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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a locally acting antacid that neutralizes gastric acid. It reacts with hydrochloric acid in the stomach to form aluminium chloride and water, thereby increasing gastric pH. It also exhibits phosphate-binding properties in the gastrointestinal tract.
## Primary Indications
* Hyperacidity (heartburn, acid indigestion).
* Hyperphosphatemia (in patients with chronic kidney disease).
* Peptic ulcer disease (adjunctive therapy/symptom relief).
## Adult Dosing
* **Antacid:** 500 mg to 1,500 mg orally as needed, 3–6 times daily, taken 1 hour after meals and at bedtime.
* **Hyperphosphatemia:** 500 mg to 1,800 mg orally with meals; dose titration is guided by serum phosphate levels.
* *Note:* Maximum doses depend on formulation and specific indication; consult institutional protocols.
## Pediatric Dosing
* **Antacid:** 5–15 mL (standard suspension, usually 320 mg/5 mL) every 3–6 hours as needed.
* **Hyperphosphatemia:** 50 mg/kg/day to 150 mg/kg/day divided in 4–6 doses, tailored to efficacy in phosphorus control.
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with chronic kidney disease (CKD) due to risk of aluminium accumulation/toxicity (systemic absorption in renal failure).
* **Dialysis:** Often monitored closely when used as a phosphate binder; assess for signs of aluminium toxicity.
## Contraindications
* Hypersensitivity to aluminium products.
* Severe abdominal pain of unknown origin.
* Prolonged use in patients with severe renal impairment (risk of neurotoxicity/osteomalacia).
## Adverse Effects
* **Gastrointestinal:** Constipation (common), intestinal obstruction (in high doses/prolonged use).
* **Metabolic:** Hypophosphatemia (with chronic/excessive use), aluminium toxicity (manifesting as encephalopathy, seizures, or osteomalacia in renal failure patients).
## Key Drug Interactions
* **Absorption Inhibition:** Aluminium hydroxide interferes with the absorption of many drugs due to pH changes and chelation.
* **Medication Spacing:** Separate doses by at least 2 hours from: Tetracyclines, fluoroquinolones, ketoconazole, iron salts, levothyroxine, and bisphosphonates.
* **Citrates:** Do not take with citrates (e.g., potassium citrate), as they significantly increase aluminium absorption, heightening toxicity risk.
## Monitoring
* Serum phosphate levels (if used as phosphate binder).
* Signs of constipation or bowel obstruction.
* Neuropsychiatric status (if long-term usage or renal impairment exists).
## Clinical Pearls
* **Constipation:** Often combined with magnesium hydroxide to balance the constipating effect of aluminium with the laxative effect of magnesium.
* **Phosphate Binding:** Must be taken *with* meals to bind dietary phosphorus; taking it between meals is ineffective for this purpose.
* **Liquid vs. Tablet:** Liquid preparations generally have a faster onset and higher neutralizing capacity than tablets. Ensure tablets are chewed thoroughly before swallowing.
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*Disclaimer: This information is for educational purposes only. Dosage and clinical appropriateness must be verified against current institutional policies, regional protocols, and individual patient clinical status before prescribing or administration.*
