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# Aluminium Hydroxide (antacid)
## Overview
Aluminium hydroxide is an antacid that neutralizes gastric acid. It is commonly found in combination products (e.g., with magnesium hydroxide to counter constipation) but available as a single agent. Note: "aluminium hydrochloric" likely refers to aluminium hydroxide.
## Primary Indications
- Symptomatic relief of heartburn, dyspepsia, gastroesophageal reflux
- Hyperphosphatemia in chronic kidney disease (CKD) — but rarely first-line due to aluminium toxicity risk.
- Peptic ulcer disease (adjunctive).
## Adult Dosing
- **Antacid**: 600–1200 mg (as hydroxide) between meals and at bedtime, up to 4× daily. Maximum ~4 g/day short-term.
- **Hyperphosphatemia (CKD)**: 300–600 mg orally with meals. Titrate to serum phosphate. **Use lowest effective dose**; reserve for short-term or phosphate binders resistant cases. Avoid prolonged use.
## Pediatric Dosing
- **Antacid**: 5–15 mL of suspension (320–600 mg/5 mL) as needed, up to 4× daily. Doses vary by product; follow local protocol.
- **Hyperphosphatemia**: Not routinely recommended. If used, expert guidance required (max 100 mg/kg/day in divided doses; avoid in infants).
- **Maximum**: Do not exceed 2–3 weeks without medical evaluation.
## Dose Adjustments
- **Renal impairment**: Use with extreme caution. Aluminium accumulates in CKD. Avoid in dialysis unless hyperphosphatemia is refractory.
- **Hepatic impairment**: No specific adjustment.
## Contraindications
- Hypersensitivity to aluminium compounds
- Hypophosphatemia
- Severe renal failure (long-term use)
- Intestinal obstruction or GI hemorrhage (relative)
## Adverse Effects
- Constipation (common)
- Hypophosphatemia (prolonged use / high doses)
- Osteomalacia, encephalopathy, neurotoxicity (chronic use, especially in renal impairment)
- Metallic taste, nausea (uncommon)
## Key Drug Interactions
- **Tetracyclines, fluoroquinolones, iron, digoxin, thyroid hormones**: reduced absorption (separate by ≥2 hours)
- **Sodium polystyrene sulfonate**: bowel obstruction risk; do not co-administer
## Monitoring
- Serum phosphate, magnesium, calcium with prolonged use
- Neurologic status in CKD patients
## Clinical Pearls
- Use combinations (e.g., with magnesium hydroxide) to reduce constipation.
- Avoid extra or unintended doses; do not exceed product maximum.
- Educate patients to separate from other medications by at least 2 hours.
- Short-term use only — consider other acid suppression if symptoms persist.
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**Disclaimer**: This information is for educational purposes. Always verify current prescribing information, local product labeling, and clinical guidelines. Dosing may vary by formulation and protocol.
