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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 accumulate in patients with renal impairment.
## Primary Indications
* Symptomatic relief of dyspepsia, heartburn, and gastroesophageal reflux disease (GERD).
* Hyperphosphatemia (as a phosphate binder in chronic kidney disease).
## Adult Dosing
* **Antacid (Dyspepsia/GERD):** 500 mg to 1500 mg orally 3–6 times daily, or as needed, taken 1–3 hours after meals and at bedtime. Maximum: Refer to specific product labeling (often limited to 3-4 weeks of self-use).
* **Phosphate Binding:** 500 mg to 1.8 g orally 3 times daily with meals. Dosing must be titrated based on serum phosphate levels.
## Pediatric Dosing
* **Antacid:** 50–150 mg/kg/day in divided doses every 4–6 hours.
* **Phosphate Binding:** 50–150 mg/kg/day in divided doses administered with meals.
* *Note: Pediatric dosing is highly variable; consult local institutional protocols or a pediatric dosing formulary for age-specific weight-based adjustments.*
## Dose Adjustments
* **Renal Impairment:** Avoid or use with extreme caution. Chronic use in patients with renal failure (CrCl <30 mL/min) can lead to aluminium toxicity (encephalopathy, osteomalacia).
* **Hepatic Impairment:** No specific dosage adjustment usually required, but use caution regarding electrolytes.
## Contraindications
* Hypersensitivity to aluminium products.
* Severe abdominal pain of unknown origin (potential appendicitis or bowel obstruction).
## Adverse Effects
* **Gastrointestinal:** Constipation (very common), intestinal obstruction (in high doses/prolonged use).
* **Metabolic:** Hypophosphatemia (with chronic high-dose use), hyperaluminemia (in renal impairment).
## Key Drug Interactions
* **Reduced Absorption:** Aluminium hydroxide binds to and severely reduces the absorption of tetracyclines, fluoroquinolones (e.g., ciprofloxacin), bisphosphonates, levothyroxine, and azole antifungals.
* **Dosing Separation:** Administer other medications at least 2 hours before or after aluminium hydroxide to avoid chelation interactions.
* **Citrates:** Do not take with citrates (e.g., potassium citrate for kidney stones) as they significantly increase aluminium absorption, risking toxicity.
## Monitoring
* **Phosphate Levels:** Monitor serum phosphorus closely when used as a binder; adjust dosage to target range.
* **Renal Function:** Monitor baseline and periodic renal function.
* **Symptoms:** Monitor for resolution of dyspepsia; chronic use beyond 2 weeks requires professional medical evaluation to rule out malignancy or ulceration.
## Clinical Pearls
* **Constipation:** Frequently combined with magnesium hydroxide to balance the laxative effect of magnesium with the constipating effect of aluminium.
* **Aluminium Toxicity:** Patients with chronic kidney disease are at high risk for neurotoxicity; use non-aluminium phosphate binders (e.g., sevelamer, calcium acetate) if possible.
* **Administration:** Suspension forms provide a faster onset of action than tablets.
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*Disclaimer: This information is for educational purposes only. Always consult the latest package insert, clinical guidelines, or institutional formulary to verify dosing, safety info, and contraindications before prescribing or administration.*
