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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is a non-systemic antacid that functions by neutralizing gastric hydrochloric acid, forming aluminium chloride and water. It is also used as a phosphate binder in patients with chronic kidney disease (CKD).
## Primary Indications
* **Antacid:** Relief of heartburn, acid indigestion, and sour stomach (symptomatic relief).
* **Phosphate Binder:** Management of hyperphosphatemia in patients with chronic kidney disease.
## Adult Dosing
* **Antacid:** 500 mg to 1800 mg orally, 3 to 6 times daily, taken 1–3 hours after meals and at bedtime. Do not exceed 8 g/day.
* **Phosphate Binder:** 500 mg to 1800 mg orally with meals. Dosing is highly individualized based on serum phosphate levels; titrate to target phosphate range.
## Pediatric Dosing
* **Antacid:** Safety and efficacy are not well established for children. Use by provider order only (typically small doses 5–15 mL of suspension, depending on concentration, as needed for symptoms).
* **Phosphate Binder:** 50–150 mg/kg/day in divided doses with meals. Use with extreme caution due to the risk of aluminium toxicity.
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with renal insufficiency. Chronic administration may lead to aluminium accumulation. In ESRD, monitor for symptoms of aluminium toxicity.
## Contraindications
* Hypersensitivity to aluminium products.
* Severe abdominal pain of unknown origin.
* Concomitant use with sodium polystyrene sulfonate (risk of metabolic alkalosis and intestinal obstruction).
## Adverse Effects
* **Common:** Constipation (frequent, often dose-dependent), hypophosphatemia.
* **Serious:** Aluminium toxicity (manifesting as encephalopathy, osteomalacia), metabolic alkalosis (rare), bowel obstruction (with chronic high-dose use).
## Key Drug Interactions
* **Absorption Interference:** Aluminium hydroxide significantly decreases the absorption of many drugs due to chelation or increased gastric pH. This includes tetracyclines, fluoroquinolones, ketoconazole, levothyroxine, and iron salts. **Administer these drugs at least 2 hours before or 6 hours after aluminium hydroxide.**
* **Citrates:** May increase aluminium absorption; avoid concurrent use.
## Monitoring
* **Hyperphosphatemia:** Serum phosphate, calcium, and aluminium levels (in patients on chronic dialysis).
* **General:** Monitor for constipation or signs of intestinal obstruction.
## Clinical Pearls
* **Constipation:** Frequently cited as a major drawback; often combined with magnesium hydroxide in commercial products to balance gastrointestinal motility.
* **Phosphate Binding:** Must be taken *with* meals to effective bind dietary phosphorus.
* **Clinical Uncertainty:** Exact dosing for phosphate binding is highly dependent on local protocols and severity of hyperphosphatemia; always verify specific facility guidelines.
* **Pediatric Risk:** Long-term use in pediatrics is generally avoided due to concerns regarding neurotoxicity and metabolic bone disease.
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*Disclaimer: This information is for educational purposes and does not substitute for clinical judgment. Always verify current prescribing information, institutional protocols, and specific product labels prior to administration.*
