mean, calcitriol with lanthanum carbonate vs calcitriol alone: 429 pg h/mL vs 318 pg h/mL, respectively; P = 0.171]. Similarly, there was no significant effect on maximum concentration (C(max)). In contrast, co-administration with sevelamer was associated with a significant reduction in bioavailability parameters for calcitriol (calcitriol with sevelamer carbonate vs calcitriol alone, LS mean AUC(0-48): 137 pg h/mL vs 318 pg h/mL, respectively; P = 0.024; LS mean C(max): 40.1 pg/mL vs 49.7 pg/mL, respectively; P < 0.001).

Conclusions: Sevelamer carbonate significantly reduces serum concentrations of exogenous calcitriol when administered concomitantly with oral calcitriol, whereas lanthanum carbonate has no significant effect. This should be considered when treating CKD patients who require phosphate binders and oral vitamin D.

Fig. 1

Study design. Study medications were administered orally with 240 mL of de-ionized water half-way through ingestion of the meal.

Fig. 2

Mean serum concentrations of (a) exogenous and (b) total calcitriol after a single dose, with or without co-administration of lanthanum carbonate or sevelamer carbonate. Regimen A: calcitriol 1.0 μg; regimen B: calcitriol 1.0 μg + lanthanum carbonate (1000 mg t.i.d.); regimen C: calcitriol 1.0 μg + sevelamer carbonate (2400 mg t.i.d.).