Fosrenol LANTHANUM CARBONATE TAKEDA PHARMACEUTICALS AMERICA, INC. FDA Approved FOSRENOL contains lanthanum carbonate with molecular formula La 2 (CO 3 ) 3 xH 2 O (on average x=4-5 moles of water) and molecular weight 457.8 (anhydrous mass). Lanthanum carbonate is described as white to almost-white powder. Lanthanum carbonate is practically insoluble in water and is insoluble in organic solvents; it dissolves in dilute mineral acids with effervescence. Each FOSRENOL, white to off-white, chewable tablet contains lanthanum carbonate hydrate equivalent to 500, 750, or 1,000 mg of elemental lanthanum and the following inactive ingredients: colloidal silicon dioxide, dextrates (hydrated), magnesium stearate. FOSRENOL Oral Powder is a white to off-white powder containing lanthanum carbonate hydrate equivalent to 750 or 1,000 mg of elemental lanthanum and the following inactive ingredients: colloidal silicon dioxide, dextrates (hydrated), magnesium stearate.

Drug Facts

Composition & Profile

Dosage Forms
Tablet
Strengths
500 mg 750 mg 1000 mg 2.1 g 2.8 g
Quantities
2 bottles 45 tablets 6 bottles 15 tablets 9 bottles 10 tablets
Treats Conditions
1 Indications And Usage Fosrenol Is A Phosphate Binder Indicated To Reduce Serum Phosphate In Patients With End Stage Renal Disease Esrd Management Of Elevated Serum Phosphorus Levels In Patients With Esrd Usually Includes All Of The Following Reduction In Dietary Intake Of Phosphate Removal Of Phosphate By Dialysis And Reduction Of Intestinal Phosphate Absorption With Phosphate Binders Fosrenol Is A Phosphate Binder Indicated To Reduce Serum Phosphate In Patients With End Stage Renal Disease Esrd 1
Pill Appearance
Shape: round Color: white Imprint: S405;1000

Identifiers & Packaging

Container Type BOTTLE
UNII
490D9F069T
Packaging

16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 FOSRENOL Chewable Tablets FOSRENOL is supplied as a chewable tablet in three dosage strengths for oral administration: 500-mg tablets, 750-mg tablets, and 1,000-mg tablets. Each chewable tablet is white to off-white round, flat with a beveled edge, and debossed on one side with 'S405' above the dosage strength corresponding to the content of elemental lanthanum. 500-mg Patient Pack (2 bottles of 45 tablets, NDC 54092-252-45, per each patient pack) NDC 54092-252-90. 750-mg Patient Pack (6 bottles of 15 tablets, NDC 54092-253-15, per each patient pack) NDC 54092-253-90. 1,000-mg Patient Pack (9 bottles of 10 tablets, NDC 54092-254-10, per each patient pack) NDC 54092-254-90. 16.2 FOSRENOL Oral Powder FOSRENOL Oral Powder is supplied in two dosage strengths for oral administration: 750 mg and 1,000 mg. Each 750-mg and 1,000-mg stick pack contains 2.1 g and 2.8 g oral powder, respectively, packed in a polyethylene terephthalate/aluminum/polyethylene laminate. Strength Carton of 10 Stick Packs Patient Pack of 9 Cartons 750 mg NDC 54092-256-01 NDC 54092-256-02 1,000 mg NDC 54092-257-01 NDC 54092-257-02 Storage and Handling Store FOSRENOL Chewable Tablets and FOSRENOL Oral Powder at 25°C (77°F): excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP controlled room temperature.]; PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Label NDC 54092-252-45 FOSRENOL ® (lanthanum carbonate) chewable tablets 500 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 45 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Label; PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Package NDC 54092-252-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 500 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 2 bottles/45 chewable tablets each Rx only Active Ingredient: Each tablet contains 500 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25°C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Package; PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Label NDC 54092-253-15 FOSRENOL ® (lanthanum carbonate) chewable tablets 750 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 15 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Label; PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Package NDC 54092-253-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 750 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 6 bottles/15 chewable tablets each Rx only Active Ingredient: Each tablet contains 750 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25°C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Package; PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Label NDC 54092-254-10 FOSRENOL ® (lanthanum carbonate) chewable tablets 1000 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 10 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Label; PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Package NDC 54092-254-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 1000 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 9 bottles/10 chewable tablets each Rx only Active Ingredient: Each tablet contains 1000 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25° C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Package; PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 10 Stick Pack NDC 54092-256-01 Fosrenol ® (lanthanum carbonate) oral powder 750 mg Mix with small quantity of soft food and take immediately Takeda 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 10 Stick Pack; PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 90 Stick Pack NDC 54092-256-02 Fosrenol ® (lanthanum carbonate) oral powder 750 mg Mix with small quantity of soft food and take immediately Takeda 9 cartons, each carton contains 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 90 Stick Pack; PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 10 Stick Pack NDC 54092-257-01 Fosrenol ® (lanthanum carbonate) oral powder 1000 mg Mix with small quantity of soft food and take immediately Takeda 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 10 Stick Pack; PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 90 Stick Pack NDC 54092-257-02 Fosrenol ® (lanthanum carbonate) oral powder 1000 mg Mix with small quantity of soft food and take immediately Takeda 9 cartons, each carton contains 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 90 Stick Pack

