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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a non-absorbable antacid that neutralizes gastric hydrochloric acid to form aluminium chloride and water. It is non-systemic and acts locally within the gastrointestinal tract.
## Primary Indications
* Relief of heartburn, acid indigestion, and sour stomach.
* Hyperphosphatemia (in patients with chronic kidney disease).
* Treatment of peptic ulcer disease and GERD (often in combination with magnesium salts).
## Adult Dosing
* **Antacid (Suspension/Tablet):** 500 mg to 1500 mg orally 3 to 6 times daily, taken 1 to 3 hours after meals and at bedtime.
* **Hyperphosphatemia:** 500 mg to 1800 mg orally 3 to 4 times daily, titrated based on serum phosphate levels.
* **Maximum:** Do not exceed 8 g/day unless directed by a physician.
## Pediatric Dosing
* **Antacid (Label off-label):** 5-15 mL (typically 300–600 mg) of suspension orally every 3–6 hours as needed.
* **Hyperphosphatemia:** 50–150 mg/kg/day divided into 4–6 doses, titrated to serum phosphate.
* *Note: Precise pediatric dosing is highly dependent on institutional protocols and clinical indication; consult a pediatric specialist.*
## Dose Adjustments
* **Renal Impairment:** Use caution. Chronic use in patients with renal impairment may lead to systemic aluminium accumulation, leading to encephalopathy and osteomalacia. Phosphate levels must be monitored closely.
## Contraindications
* Hypersensitivity to any component of the product.
* Severe abdominal pain of unknown cause.
* Prolonged use in patients with severe renal failure.
## Adverse Effects
* **Common:** Constipation (often dose-limiting).
* **Serious:** Hypophosphatemia (with chronic high-dose use), aluminium toxicity (manifesting as encephalopathy, seizures, or bone pain in renal patients), and fecal impaction.
## Key Drug Interactions
* **Reduced Absorption:** Aluminium hydroxide significantly decreases the absorption of tetracyclines, fluoroquinolones (e.g., ciprofloxacin, levofloxacin), bisphosphonates, azole antifungals, and iron salts.
* **Timing:** Separate doses by at least 2 hours (ideally 4 hours for fluoroquinolones) before or after other medications.
* **Enhanced Absorption:** May increase the absorption of levodopa or enteric-coated preparations (by raising gastric pH and causing premature dissolution).
## Monitoring
* **Phosphate:** Monitor serum phosphorus levels regularly if used as a phosphate binder.
* **Bowel Function:** Monitor for constipation or signs of intestinal obstruction.
* **Renal Function:** Assess baseline and periodic BUN/Creatinine in long-term users.
## Clinical Pearls
* **Constipation:** Aluminium hydroxide is frequently combined with magnesium hydroxide to balance the constipating effects of aluminium with the laxative effects of magnesium.
* **Hypophosphatemia:** Even in patients with normal renal function, prolonged high-dose use can cause "phosphate depletion syndrome," characterized by malaise, anorexia, and bone resorption.
* **Patient Education:** Advise patients to take doses with a full glass of water to assist with absorption and gastric transit.
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**Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and safety profiles can change based on current research and local clinical guidelines. Always consult official prescribing information (package insert) or a licensed healthcare professional before prescribing or administering medication.
