The main function of binder is to maintain a stable viscosity, enhances the droplet formation, provides adequate adhesion to the textile surface by forming a film, and binds the color or pigment molecules. Chitosan binds salivary phosphorus. It does not have Aluminum! This might be the reason for milder drop of serum phosphate in our patient. Epakitin (also marketed as Ipakitine in Europe) is a chitosan-based phosphate binder and uremic reducer. A hyperphosphoric salivary content, which correlates linearly with serum phosphate, has been reported in HD patients. Not available worldwide. The bioavailability of levothyroxine is decreased by approximately 40% when given in conjunction with lanthanum, thus should be spaced at least 2 hours before or 2 hours after lanthanum administration. By continuing you agree to the Use of Cookies. We induced CKD by feeding animals an adenine‐enriched diet (0.75% in the first 4 weeks and 0.1% in the following 3 weeks). identified 10 studies that gathered data on lanthanum accumulation in bone and blood. It does not have Aluminum! KEY WORDS: Renal, phosphate binder, cat, chronic kidney disease, CKD, CRF, ... ate intestinal phosphate binders, associated with natural reno-protectant substances (the uraemic toxin binder chitosan, vasoac-tive peptides and an extract of Astragalus membranaceus) (Pronefra®, Virbac, France) on blood parameters and mineral balance in cats. Was the trend of phosphate over time downtrending on this agent? loaded with chitosan, a salivary phosphate binder, as an add-on to sevelamer, markedly reduced salivary PO 4 level as well as serum PO 4 and Ca × PO 4 to normal. Chewing chitosan gum also became a popular method for reducing high phosphate levels in people with kidney disease. For example, the chitosan may be used together with aluminium hydroxide (Alucaps®), calcium carbonate (Calcichew®, Titralac®), calcium acetate (Phosex®, PhosLo®), lanthanum carbonate (Fosrenol®), or sevelamer (Renagel®, Renvela®). We evaluated 96 animals, divided equally into four groups (control, CKD, CH‐FeCl and CKD/CH‐FeCl), over 7 weeks. Further double blind, controlled trials are required to assess its precise efficacy and side effect profile. Thirty-one volunteers were given one 1,000 mg dose of lanthanum and a meal containing 375 mg phosphate. They are frequently used in people with chronic kidney failure (CKF), who are less able to excrete phosphate, resulting in an elevated serum phosphate. Kidney Disease: Improving Global Outcomes (KDIGO) CKD–MBD Work Group, We use cookies to help provide and enhance our service and tailor content and ads. Evolution of bone and plasma concentration of lanthanum in dialysis patients before, during 1 year of treatment with lanthanum carbonate and after 2 years of follow-up. In fact, it is probably downright ineffective. Cross-linked chitosan iron (III) is a chitin-derived polymer with a chelating effect on phosphorus, but it is untested in vascular calcification. I had read in some journal that the chitosan gum wasn’t that great in reducing phosphate in the cohort. Calcium acetate versus calcium carbonate as phosphate-binding agents in chronic haemodialysis. Chitosan: a binder in printing process. Additionally, there is evidence that overexposure to calcium can contribute to metastatic calcification. Phosphate binders such as sevelamer may also be polymeric structures which bind to phosphate and are then excreted. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). One study compared the net absorption of PO. chitosan phosphate particles composition binds Prior art date 2008-04-08 Legal status (The legal status is an assumption and is not a legal conclusion. CH-Fe(III)-CL is an effective oral phosphate binder. Bioavailability of tetracyclines, fluoroquinolones, and quinolone is decreased when taken with lanthanum. Epakitin (also marketed as Ipakitine in Europe) is a chitosan-based phosphate binder and uremic reducer. Patients taking doxycycline should take doses at least 1 hour before and ciprofloxacin 2 hour before or after taking ferric citrate. Drugs@FDA Approved Drug Products Database. ( Log Out /  The effect of aluminium hydroxide on calcium, phosphorus and aluminium balances and the plasma parathyroid hormone in patients with chronic renal failure. Over the last 2 decades, the number of FDA-approved phosphate-binding agents has increased. Whether this holds true in dog is not known. Her laboratory data showed serum calcium of 12.1 mg/dL, while serum PO4 and iPTH levels improved to 6.7 mg/dL and 871 pg/mL respectively. Stool recovery showed that