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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 in patients with chronic kidney disease ## Adult Dosing * **Antacid:** 500 mg to 1200 mg orally every 4-6 hours as needed. Maximum daily dose is typically 6000 mg. * **Phosphate Binder:** 500 mg to 1000 mg orally with meals and snacks. Dosing is individualized based on serum phosphate levels. ## Pediatric Dosing There is limited established pediatric dosing. Dosing in children should be individualized and supervised by a healthcare professional. ## Dose Adjustments * **Renal Impairment:** Use with caution. Aluminium can accumulate, leading to toxicity. Dosing should be significantly reduced and serum aluminium levels monitored. ## Contraindications * Hypersensitivity to aluminium hydroxide * Severe renal impairment ## Adverse Effects * Constipation * Nausea, vomiting * Anorexia * Hypophosphatemia (with prolonged use, especially as a phosphate binder) * Aluminium accumulation and toxicity (bone pain, encephalopathy, osteomalacia), particularly in patients with renal impairment. ## Key Drug Interactions * **Tetracyclines, fluoroquinolones, iron supplements, digoxin:** Aluminium hydroxide can chelate these drugs, reducing their absorption. Separate administration by at least 2 hours. * **Ketoconazole, itraconazole:** Decreased absorption may occur due to increased gastric pH. * **Sodium polystyrene sulfonate:** Reduced efficacy of both drugs. ## Monitoring * **For Antacid Use:** Symptomatic relief of heartburn, epigastric pain. * **For Phosphate Binder Use:** Serum phosphate levels, serum calcium, and magnesium levels. Monitor for signs of aluminium toxicity (bone pain, neurological changes) in patients with renal impairment. ## Clinical Pearls * Shake liquid suspensions well before use. * For phosphate binding, administration with meals is crucial for efficacy. * Prolonged use, especially in renal impairment, carries a risk of aluminium accumulation. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and clinical guidelines before making therapeutic decisions.*