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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a locally acting antacid that neutralizes gastric hydrochloric acid to form aluminium chloride and water. It is non-absorbable, though small amounts may be systemically absorbed and excreted renally.
## Primary Indications
* Symptomatic relief of hyperacidity (heartburn, acid indigestion).
* Hyperphosphatemia (as a phosphate binder in chronic kidney disease).
* Adjunct in the treatment of peptic ulcer disease or GERD.
## Adult Dosing
* **Antacid:** 500–1500 mg orally as needed, 3–6 times daily, or 1–3 hours after meals and at bedtime. Maximum: Varies by product, typically 6 g/day.
* **Phosphate Binder:** 500–1800 mg orally, administered with meals. Titrate based on serum phosphate levels.
## Pediatric Dosing
* **Antacid:** 50–150 mg/kg/day in 4–6 divided doses. Consult local pediatric formulary guidelines for specific age-based weight dosing.
* **Phosphate Binder:** 50–150 mg/kg/day in divided doses with meals.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Chronic use in patients with renal failure can lead to elevated serum aluminium levels, potentially resulting in osteomalacia, encephalopathy, and microcytic anemia.
## Contraindications
* Hypersensitivity to aluminium salts.
* Severe abdominal pain of unknown origin.
* Symptomatic appendicitis.
## Adverse Effects
* **Common:** Constipation (very common), chalky or bitter taste.
* **Severe:** Aluminium toxicity (in renal impairment), hypophosphatemia (with chronic high-dose use or low-phosphate diets), intestinal obstruction, fecal impaction.
## Key Drug Interactions
Aluminium hydroxide significantly reduces the absorption of many drugs due to binding (chelation) and elevation of gastric pH.
* **Space administration by at least 2 hours** for: Tetracyclines, fluoroquinolones, ketoconazole, iron salts, bisphosphonates, levothyroxine, and warfarin.
## Monitoring
* **Renal patients:** Monitor serum phosphate, calcium, and aluminium levels.
* **Long-term use:** Monitor phosphate levels to avoid hypophosphatemia.
* **GI:** Assess for constipation or changes in bowel habits.
## Clinical Pearls
* **Constipation Management:** Often formulated with magnesium hydroxide (e.g., Maalox) to counteract the constipating effects of aluminium.
* **Drug Absorption:** Always advise patients to take medications that require acidic environments or are prone to chelation at least 2 hours apart from antacids.
* **Dietary:** If used as a phosphate binder, it must be taken *with* meals to actively bind dietary phosphate.
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*Disclaimer: This information is for educational purposes only. Clinical practice guidelines and local protocols vary significantly. Always consult the latest package insert, official clinical guidelines, or a hospital formulary before prescribing or administering medication.*