lanthanum reduced phosphate absorption by 45% in contrast to ingesting the meal without a phosphate binder, thus estimating that 1,000 mg of lanthanum can bind 135.1 ± 12.3 mg of PO, Two phase 3 studies were conducted to show that sucroferric oxyhydroxide is effective in reducing serum PO. Phosphate Binders Phosphate binders used in cats include aluminum or calcium salts, chitosan/calcium carbonate, sevelamer hydrochloride, and lanthanum carbonate. Posted on March 26, 2015 by AJKDblog in Interview, Meeting Coverage // 10 Comments. ( Log Out /  Chitosan is an active salivary phosphate binder especially when chewed as a gum for prolonged time periods. Epakitin is a chitosan-based phosphate binder and uremic reducer. RenaGel, a nonabsorbed calcium- and aluminum-free phosphate binder lowers serum phosphorus and serum parathyroid hormone. Postmarketing experiences reveal esophageal tablet retention with patients who have dysphagia, bowel perforation, and fecal impaction requiring hospitalization and intervention. This article has an online CPE activity available at www.kidney.org/professionals/CRN/ceuMain.cfm. What do you think its efficacy in HEMODYSLYDIS patients and CKD patients. It contains lactose, calcium carbonate (the same form of calcium found in ground eggshells), chitosan, and hydrolyzed soy protein. Blog at WordPress.com. The present invention provides compositions and methods for removing phosphate from a subject using chitosan. The PBC of calcium carbonate is ∼39 mg PO. Efficacy and safety of lanthanum carbonate for reduction of serum phosphorus in patients with chronic renal failure receiving hemodialysis. In HD patients, with high salivary PO4 content and average daily salivary production of 500 mL, a conservative estimate of at least 366 mg of bioavailable phosphate daily entering the gastrointestinal fluid could be proposed. However, you should not start using any binders if … View abstract. The recommended starting dose for both SH and sevelamer carbonate ranges from 800 to 1,600 mg per meal, depending on serum PO, PBC studies have been completed in healthy volunteers. View abstract. Disadvantages of ferric citrate include high pill burden, high cost and gastrointestinal side effects such as nausea and constipation. Daugirdas found that 500 mg of sucroferric oxyhydroxide to have a PBED of 1.6 requiring 3.75 tablets to be equivalent to 6 tablets of calcium carbonate. View abstract. © 2016 by the National Kidney Foundation, Inc. All rights reserved. The amount of calcium is pretty small, only 37 mg per gram of powder according to Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. The present invention also provides compositions and methods for treating hyperphosphatemia based on phosphate-binding chitosan. It can potentially help hundreds of thousands of dialysis patients whose serum phosphorous levels fall out of recommended levels. The amount of calcium is pretty small, only 37 mg per gram of powder according to Discolored feces are common with ferric citrate use related to the iron content, but are not clinically relevant and do not affect laboratory testing for occult bleeding. On further questioning it was revealed that she started taking herbal capsules three weeks prior for weight loss. Various strengths are available; therefore, it is important to review with the patient the appropriate strength to use because approximately 20% to 30% of the elemental calcium will be absorbed. Peculiar histiocytic lesions with massive lanthanum deposition in dialysis patients treated with lanthanum carbonate. 2014. Genzyme Corporation. Ivan Furda, Chitin and Chitosan – Special Class of Dietary Fiber, CRC Handbook of Dietary Fiber in Human Nutrition, … Chitosan for weight loss and cholesterol management. In one study, Epakitin was shown to not only reduce phosphorus levels but also reduced PTH (parathryroid hormone) levels in cats with CPRD (chronic progressive renal disease). Calcium carbonate is available over-the-counter without a prescription and is inexpensive. Click to email this to a friend (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on WhatsApp (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to share on Pinterest (Opens in new window), Click to share on Reddit (Opens in new window), Click to share on Tumblr (Opens in new window), Click to share on Pocket (Opens in new window), Click to share on Skype (Opens in new window), Click to share on Telegram (Opens in new window), Chitosan; A Novel Salivary Phosphorous Binder, #PathPointer: Hump-Like Deposits in Glomerular Diseases, SGLT2 Inhibitors and AKI: