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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an inorganic salt used primarily as an antacid and phosphate binder. It acts by neutralizing hydrochloric acid in the stomach to form aluminium chloride and water, and by binding dietary phosphates in the gastrointestinal tract to form insoluble aluminium phosphate.
## Primary Indications
* **Antacid:** Relief of heartburn, acid indigestion, and sour stomach.
* **Phosphate Binder:** Management of hyperphosphatemia in patients with chronic kidney disease (CKD).
## Adult Dosing
* **Antacid:** 500 mg to 1,800 mg orally between meals and at bedtime, as needed. Do not exceed 8,000 mg/day.
* **Phosphate Binder:** 500 mg to 1,800 mg three times daily with meals. Dosage must be titrated based on serum phosphate levels.
## Pediatric Dosing
* **Antacid/Phosphate Binder:** Safety and efficacy are not well established for long-term use.
* **Phosphate Binder:** Commonly 50–150 mg/kg/day in divided doses with meals, titrated to effect. High variability exists based on local institutional protocols; consult a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Aluminium accumulation can occur in patients with renal failure, leading to neurotoxicity and osteomalacia. Monitor aluminum levels closely if long-term therapy is required.
## Contraindications
* Hypersensitivity to aluminium products.
* Severe abdominal pain of unknown origin.
* Concomitant use with citrate salts (may significantly increase systemic aluminium absorption).
## Adverse Effects
* **Common:** Constipation, fecal impaction, intestinal obstruction (high doses).
* **Metabolic:** Hypophosphatemia (with prolonged use), hyperaluminemia, osteomalacia, and encephalopathy (primarily in chronic kidney disease).
## Key Drug Interactions
* **Absorption Inhibition:** Aluminium hydroxide reduces the absorption of tetracyclines, fluoroquinolones (e.g., ciprofloxacin, levofloxacin), bisphosphonates, levothyroxine, and ketoconazole.
* **Management:** Separate administration by at least 2 hours before or 4–6 hours after other oral medications.
* **Citrate Salts:** Increases aluminium absorption; avoid concurrent use.
## Monitoring
* **Serum Phosphate:** Monitor levels every 1–2 weeks during initial titration; monthly/quarterly thereafter.
* **Serum Aluminium:** Monitor periodically in patients with CKD, especially if on long-term therapy or presenting with unexplained neurological or bone symptoms.
* **Bowel function:** Assess for constipation.
## Clinical Pearls
* **Constipation:** Almost universal; often combined with magnesium hydroxide (e.g., Maalox/Mylanta) to balance bowel effects.
* **Phosphate Binding:** Must be taken **with meals** to be effective as a phosphate binder.
* **Chronic Use:** Avoid long-term use as a primary antacid due to the risk of aluminium systemic absorption and phosphate depletion.
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**Educational Disclaimer:** This information is for educational purposes and does not substitute for professional clinical judgment. Always verify current prescribing information, institutional protocols, and local drug monographs before prescribing or administering medication.
