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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a non-systemic antacid that functions by neutralizing gastric acid to form aluminium chloride and water. It is generally available as a suspension or tablet, often combined with magnesium hydroxide to mitigate constipation.
## Primary Indications
* Relief of heartburn, acid indigestion, and sour stomach.
* Hyperphosphatemia (in patients with chronic kidney disease).
* Adjunct therapy in peptic ulcer disease and GERD.
## Adult Dosing
* **Antacid (Heartburn/Indigestion):** 500 mg to 1,500 mg orally 3 to 6 times daily, or as needed, taken 1–3 hours after meals and at bedtime. Maximum daily dose typically 6,000 mg unless directed by a physician.
* **Hyperphosphatemia:** Initial doses are highly variable; typically 500 mg to 1,800 mg taken with meals three times daily. Titrate based on serum phosphate levels.
## Pediatric Dosing
* **Antacid:** Safety/efficacy not well established for routine pediatric use. If used, typically 5–15 mL of a standard suspension (approx. 300 mg/5 mL) every 3–6 hours. Consult local pediatric protocols or institutional guidelines.
* **Hyperphosphatemia:** 50–150 mg/kg/day in divided doses with meals, titrated to target serum phosphate.
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with renal failure. Aluminium accumulation can lead to neurotoxicity, osteomalacia, and encephalopathy. Monitor renal function closely.
## Contraindications
* Hypersensitivity to aluminium salts.
* Severe abdominal pain of unknown origin.
* Small bowel obstruction.
## Adverse Effects
* **Common:** Constipation (very frequent), hypophosphatemia (with chronic high-dose use), and accumulation of aluminium in tissues.
* **Serious:** Neurological symptoms (confusion, dementia—rare, usually in renal failure), intestinal obstruction (fecal impaction).
## Key Drug Interactions
* **Reduced Absorption:** Aluminium hydroxide decreases the bioavailability of many drugs due to binding (chelation) and increased gastric pH.
* **Notable Interactions:** Fluoroquinolones, tetracyclines, azole antifungals, bisphosphonates, levothyroxine, and iron salts.
* **Strategy:** Administer interacting medications at least 2 hours before or 4–6 hours after aluminium hydroxide.
## Monitoring
* **Hyperphosphatemia:** Monitor serum phosphate, calcium, and aluminium levels periodically.
* **General Use:** Monitor bowel habits. In long-term therapy or renal impairment, monitor for signs of aluminium toxicity (neurological changes, bone pain).
## Clinical Pearls
* **Constipation:** Almost universal with monotherapy; often combined with magnesium to balance bowel transit effects.
* **Phosphate Binder:** Must be taken *with* meals to successfully bind dietary phosphorus.
* **Toxicity:** Chronic use in patients with poor renal function is highly discouraged due to the risk of aluminium-induced bone disease and encephalopathy.
* **Bioavailability:** Suspensions are generally more effective and faster-acting than tablets.
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**Educational 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 contraindications before administering any medication.