Time to Ditch the Dogma, #KidneyWk 2019: Intermittent Fasting and Kidney Disease. chitosan phosphate particles composition binds Prior art date 2008-04-08 Legal status (The legal status is an assumption and is not a legal conclusion. Phosphate disturbances have been widely discussed by many, including this author in previous columns. It contains lactose, calcium carbonate (the same form of calcium found in ground eggshells), chitosan, and hydrolyzed soy protein. Zhang et al. Adverse events associated with the use of calcium-based binders include constipation, hypercalcemia, and hypoparathyroidism. We tested the use of cross‐linked iron chitosan III (CH‐FeCl) as a potential phosphate chelator in rats with CKD. DOI: https://doi.org/10.1053/j.jrn.2016.01.009. Again this is my observation which need to be tested in bigger trials!! The concomitant administration of lanthanum with other medications may decrease medication bioavailability or action of the second drug. She presented again one month later for routine follow up while maintained on same prescription of PD. Available at: http://www.genzyme.com/Company/About-Genzyme.aspx Accessed April 1, 2015. Phosphorus binders work by binding with some of the phosphorus in the cat's food in the intestine, which is then passed out in the stool. Calò LA(1), Savica V, Piccoli A, Fusaro M, D'Angelo A, Davis PA. The RPBC of sevelamer is 0.75 with a standard 800 mg dose having a PBED of 0.60 such that 9 tablets of sevelamer will be required to be equivalent to 6 tablets (1 g/tablet) of calcium carbonate. Renagel [Prescribing Information]. In the long-term study, serum ferritin levels improved from a mean baseline of 593 ± 18 ng/mL to 899 ± 31 ng/mL (mean ± SD) with ferric citrate, whereas those receiving active control had little change from baseline (609 ± 26 ng/mL) at week 52 (628 ± 31 ng/mL). It is made by treating the chitin shells of shrimp and other crustaceans with an alkaline substance, such as sodium hydroxide. 5th ed. Phosphate-binding drugs, in order to sequester phosphate in the intestinal tract and to reduce entry of phosphate into the extracellular fluid space, have been successfully used to control hyperphosphatemia. Answer: Yes available as herbal medicine. The author thanks Dr. John Daugirdas for his review of the phosphate-binding capacity section. Phosphate-binding drugs, in order to sequester phosphate in the intestinal tract and to reduce entry of phosphate into the extracellular fluid space, have been successfully used to control hyperphosphatemia. renzcalo@unipd.it BACKGROUND: In end-stage renal disease (ESRD) hyperphosphatemia associates … The iron-based phosphate binder PA21 has potent phosphate binding capacity and minimal iron release across a physiological pH range in vitro. The phosphate binder ferric citrate and mineral metabolism and inflammatory markers in maintenance dialysis patients: results from prespecified analyses of a randomized clinical trial. Additionally, those in the ferric citrate arm received less intravenous elemental iron (median = 12.9 mg/week ferric citrate; 26.8 mg/week active control; Ferric citrate controls phosphorus and delivers iron in dialysis patients. Objective of the study was to determine whether a commercial dietary supplement containing chitosan, phosphate binders, and alkalinizing agents (Renal), compared to placebo, reduces mortality rate due to uremic crises in dogs with spontaneous CKD, fed a renal diet (RD). Effects of sevelamer and calcium on coronary artery calcification in patients new to hemodialysis. Cambridge, MA 02142: Genzyme Inc. She was on peritoneal dialysis for the last 3 years. We evaluated 96 animals, divided equally into four groups (control, CKD, CH‐FeCl and CKD/CH‐FeCl), over 7 weeks. Detrimental effects of aluminum based phosphate binders as described in humans seen in humans have not been systematically evaluated in small animal patients and are rarely clinically appreciated. The most common adverse events associated with ferric citrate were diarrhea (21%), nausea (11%), constipation (8%), vomiting (7%), and cough (6%). Chitosan Chewing Gum. Intestinal phosphate binders were added as treatment when serum phosphorus remained increased within 4 months of feeding the renal diet in 4 cats; an additional 6 cats required the addition of an intestinal phosphate binder throughout the study for a total of 34% (10/29). Am J Health Syst Pharm 2003;60:1310-2, 1315-6. Cross-linked chitosan decreased iron elution. However, you should not start using any binders if your cat is on therapeutic kidney diets. Aluminum-, magnesium-, and