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# Aluminium hydroxide
## Overview
Aluminium hydroxide is an antacid that neutralizes gastric acid. It is also a phosphate binder.
## Primary Indications
* Gastric acid hypersecretion (e.g., peptic ulcer disease, GERD)
* Hyperphosphatemia
## Adult Dosing
* **Antacid:** 300-600 mg orally 1 to 3 hours after meals and at bedtime. Maximum dose is typically 2000 mg per day; however, some sources suggest up to 4800 mg per day in divided doses.
* **Phosphate Binder:** 500-1800 mg orally with meals, taken in divided doses. Titrate based on serum phosphate levels. Maximum dose typically 2300 mg per meal, or up to 9200 mg per day.
## Pediatric Dosing
Dosing is not well-established in pediatrics. Use with caution and consider alternatives if possible. If used for phosphate binding, titrate carefully based on response and monitor for toxicity.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is necessary due to risk of aluminium accumulation. Start with lower doses and monitor serum aluminium levels.
## Contraindications
* Hypersensitivity to aluminium hydroxide.
* Severe renal impairment (relative contraindication, use with extreme caution).
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, abdominal pain.
* **Serious:** Aluminium toxicity (bone disease, encephalopathy, anemia) with prolonged use, especially in renal impairment. Hypophosphatemia with chronic use as a phosphate binder.
## Key Drug Interactions
* **Decreases absorption of:** Tetracyclines, fluoroquinolones, digoxin, iron salts, isoniazid, nitrofurantoin, ketoconazole, itraconazole, salicylates. Separate administration by at least 2 hours.
* **May decrease absorption of:** Bisphosphonates, certain antiretrovirals.
## Monitoring
* **Antacid use:** Symptomatic relief, gastric pH.
* **Phosphate binder use:** Serum phosphate levels (target < 5.5 mg/dL), serum calcium, alkaline phosphatase.
* **Renal impairment:** Serum aluminium levels to prevent accumulation.
## Clinical Pearls
* Aluminium hydroxide is a slow-acting antacid with a prolonged duration of action.
* It can cause constipation, which may be dose-limiting.
* As a phosphate binder, it is most effective when taken with meals.
* Long-term use, especially in patients with renal insufficiency, carries a significant risk of aluminium toxicity. Consider alternative phosphate binders if feasible.
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*Disclaimer: This information is intended for clinical reference only. Always consult the most current prescribing information and consider individual patient factors. Local protocols may differ.*
