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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a nonsystemic antacid that neutralizes gastric hydrochloric acid to form aluminium chloride and water. It is poorly absorbed from the GI tract but can bind phosphate in the gut, making it useful in treating hyperphosphatemia in addition to dyspepsia.
## 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:** 500–1,500 mg orally as needed (suspension or tablet), 3–6 times daily, or 1–3 hours after meals and at bedtime. Do not exceed 6,000 mg/24 hours.
* **Hyperphosphatemia:** Initially 500–1,800 mg orally, 3–4 times daily, taken with meals. Titrate based on serum phosphate levels.
## Pediatric Dosing
* **Antacid:** Safety and efficacy are not well established for pediatric use. Consult local institutional protocols.
* **Hyperphosphatemia:** 50–150 mg/kg/day orally in divided doses with snacks and meals. Titrate to effect.
## Dose Adjustments
* **Renal Impairment:** Use caution in patients with CKD due to risk of aluminium accumulation. Chronic use should be monitored closely to avoid neurotoxicity and osteomalacia.
## Contraindications
* Hypersensitivity to the drug or components.
* Hypophosphatemia.
* Severe abdominal pain of unknown etiology, especially if associated with fever or vomiting.
## Adverse Effects
* **Common:** Constipation (very common), intestinal obstruction (in high doses/prolonged use), fecal impaction.
* **Serious:** Hypophosphatemia (with prolonged use), aluminium neurotoxicity, osteomalacia, encephalopathy (primarily in chronic renal failure).
## Key Drug Interactions
* **Reduced Absorption:** Aluminium hydroxide can significantly decrease the absorption of tetracyclines, fluoroquinolones (e.g., ciprofloxacin), ketoconazole, iron salts, and levothyroxine.
* **Separation:** Administer these medications at least 2 hours before or 4–6 hours after aluminium hydroxide.
* **Citrate Salts:** Avoid concurrent use with citrates (e.g., potassium citrate), as they significantly increase aluminium absorption, heightening toxicity risk.
## Monitoring
* **Hyperphosphatemia:** Serum phosphate, calcium, and intact PTH levels.
* **Long-term use:** Serum aluminium levels, phosphate intake, and signs of bone mineral disease or neurologic changes.
## Clinical Pearls
* **Constipation:** Often combined with magnesium hydroxide to balance the constipating effect of aluminium with the laxative effect of magnesium.
* **Aluminium Toxicity:** Patients with poor renal function are at high risk; avoid long-term use unless specifically indicated for phosphate binding under physician supervision.
* **Administration:** Tablets should be chewed thoroughly before swallowing to ensure efficacy. Suspension should be shaken well.
* **Dosage Variance:** Dosing varies widely depending on product concentration; always verify the mg/mL or mg/tablet strength before administration.
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*Disclaimer: This information is for educational purposes and does not substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