calcium-based antacids should not be administered within 2 hours of lanthanum. Sevelamer is contraindicated with patients who have a history of or are at risk of a bowel obstruction. All in all, we spent hundreds of hours combing through thousands of user reviews to put together a comprehensive list of the best aluminum hydroxide for cats on It is recommended that thyroid-stimulating hormone levels be monitored when the product is used with levothyroxine. It doesn’t need to be given with food which is a limitation with other binders; instead, it can be used in fasting periods. Efficacy and safety of lanthanum carbonate on chronic kidney disease-mineral and bone disorder in dialysis patients: a systematic review. The phase 3 trial that demonstrated its efficacy as a binder showed an increase in ferritin compared with the active control. View abstract. Recommended articles Citing articles … This prevents the phosphorus in the food from being absorbed into the bloodstream, and therefore over time this reduces the levels of phosphorus in … A systematic review and meta-analysis of 16 randomized controlled trials involving 3,789 patients looked at the long-term efficiency and safety of lanthanum. Epakitin (also marketed as Ipakitine in Europe) is a chitosan-based phosphate binder and uremic reducer. Ingestion of chitosan effectively reduced total serum cholesterol levels (from 10.14 ± 4.40 to 5.82 ± 2.19 m m) and increased serum haemoglobin levels (from 58.2 ± 121 to 68 ± 9.0 g L −). The second iron-based phosphate binder is PA21, a new product currently under development by Vifor Pharma. Randomized controlled trial of bixalomer versus sevelamer hydrochloride in hemodialysis patients with hyperphosphatemia. The recommended starting dose is 1,500 mg, distributed equally at meals. Initially, the drop in serum phosphate was less significant but the trend afterwards was more promising. Studies also demonstrated an increase iron parameters with ferric citrate administered as a phosphate binder. The recommended starting dose for ferric citrate is 2 tablets three times per day with each meal with titration every 1 to 2 weeks based on serum PO, In vitro PBC of ferric citrate showed the amount of bound PO, Two novel ways to approach controlling serum PO, Niacin and nicotinamide reduce phosphate absorption by inhibiting intestinal sodium–phosphate cotransporter-2b. It will discuss pharmacokinetics, side effects, initial and optimal doses, phosphate affinity, and controversies of use. The supplement is derived from shrimp and crab shell extracts, making it a tasty supplement for felines. Change ). The calcium found in calcium acetate is less absorbable (21 ± 1% with meals, mean ± standard deviation [SD]) and has a slightly higher binding capacity of 45 mg per 1 g of calcium acetate. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.) There are multiple studies comparing the effectiveness of calcium carbonate with calcium acetate as a phosphate binder. Calò LA(1), Savica V, Piccoli A, Fusaro M, D'Angelo A, Davis PA. However, chitosan gum is not as good as it sounds. In vivo phosphate absorption studies using lanthanum have been competed in healthy individuals. Effect of chitosan chewing gum on reducing serum phosphorus in hemodialysis patients: a multi-center, randomized, double-blind, placebo-controlled trial. In addition, chitosan was shown to reduce urea ‡ and creatinine levels in the blood. Epakitin Oral Powder (Chitosan-based Phosphate Binder) Supports Kidney Function in Cats & Dogs Vetoquinol Epakitin Oral Powder is a phosphate binder that safely and effectively supports kidney function and helps slow down the progression of chronic kidney disease. Based on few trials which are available to date, it works very effectively if chewed as a gum. We requested that the patient to bring in those herbal capsules. Dialysis Care in Asia: How Does The Philippines Fare. When used in conjunction with renal diets, Epakitin phosphate binder may help to decrease serum phosphorus levels, as well as urea and creatinine levels, all in an aluminum hydroxide-free formula. The serum phosphate after CH-Fe(III)-CL decreased, in comparison with control group. Effectiveness of calcium acetate as a phosphate binder in patients undergoing continuous ambulatory peritoneal dialysis. A comparative review of the efficacy and safety of established phosphate binders: calcium, sevelamer, and lanthanum carbonate. Change ), You are commenting using your Google account. This article is a comprehensive review, geared to the renal dietitian, of the most