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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an inorganic salt used as a phosphate binder and antacid.
## Primary Indications
* **Hyperphosphatemia:** Primarily in patients with chronic kidney disease (CKD).
* **Peptic Ulcer Disease/Gastric Hyperacidity:** As an antacid to neutralize gastric acid.
## Adult Dosing
* **Phosphate Binder:** Dosing is highly individualized based on serum phosphate levels. Start with 300-600 mg (typically one to two 300mg tablets) with meals and titrate as needed. Aim for serum phosphate < 6 mg/dL. Maximum doses can exceed 2000 mg per day.
* **Antacid:** 300-600 mg (oral suspension/tablets) taken 1-3 hours after meals and at bedtime.
## Pediatric Dosing
* **Phosphate Binder:** Dosing is highly individualized and typically initiated at lower doses. For example, some guidelines suggest starting around 50 mg/kg/day in divided doses with meals, titrating based on phosphate levels. Dosing should be guided by nephrology. Maximum doses are not well-established and require careful monitoring.
* **Antacid:** Generally not recommended in infants and young children due to potential for aluminium accumulation.
## Dose Adjustments
* **Renal Impairment:** Aluminium hydroxide should be used with extreme caution or avoided in patients with significant renal impairment due to the risk of accumulation and toxicity. Dosing adjustments are complex and depend on degree of renal dysfunction and serum aluminium levels.
## Contraindications
* Hypersensitivity to aluminium hydroxide.
* Severe renal impairment.
* Bowel obstruction.
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, abdominal pain.
* **Serious:** Hyperaluminemia, osteomalacia, encephalopathy, bone pain, anemia (especially with long-term use in renal impairment).
## Key Drug Interactions
* **Tetracyclines, Fluoroquinolones, Bisphosphonates, Levothyroxine, Iron Supplements, Digoxin:** Aluminium hydroxide can chelate these drugs, reducing their absorption. Administer aluminium hydroxide at least 2 hours before or 6 hours after these medications.
* **Sodium-restricted diets:** May be a concern due to the sodium content in some formulations.
## Monitoring
* Serum phosphate levels.
* Serum calcium and magnesium levels.
* Serum aluminium levels (especially in patients with renal impairment or on long-term therapy).
* Signs and symptoms of hyperaluminemia (e.g., bone pain, neurological changes).
* Bowel function.
## Clinical Pearls
* Must be taken with meals to be effective as a phosphate binder.
* Chewable tablets should be chewed thoroughly to maximize surface area and efficacy.
* Long-term use, particularly in patients with renal insufficiency, can lead to aluminium accumulation and toxicity. Use non-aluminium-containing antacids if possible for chronic acid suppression.
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*This drug information is intended for healthcare professionals and should not replace clinical judgment. Always consult the most current prescribing information for complete details.*