Package Descriptions
  • 16 HOW SUPPLIED/STORAGE AND HANDLING 16.1 FOSRENOL Chewable Tablets FOSRENOL is supplied as a chewable tablet in three dosage strengths for oral administration: 500-mg tablets, 750-mg tablets, and 1,000-mg tablets. Each chewable tablet is white to off-white round, flat with a beveled edge, and debossed on one side with 'S405' above the dosage strength corresponding to the content of elemental lanthanum. 500-mg Patient Pack (2 bottles of 45 tablets, NDC 54092-252-45, per each patient pack) NDC 54092-252-90. 750-mg Patient Pack (6 bottles of 15 tablets, NDC 54092-253-15, per each patient pack) NDC 54092-253-90. 1,000-mg Patient Pack (9 bottles of 10 tablets, NDC 54092-254-10, per each patient pack) NDC 54092-254-90. 16.2 FOSRENOL Oral Powder FOSRENOL Oral Powder is supplied in two dosage strengths for oral administration: 750 mg and 1,000 mg. Each 750-mg and 1,000-mg stick pack contains 2.1 g and 2.8 g oral powder, respectively, packed in a polyethylene terephthalate/aluminum/polyethylene laminate. Strength Carton of 10 Stick Packs Patient Pack of 9 Cartons 750 mg NDC 54092-256-01 NDC 54092-256-02 1,000 mg NDC 54092-257-01 NDC 54092-257-02 Storage and Handling Store FOSRENOL Chewable Tablets and FOSRENOL Oral Powder at 25°C (77°F): excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP controlled room temperature.]
  • PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Label NDC 54092-252-45 FOSRENOL ® (lanthanum carbonate) chewable tablets 500 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 45 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Label
  • PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Package NDC 54092-252-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 500 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 2 bottles/45 chewable tablets each Rx only Active Ingredient: Each tablet contains 500 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25°C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 500 mg Tablet Bottle Package
  • PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Label NDC 54092-253-15 FOSRENOL ® (lanthanum carbonate) chewable tablets 750 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 15 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Label
  • PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Package NDC 54092-253-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 750 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 6 bottles/15 chewable tablets each Rx only Active Ingredient: Each tablet contains 750 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25°C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 750 mg Tablet Bottle Package
  • PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Label NDC 54092-254-10 FOSRENOL ® (lanthanum carbonate) chewable tablets 1000 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. ATTENTION PHARMACIST: Each patient is required to receive the enclosed Medication Guide. 10 TABLETS Rx only Takeda PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Label
  • PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Package NDC 54092-254-90 FOSRENOL ® (lanthanum carbonate) chewable tablets 1000 mg Do not swallow tablets whole. Chew or crush tablets completely before swallowing. Take with or immediately after meals. 9 bottles/10 chewable tablets each Rx only Active Ingredient: Each tablet contains 1000 mg of lanthanum as lanthanum carbonate hydrate Inactive Ingredients: Colloidal silicon dioxide, dextrates, and magnesium stearate. See package insert for full prescribing information. Store at 25° C (77°F) excursions permitted to 15-30°C (59-86°F) [see USP Controlled Room Temperature] Takeda PRINCIPAL DISPLAY PANEL - 1000 mg Tablet Bottle Package
  • PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 10 Stick Pack NDC 54092-256-01 Fosrenol ® (lanthanum carbonate) oral powder 750 mg Mix with small quantity of soft food and take immediately Takeda 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 10 Stick Pack
  • PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 90 Stick Pack NDC 54092-256-02 Fosrenol ® (lanthanum carbonate) oral powder 750 mg Mix with small quantity of soft food and take immediately Takeda 9 cartons, each carton contains 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 750 mg Packet Carton - 90 Stick Pack
  • PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 10 Stick Pack NDC 54092-257-01 Fosrenol ® (lanthanum carbonate) oral powder 1000 mg Mix with small quantity of soft food and take immediately Takeda 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 10 Stick Pack
  • PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 90 Stick Pack NDC 54092-257-02 Fosrenol ® (lanthanum carbonate) oral powder 1000 mg Mix with small quantity of soft food and take immediately Takeda 9 cartons, each carton contains 10 stick packs Rx only PRINCIPAL DISPLAY PANEL - 1000 mg Packet Carton - 90 Stick Pack