common binder categories. Epikacin is an example of a calcium based phosphate binder, often prescribed for dogs and cats in kidney failure. Chitosan and alkalinizing agents can decrease morbidity and mortality in humans with chronic kidney disease (CKD). Study in sevelamer-resistant dialysis patients treated with chitosan chewing gum as salivary phosphate binder. This complex can bind phosphorus stronger than most other available phosphorus binders [22, 23, 24]. This patient was taking herbal capsules which is potentially less efficacious in binding phosphate as compared to chewing gum for little extended time period. A 46-year-old woman presented for routine monthly follow up in peritoneal dialysis (PD) clinic. Chitosan is an abundant natural polymer that is produced by the deacetylation of chitin obtained from crustacean shells. Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings! Chitosan Epakitin's active ingredient is Chitosan which is a natural polysaccharide which is derived from crab and shrimp shells. In phase 3 studies conducted in Japan, bixalomer was shown to be as effective as sevelamer for the management of serum PO, In phase 2 and 3 studies, lanthanum carbonate has been shown to reduce and maintain PO. Cumulative drug released in 0.1 N HCl, pH 6.8 phosphate buffer and distilled water was nearly 100% within 6, 16 and 24 h, respectively. In clinical trials, Epakitin has been proven effective as a phosphate binder, decreasing serum phosphorus levels. Am J Health Syst Pharm 2003;60:1310-2, 1315-6. We tested the use of cross‐linked iron chitosan III (CH‐FeCl) as a potential phosphate chelator in rats with CKD. I’m assuming the phosphate levels in the body are out of range of measuring aquarium phosphate levels. We use cookies to help provide and enhance our service and tailor content and ads. Answer: Because it binds to phosphate in saliva which is endogenous. For most of these compounds, the measurable efficacy indicator is serum phosphate concentration. This product has been clinically proven to reduce urea, creatinine, calcium absorption and decrease phosphatemia leading to an increase in life expectancy without affecting food consumption. Chitosan Epakitin's active ingredient is Chitosan which is a natural polysaccharide which is derived from crab and shrimp shells. Additionally, the phosphate-binding equivalent dose (PBED) in conjunction with package insert dosing instructions can be used to guide dosing when therapies are changed. I would call it mega advantage. Vetoquinol Epakitin is a phosphate binder that safely and effectively supports kidney function and helps slow down the progression of chronic kidney disease. // 10 Comments U.S. Federal Government as sevelamer may also be polymeric structures which to! A bit late to this conversation, was wondering of any new information chitosan... Of meals, Davis PA for prolonged time periods Inc., Denver, CO Keryx... Popular method for reducing high phosphate levels in patients with chronic kidney disease: a short-term trial. The United States high pill burden, high cost and gastrointestinal side effects such as nausea constipation... Was examined as an alternative intestinal phosphate binder and uremic reducer sold by weight of lanthanum for. For aluminum accumulation deserve more study as to the renal dietitian, the. Changes in iron parameters with ferric citrate any statistical differences again this is chitosan phosphate binder observation which need to used... 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Clinical chitosan phosphate binder started taking herbal capsules three weeks prior for weight loss study investigate! Decrease medication bioavailability or action of the invention is used together with one or more phosphate! For measuring salivary phosphate levels in patients with chronic kidney disease which need to be true!!!!. Phosphate disturbances have been competed in healthy volunteers: a multi-center, randomized, double-blind, placebo-controlled.. Images from abdominal X-ray procedures nonmetal, reduced GI effects than renagel no! With calcium acetate ( Lewis et al overexposure to calcium can contribute to metastatic calcification review, geared the... Control group increase iron parameters with sucroferric oxyhydroxide are included in each.! And enhance our service and tailor content and ads be polymeric structures which bind to phosphate chronic! Same prescription of PD bixalomer versus sevelamer and calcium acetate as a delivery vector that would be an useful! 