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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an antacid that neutralizes gastric acid. It is also used as a phosphate binder.
## Primary Indications
* Gastric acid neutralization (heartburn, indigestion)
* Hyperphosphatemia (in patients with chronic kidney disease)
## Adult Dosing
**Antacid:** 200 mg to 1200 mg orally every 4-6 hours as needed or after meals. Maximum daily dose is generally not to exceed 6000 mg.
**Phosphate Binder:** 160 mg to 1200 mg orally with meals. Dosing is highly individualized based on serum phosphate levels. Titrate to maintain serum phosphate < 6 mg/dL.
## Pediatric Dosing
**Antacid:** Dosing not well established, use with caution. Generally 5-15 mL of a liquid suspension (containing approximately 300 mg/5 mL) every 4-6 hours as needed.
**Phosphate Binder:** Dosing not well established, use with caution. Titrate based on serum phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Accumulation can occur, leading to aluminium toxicity. Dose reduction is typically required, but specific guidelines are lacking due to variability in renal function and toxicity risk. Close monitoring is essential.
## Contraindications
* Severe renal impairment.
* Hypersensitivity to aluminium hydroxide.
## Adverse Effects
* Constipation
* Nausea, vomiting
* Anorexia
* Abdominal pain
* Hypophosphatemia (with chronic use, especially as a phosphate binder)
* Aluminium toxicity (bone pain, encephalopathy, osteomalacia) in patients with impaired renal function.
## Key Drug Interactions
* **Tetracyclines, fluoroquinolones, bisphosphonates, iron, digoxin, ketoconazole, itraconazole:** Decreases absorption due to chelation. Separate administration by at least 2 hours.
* **Cation-donating medications (e.g., polycarbophil):** Can lead to intestinal obstruction if taken together.
## Monitoring
* **For Antacid Use:** Symptom relief.
* **For Phosphate Binder Use:** Serum phosphate levels, serum calcium, and signs of aluminium toxicity (especially in renal impairment).
## Clinical Pearls
* Aluminium hydroxide is a slow-acting but long-lasting antacid.
* Can cause significant constipation. Co-administration with magnesium-containing antacids may help mitigate this effect, but increases the risk of diarrhea and electrolyte imbalances.
* Long-term use, especially in renal impairment, can lead to aluminium accumulation and toxicity.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
