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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a nonsystemic antacid that reacts with gastric hydrochloric acid to form aluminium chloride and water, effectively neutralizing gastric acidity and raising intragastric pH. It also possesses mild phosphate-binding properties.
## Primary Indications
* Hyperacidity (dyspepsia, heartburn).
* Peptic ulcer disease (adjunctive therapy).
* Hyperphosphatemia (in patients with chronic kidney disease).
## Adult Dosing
* **Antacid:** 500 mg to 1,500 mg orally 3–6 times daily, taken 1–3 hours after meals and at bedtime.
* **Hyperphosphatemia:** 500 mg to 1,800 mg orally 3–4 times daily, taken with meals. Dosing must be titrated based on serum phosphate levels.
* **Maximum Dose:** Generally 6,000 mg/day for short-term antacid use unless directed by a physician.
## Pediatric Dosing
* **Antacid:** 50–150 mg/kg/day in 4–6 divided doses.
* **Hyperphosphatemia:** 50–150 mg/kg/day in divided doses with meals.
* *Note:* Pediatric dosing varies significantly by institution; strictly follow weight-based institutional protocols.
## Dose Adjustments
* **Renal Impairment:** Reduce dose or avoid chronic use due to the risk of systemic aluminium accumulation and neurotoxicity (dialysis encephalopathy) or osteomalacia. Use with extreme caution in patients with CrCl < 30 mL/min.
## Contraindications
* Hypersensitivity to aluminium products.
* Hypophosphatemia.
* Severe abdominal pain of unknown origin (potential appendicitis or bowel obstruction).
## Adverse Effects
* **Gastrointestinal:** Constipation (very common), intestinal obstruction (in high doses or pre-existing motility disorders).
* **Metabolic:** Hypophosphatemia (with chronic or high-dose use), hyperaluminemia, decreased serum bicarbonate.
* **Neurological:** Encephalopathy (in chronic renal failure).
## Key Drug Interactions
* **Absorption Inhibition:** Aluminium hydroxide significantly decreases the bioavailability of tetracyclines, fluoroquinolones (ciprofloxacin, levofloxacin), digoxin, ketoconazole, iron salts, and thyroid hormones.
* **Administration Timing:** Separate doses by at least 2–4 hours from these medications to prevent binding/interaction.
* **Citrates:** Do not administer with citrates (e.g., sodium citrate) as they may significantly increase systemic absorption of aluminium.
## Monitoring
* **Hyperphosphatemia:** Monitor serum phosphate, calcium, and aluminium levels periodically, especially in patients with impaired renal function.
* **Bowel Function:** Monitor for constipation.
* **Long-term use:** Monitor neurological status and signs of metabolic bone disease.
## Clinical Pearls
* **Constipation:** Frequently combined with magnesium hydroxide to balance the laxative effect of magnesium with the constipating effect of aluminium.
* **Phosphate Binding:** Take specifically with meals for phosphate binding; the antacid effect is best achieved 1–3 hours after meals.
* **Safety:** Avoid in patients prone to fecal impaction or those with severe renal impairment unless prescribed under careful supervision.
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*Disclaimer: This information is for educational purposes. Clinical guidelines, specific product formulations, and institutional protocols vary. Always verify current prescribing information, dosage calculations, and drug compatibility via official package inserts or hospital pharmacy resources before administration.*