Overview

FOSRENOL contains lanthanum carbonate with molecular formula La 2 (CO 3 ) 3 xH 2 O (on average x=4-5 moles of water) and molecular weight 457.8 (anhydrous mass). Lanthanum carbonate is described as white to almost-white powder. Lanthanum carbonate is practically insoluble in water and is insoluble in organic solvents; it dissolves in dilute mineral acids with effervescence. Each FOSRENOL, white to off-white, chewable tablet contains lanthanum carbonate hydrate equivalent to 500, 750, or 1,000 mg of elemental lanthanum and the following inactive ingredients: colloidal silicon dioxide, dextrates (hydrated), magnesium stearate. FOSRENOL Oral Powder is a white to off-white powder containing lanthanum carbonate hydrate equivalent to 750 or 1,000 mg of elemental lanthanum and the following inactive ingredients: colloidal silicon dioxide, dextrates (hydrated), magnesium stearate.

Indications & Usage

FOSRENOL ® is a phosphate binder indicated to reduce serum phosphate in patients with end-stage renal disease (ESRD). Management of elevated serum phosphorus levels in patients with ESRD usually includes all of the following: reduction in dietary intake of phosphate, removal of phosphate by dialysis, and reduction of intestinal phosphate absorption with phosphate binders. FOSRENOL is a phosphate binder indicated to reduce serum phosphate in patients with end-stage renal disease (ESRD). ( 1 )

Dosage & Administration

Divide the total daily dose of FOSRENOL and take with or immediately after meals. The recommended initial total daily dose of FOSRENOL is 1,500 mg. Titrate the dose every 2 to 3 weeks until an acceptable serum phosphate level is reached. Monitor serum phosphate levels as needed during dose titration and on a regular basis thereafter. FOSRENOL has the potential to bind other orally administered drugs; consider separating the administration of other oral medications [see Drug Interactions (7) ] . In clinical studies of patients with ESRD, FOSRENOL doses up to 4,500 mg were evaluated. Most patients required a total daily dose between 1,500 mg and 3,000 mg to reduce plasma phosphate levels to less than 6.0 mg/dL. Doses were generally titrated in increments of 750 mg/day. The recommended initial total daily dose of FOSRENOL is 1,500 mg in divided doses. Titrate every 2 to 3 weeks based on serum phosphate level. ( 2 ) Take FOSRENOL with or immediately after meals. ( 2 ) FOSRENOL Chewable Tablets: Chew or crush tablet completely before swallowing. ( 2 ) FOSRENOL Oral Powder: Sprinkle powder on a small quantity of applesauce or other similar food and consume immediately. Consider powder formulation in patients with poor dentition or who have difficulty chewing tablets. ( 2 ) Information for FOSRENOL Chewable Tablets Chew or crush FOSRENOL Chewable Tablets completely before swallowing. Do not swallow intact FOSRENOL Chewable Tablets. Information for FOSRENOL Oral Powder Sprinkle FOSRENOL Oral Powder on a small quantity of applesauce or other similar food and consume immediately. Do not open until ready to use. Do not store FOSRENOL Oral Powder for future use once mixed with food. Because FOSRENOL Oral Powder is insoluble, do not attempt to dissolve in liquid for administration. Consider using the oral powder formulation in patients with poor dentition or who have difficulty chewing tablets.

