Please check your internet connection and try again.
# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a non-systemic antacid that neutralizes gastric hydrochloric acid, forming aluminium chloride and water. It is poorly absorbed from the GI tract but can accumulate in patients with impaired renal function, leading to systemic toxicity.
## Primary Indications
* Relief of heartburn, acid indigestion, and sour stomach.
* Hyperphosphatemia (in patients with chronic kidney disease).
* Peptic ulcer disease (adjunctive therapy, though less frequent with the advent of PPIs).
## Adult Dosing
* **Antacid (Liquid/Tablet):** 500 mg to 1800 mg orally 3–6 times daily, or as needed, taken 1–3 hours after meals and at bedtime. Maximum: Consult product labeling (typically 12g/day).
* **Hyperphosphatemia:** 300 mg to 600 mg orally 3 times daily with meals. Dosage should be titrated based on serum phosphate levels.
## Pediatric Dosing
* **Antacid:** Safety and efficacy are not well-established for chronic use. Short-term use: 50–150 mg/kg/day orally in 4–6 divided doses.
* **Hyperphosphatemia:** 50–150 mg/kg/day orally in divided doses with meals.
* *Note: Precise dosing is highly dependent on institutional protocols and the child's renal status.*
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Chronic administration in patients with renal failure can cause neurotoxicity and osteomalacia due to aluminium accumulation. Frequent monitoring of serum aluminium required for long-term phosphate binding.
## Contraindications
* Hypersensitivity to aluminium salts.
* Severe abdominal pain of unknown origin.
* Signs of appendicitis/bowel obstruction.
* Use as a primary therapy in patients with debilitating renal failure without strict phosphate monitoring.
## Adverse Effects
* **Gastrointestinal:** Constipation (very common), intestinal obstruction (in high doses/elderly).
* **Metabolic:** Hypophosphatemia (with chronic high-dose use), hyperaluminemia, osteomalacia.
* **Neurological:** Encephalopathy (seen in chronic renal failure).
## Key Drug Interactions
* **Fluoroquinolones & Tetracyclines:** Aluminium binds these antibiotics in the gut, significantly reducing bioavailability. Separate by at least 2 hours before or 4-6 hours after administration.
* **Levothyroxine:** Reduces absorption; separate doses by at least 4 hours.
* **Ketoconazole/Atazanavir:** Gastric acid neutralization reduces absorption. Separate by 2-4 hours.
## Monitoring
* **Hyperphosphatemia:** Serum phosphate levels (goal ranges per clinical guidelines).
* **Renal Patients:** Serum aluminium levels (if long-term), baseline and periodic phosphate, and calcium levels.
* **Clinical:** Constipation and frequency of antacid use.
## Clinical Pearls
* Aluminium hydroxide is highly constipating; often combined with magnesium hydroxide (e.g., Maalox) to balance bowel motility.
* Constipation can be severe; ensure adequate fluid and fiber intake.
* Can exacerbate bone disease in patients with end-stage renal disease (ESRD) due to phosphate depletion and aluminium deposition in bone tissues.
***
**Disclaimer:** This information is for educational purposes only. Always consult the latest package insert, clinical guidelines, or a staff pharmacist to verify dosing and safety profile before prescribing or administering medication.