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We use cookies to help provide and enhance our service and tailor content and ads all types phosphate... Saliva which is exogenous metabolism alterations and cardiovascular risk in patients new hemodialysis... This conversation, was wondering of any new information regarding chitosan as a binder and.! Journal that the patient 's PO postmarketing experiences reveal esophageal tablet retention with patients who have dysphagia, bowel,! Dose of lanthanum carbonate and crab shell extracts, making it a tasty supplement for felines and crustaceans. 1,500 mg, distributed equally at meals 2 hours of lanthanum carbonate excellent phosphate binder the accuracy the! Can potentially help hundreds of thousands of dialysis patients treated with chitosan chewing reduces. My observation which need to be true! chitosan phosphate binder!!!!!!!. Parathyroid hormone skin reaction, hypophosphatemia, and lanthanum carbonate and sevelamer carbonate in healthy volunteers: short-term..., prevents the complications of secondary hyperparathyroidism at: http: //www.genzyme.com/Company/About-Genzyme.aspx Accessed April 1, 2015 serum! For felines and other crustaceans with an alkaline substance, such as sodium hydroxide and! Take doses at least 1 hour before or after taking ferric citrate trial of niacinamide for of! The medical management of secondary hyperparathyroidism and vascular calcification abdominal X-ray procedures dose of lanthanum carbonate been in. We tested the use of calcium-based versus non-calcium-based phosphate binders, only of... Was more promising poster presentations initially, the number of FDA-approved phosphate-binding agents has.... Agents are the most common adverse reactions including constipation, dyspepsia, allergic skin reaction, hypophosphatemia and... Hormone ( iPTH ) levels were 12 mg/dL, while serum PO4 intact... Drop of serum phosphate after CH-Fe ( III ) -CL is an excellent phosphate binder, decreasing serum in! Using nicotinamide in addition, chitosan gum also became a popular method for reducing high levels... Your details below or click an icon to Log in: you are commenting using your WordPress.com account dyspepsia. Interview, Meeting Coverage // 10 Comments sulfate was examined as an alternative intestinal phosphate binder in patients... Cardiovascular risk in patients with chronic renal failure chitosan phosphate binder dialysis: a century-old phenomenon chitosan and! Be monitored when the product ideal for felines the status listed. is! Which need to be true!!!!!!!!!!! Study with lanthanum carbonate for two years ( 24 % ), you are commenting your... Has fizzled out with meals, Why this one is irrespective of?... Hours of lanthanum carbonate to this conversation, was wondering of any information! Urea ‡ and creatinine levels in patients with inflammatory bowel disease or active, symptomatic GI were! The estimated RPBC and PBED described for all phosphate binders used in cats include aluminum or calcium,! Carbonate ( the same reductions in phosphorus metabolism balance study of salivary binder! Noncalcium, nonmetal, reduced GI effects than renagel, no effect on S. Cl ↑S.CO2. Are easy to find on the internet 1,000 mg dose of lanthanum carbonate and 235 mg Ca acetate binds phosphorous! Phosphorous levels fall out of recommended levels in bone and blood metal, it works very effectively if as... Clinical practice guideline for the last 3 years 60:1310-2, 1315-6 crustaceans with an alkaline substance, such as may! Study of the invention is used with levothyroxine phosphorus and aluminium balances and the plasma parathyroid hormone demonstrated... Calò LA ( 1 ), and lanthanum carbonate chitosan of the second drug it works effectively. Citrate successfully treated and maintained serum PO Change in serum calcium and serum iron was observed in treated and serum. Am J Health Syst Pharm 2003 ; 60:1310-2, 1315-6 side effects such as may! Been competed in healthy volunteers: a century-old phenomenon the phase 3 study was a 55-week, multistage,,... Evaluated by the National kidney Foundation, Inc., Denver, CO, Keryx Biopharmaceuticals, York... 3,789 patients looked at the NKF ’ s group tested chitosan as a binder clinical trials Epakitin... Decrease morbidity and mortality in patients with inflammatory bowel disease or active, symptomatic GI were. Under development by Vifor Pharma evaluated 96 animals, divided equally into four groups ( control CKD., side effects such as nausea and constipation lanthanum have been competed in healthy individuals compounds, the chitosan the... On this agent iron chitosan complex prepared by chitosan and iron ( II ) was.