Warnings & Precautions
Serious cases of gastrointestinal obstruction, ileus, subileus, gastrointestinal perforation, and fecal impaction. Risks include altered gastrointestinal anatomy, hypomotility disorders, and concomitant medications. Advise patients to chew or crush the tablet completely. ( 5.1 ) FOSRENOL has radio-opaque properties and, therefore, may give the appearance typical of an imaging agent during abdominal X-ray procedures. ( 5.2 ) 5.1 Gastrointestinal Adverse Effects Serious cases of gastrointestinal obstruction, ileus, subileus, gastrointestinal perforation, and fecal impaction have been reported in patients taking lanthanum, some requiring surgery or hospitalization. Consider discontinuing FOSRENOL in patients without another explanation for severe gastrointestinal symptoms. Risk factors for gastrointestinal obstruction and gastrointestinal perforation identified from post-marketing reports in patients taking FOSRENOL Chewable Tablets include abnormal gastrointestinal anatomy (e.g., diverticular disease, peritonitis, history of gastrointestinal surgery, gastrointestinal cancer, gastrointestinal ulceration), hypomotility disorders (e.g., constipation, ileus, subileus, diabetic gastroparesis), and the use of medications known to potentiate these effects. Some cases were reported in patients with no history of gastrointestinal disease. Patients with acute peptic ulcer, ulcerative colitis, Crohn's disease, or bowel obstruction were not included in FOSRENOL clinical studies [see Contraindications (4) ] . Advise patients who are prescribed FOSRENOL Chewable Tablets to chew the tablet completely and not to swallow them whole. Serious gastrointestinal complications have been reported in association with unchewed or incompletely chewed tablets [see Adverse Reactions ( 6.2 )] . 5.2 Diagnostic Tests FOSRENOL has radio-opaque properties and therefore may give the appearance typical of an imaging agent during abdominal X-ray procedures. Postmarketing reports of product residue have been reported during endoscopic imaging.
Contraindications

Contraindicated in patients with: - hypersensitivity to FOSRENOL or to any ingredient in the formulation. - bowel obstruction, including ileus and fecal impaction. Hypersensitivity to FOSRENOL or to any ingredient in the formulation. ( 4 ) Bowel obstruction, ileus, and fecal impaction. ( 4 )

Adverse Reactions

The following adverse reactions are discussed in greater detail in other sections of the labeling: Gastrointestinal Adverse Effects [see Warnings and Precautions (5.1) ] In controlled trials, the most common adverse reactions that were more frequent (≥5% difference vs. placebo) in FOSRENOL were nausea, vomiting, and abdominal pain. ( 6.1 ) The following adverse reactions have been identified during post-approval use of FOSRENOL: constipation, dyspepsia, allergic skin reactions, and tooth injury while chewing the tablet. ( 6.2 ) To report SUSPECTED ADVERSE REACTIONS, contact Takeda Pharmaceuticals U.S.A., Inc. at 1-877-TAKEDA-7 (1-877-825-3327) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. Overall, the safety profile of FOSRENOL has been studied in over 5,200 subjects in completed clinical trials. The most common adverse reactions for FOSRENOL were gastrointestinal events, such as nausea, vomiting, and abdominal pain and they generally abated over time with continued dosing. In double-blind, placebo-controlled studies where a total of 180 and 95 patients with ESRD were randomized to FOSRENOL chewable tablet and placebo, respectively, for 4 to 6 weeks of treatment, the most common reactions that were more frequent (≥5% difference) in the FOSRENOL group were nausea, vomiting, and abdominal pain (Table 1). Table 1. Adverse Reactions Expressed as the event rate for each term That Were More Common on FOSRENOL in Placebo-Controlled, Double-Blind Studies with Treatment Periods of 4 to 6 Weeks FOSRENOL % (N=180) Placebo % (N=95) Nausea 11 5 Vomiting 9 4 Abdominal pain 5 0 In an open-label, long-term 2-year extension study in 93 patients who had transitioned from other studies, resulting in a total of up to 6 years treatment, mean baseline values and changes in transaminases were similar to those observed in the earlier comparative studies, with little change during treatment. The safety of FOSRENOL was studied in two long-term, open-label clinical trials, which included 1,215 patients treated with FOSRENOL and 944 with alternative therapy. Fourteen percent (14%) of patients treated with FOSRENOL discontinued treatment due to adverse events. Gastrointestinal adverse reactions, such as nausea, diarrhea, and vomiting were the most common types of event leading to discontinuation. In pooled active comparator controlled clinical trials, hypocalcemia was noted with an incidence of approximately 5% in both lanthanum and active comparator groups. A nonclinical study and a phase 1 study have shown reduced absorption of calcium in the intestine with lanthanum carbonate treatment. In a crossover study in 72 healthy individuals comparing FOSRENOL Chewable Tablets to FOSRENOL Oral Powder, gastrointestinal adverse reactions such as nausea, diarrhea, and vomiting were more common for the oral powder formulation (18%) than for the chewable tablets (7%). 6.2 Postmarketing Experience The following adverse reactions have been identified during post-approval use of FOSRENOL. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Cases of constipation, intestinal perforation, intestinal obstruction, ileus, subileus, dyspepsia, allergic skin reactions, hypophosphatemia, and tooth injury while chewing the tablet have been reported.

