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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a nonsystemic inorganic antacid. It acts by neutralizing gastric hydrochloric acid to form aluminium chloride and water. It is poorly absorbed from the GI tract but carries a risk of systemic accumulation in patients with renal impairment.
## Primary Indications
* Symptomatic relief of hyperacidity (heartburn, acid indigestion).
* Hyperphosphatemia (as a phosphate binder in chronic kidney disease).
## Adult Dosing
* **Antacid:** 500 mg to 1,800 mg PO administered 3 to 6 times daily, typically 1–3 hours after meals and at bedtime. Maximum daily dose varies by formulation; consult local protocol or product labeling.
* **Phosphate Binder:** 500 mg to 1,800 mg PO taken with meals (titrated based on serum phosphate levels).
## Pediatric Dosing
* **Antacid:** Safety and efficacy are not well-established for chronic use. If used, 5–15 mL (standard suspension) 3–6 times daily in older children.
* **Phosphate Binder:** 50–150 mg/kg/day administered in divided doses with meals, titrated to target serum phosphate levels.
* *Note: Consult pediatric dosing guidelines or local hospital formulary as dosing is highly patient-specific.*
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Chronic use in patients with CrCl <30 mL/min increases risk of aluminium toxicity (osteomalacia, encephalopathy). Monitor serum aluminium levels if use is prolonged.
## Contraindications
* Hypersensitivity to aluminium products.
* Severe abdominal pain of unknown origin.
* Severe renal impairment (unless specifically indicated for phosphate binding under strict monitoring).
## Adverse Effects
* **Common:** Constipation (very frequent), hypophosphatemia (with chronic or high-dose use).
* **Rare/Serious:** Aluminium toxicity (manifesting as malaise, confusion, or bone pain), fecal impaction/obstruction, intestinal obstruction, and hyperaluminemia.
## Key Drug Interactions
* **Absorption Interference:** Aluminium hydroxide significantly decreases the absorption of many drugs due to increased gastric pH and complexation.
* **Key Affected Drugs:** Tetracyclines, fluoroquinolones (e.g., ciprofloxacin), ketoconazole, iron salts, dolutegravir, and levothyroxine.
* **Spacing:** Separate administration of interacting drugs by at least 2 hours before or 4–6 hours after aluminium hydroxide.
## Monitoring
* **General:** Symptom relief, bowel frequency (to assess constipation).
* **Renal/Chronic Use:** Monitor serum phosphate, calcium, and aluminium levels periodically. Monitor for signs of neurotoxicity or worsening bone density in prolonged use.
## Clinical Pearls
* **Phosphate Binding:** To be effective as a phosphate binder, the drug *must* be ingested with meals to bind dietary phosphorus.
* **Constipation Management:** Patients frequently require prophylactic stool softeners or increased fiber/fluid intake to mitigate severe constipation.
* **Formulation Variability:** Different brand formulations have varying concentrations of elemental aluminium; always verify the mg/mL or mg/tablet strength before calculating doses.
* **Drug-Nutrient:** Long-term use can lead to phosphate depletion syndrome.
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**Educational Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Dosing and safety profiles should be verified through local hospital protocols, institutional guidelines, and current package inserts before prescribing or administering medication.
