Aluminium Hydroxide (assumed From "aluminium Hydrochloric")

# Aluminium Hydroxide ## Overview Aluminium hydroxide is an inorganic antacid that acts by neutralizing hydrochloric acid in the stomach. It is poorly absorbed and has a slower onset but longer duration of action compared to sodium bicarbonate. It also possesses phosphate-binding properties. ## Primary Indications * Relief of heartburn, acid indigestion, and sour stomach. * Hyperphosphatemia (in patients with chronic kidney disease). * Adjunct therapy in peptic ulcer disease and GERD. ## Adult Dosing * **Antacid:** 500 mg to 1800 mg orally between meals and at bedtime, as needed. Do not exceed 8,000 mg/day for short-term use. * **Phosphate Binder:** Dosage must be individualized based on serum phosphate levels. Typical starting dose is 500 mg to 1500 mg taken with each meal. ## Pediatric Dosing * **Antacid:** 50–150 mg/kg/day in 4–6 divided doses. * **Phosphate Binder:** 50–150 mg/kg/day in divided doses with meals, titrated to target serum phosphate levels. * *Note:* Pediatric dosing varies significantly by institution; consult local clinical pharmacy protocols or neonatal/pediatric formularies (e.g., Harriet Lane). ## Dose Adjustments * **Renal Impairment:** Use with caution. Aluminium accumulates in patients with renal failure, leading to systemic toxicity (e.g., osteomalacia, encephalopathy). Frequent monitoring of serum aluminium levels is recommended in chronic kidney disease. ## Contraindications * Hypersensitivity to aluminium products. * Severe abdominal pain of unknown origin. * Patients with bowel obstruction. ## Adverse Effects * **Gastrointestinal:** Constipation (very common), intestinal obstruction (in high doses/prolonged use). * **Metabolic:** Hypophosphatemia (due to binding of dietary phosphate), hyperaluminemia (with chronic use). * **Neurological:** Encephalopathy (rare, seen in renal failure). ## Key Drug Interactions Aluminium hydroxide binds to many drugs, significantly reducing their bioavailability. Separate administration by at least 2 hours. Key affected drugs include: * **Tetracyclines and Fluoroquinolones:** Significant reduction in absorption. * **Bisphosphonates:** Reduced absorption. * **Levothyroxine:** Reduced absorption. * **Iron salts:** Reduced absorption. ## Monitoring * **Phosphate Levels:** Monitor serum phosphorus closely when used as a binder to avoid hypophosphatemia. * **Bowel Function:** Monitor for constipation or signs of impaction. * **Serum Aluminium:** Monitor in patients with renal impairment or long-term high-dose therapy. ## Clinical Pearls * **Constipation:** Frequently combined with magnesium hydroxide to balance the constipating effect of aluminium with the laxative effect of magnesium. * **Administration:** Suspension forms are generally more effective than tablets. Chewable tablets must be chewed thoroughly before swallowing. * **Phosphate Binding:** Must be taken *with* meals to effectively bind dietary phosphate. *** *Disclaimer: This information is for educational purposes only. Clinical guidelines and dosing protocols vary by institution. Always verify current prescribing information, institutional guidelines, and patient-specific factors with a clinical pharmacist or the official product monograph before prescribing or administering medication.*