Drug Interactions

There is a potential for FOSRENOL to interact with compounds that bind to cationic antacids (i.e., aluminum-, magnesium-, or calcium-based); therefore, do not take such compounds within 2 hours of dosing with FOSRENOL. ( 7.1 ) Oral quinolone antibiotics must be taken at least 1 hour before or 4 hours after FOSRENOL. ( 7.2 ) Do not take thyroid hormone replacement therapy within 2 hours of dosing with FOSRENOL. Monitoring of TSH levels is recommended in patients receiving both medicinal agents. ( 7.3 ) For oral medications where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, consider separation of the timing of the administration of the two drugs. ( 7.4 ) 7.1 Drugs Binding to Antacids There is a potential for FOSRENOL to interact with compounds which bind to cationic antacids (i.e., aluminum-, magnesium-, or calcium-based); therefore, do not administer such compounds within 2 hours of dosing with FOSRENOL. Examples of relevant classes of compounds where antacids have been demonstrated to reduce bioavailability include antibiotics (such as quinolones, ampicillin, and tetracyclines), thyroid hormones, ACE inhibitors, statin lipid regulators, and anti-malarials. 7.2 Quinolone Antibiotics Co-administration of FOSRENOL with quinolone antibiotics may reduce the extent of their absorption. The bioavailability of oral ciprofloxacin was decreased by approximately 50% when taken with FOSRENOL in a single-dose study in healthy volunteers. Administer oral quinolone antibiotics at least 1 hour before or 4 hours after FOSRENOL. When oral quinolones are given for short courses, consider eliminating the doses of FOSRENOL that would normally be scheduled near the time of quinolone intake to improve quinolone absorption [see Clinical Pharmacology (12.3) ] . 7.3 Levothyroxine The bioavailability of levothyroxine was decreased by approximately 40% when taken together with FOSRENOL. Administer thyroid hormone replacement therapy at least 2 hours before or 2 hours after dosing with FOSRENOL and monitor thyroid stimulating hormone (TSH) levels [see Clinical Pharmacology (12.3) ] . 7.4 Use with Other Oral Medications There are no empirical data on avoiding drug interactions between FOSRENOL and most concomitant oral drugs. For oral medications where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, consider separation of the timing of the administration of the two drugs. The duration of separation depends upon the absorption characteristics of the medication concomitantly administered, such as the time to reach peak systemic levels and whether the drug is an immediate-release or an extended-release product. Consider monitoring clinical responses or blood levels of concomitant medications that have a narrow therapeutic range.

Storage & Handling

Storage and Handling Store FOSRENOL Chewable Tablets and FOSRENOL Oral Powder at 25°C (77°F): excursions permitted to 15°C to 30°C (59°F to 86°F). [See USP controlled room temperature.]


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