Please check your internet connection and try again.
# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an inorganic salt used as a phosphate binder and antacid.
## Primary Indications
* **Antacid:** Relief of heartburn, indigestion, and upset stomach.
* **Phosphate Binder:** Management of hyperphosphatemia in patients with chronic kidney disease (CKD).
## Adult Dosing
* **Antacid:** 300 mg to 600 mg orally every 4 to 6 hours as needed. Usual dosage is 5 mL to 10 mL of liquid suspension or 1 to 2 chewable tablets. Maximum dose: 1200 mg per dose or 4800 mg per day.
* **Phosphate Binder (CKD patients):** Dosing is highly individualized and depends on serum phosphate levels. Typically initiated at 500 mg to 1000 mg orally with each meal. Titrate based on serum phosphate levels. Maximum doses vary, but generally do not exceed 2000 mg per day.
## Pediatric Dosing
* **Antacid:** 2.5 mL to 5 mL of liquid suspension or 1 chewable tablet orally every 4 to 6 hours as needed.
* **Phosphate Binder (CKD patients):** Dosing is not well-established and should be individualized by a nephrologist. Extreme caution is advised due to risk of aluminium toxicity.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution. Aluminium can accumulate, leading to toxicity. Dose reduction is essential, and frequent monitoring is required. Many guidelines suggest avoiding chronic use in severe renal impairment.
## Contraindications
* Patients with hypersensitivity to aluminium hydroxide.
* Severe renal impairment (may be used cautiously under strict monitoring).
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, abdominal pain, chalky taste.
* **Serious:** Hyperaluminemia (especially in renal impairment, can lead to osteomalacia, encephalopathy, and anemia), hypophosphatemia (with long-term use, especially as a phosphate binder).
## Key Drug Interactions
* **Tetracyclines, fluoroquinolones, bisphosphonates, iron salts, levothyroxine, digoxin:** Aluminium hydroxide can chelate these drugs, reducing their absorption. Separate administration by at least 2 hours (before or after).
* **Sodium-restricted diets:** Aluminium hydroxide contains sodium, which may be a concern for patients on sodium restriction.
## Monitoring
* Serum phosphate levels (especially in CKD patients).
* Serum calcium and magnesium levels.
* In patients with renal impairment, monitor serum aluminium levels.
* Signs of GI upset.
## Clinical Pearls
* Aluminium hydroxide is a slow-acting antacid but has a prolonged duration of action.
* When used as a phosphate binder, it is most effective when taken with meals.
* Chronic use, especially in patients with impaired renal function, carries a significant risk of aluminium accumulation and toxicity.
***
*Please consult the most current prescribing information and relevant clinical guidelines for definitive guidance. This information is intended for educational purposes and does not substitute for professional medical judgment.*
