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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an antacid used for hyperphosphatemia and to neutralize gastric acid.
## Primary Indications
* Treatment of hyperphosphatemia in patients with chronic kidney disease (CKD).
* Symptomatic relief of heartburn, indigestion, and upset stomach.
## Adult Dosing
* **Hyperphosphatemia:** Dosing is highly individualized based on serum phosphate levels. Typical starting doses range from 200 mg to 1800 mg (elemental aluminium) per day, divided into multiple doses with meals. Maximum doses can vary, but aim to maintain serum phosphate < 5.5 mg/dL. Titrate as needed. The amount of elemental aluminium per dose can be found on product labeling.
* **Antacid:** 500 mg to 1800 mg by mouth, taken with meals and at bedtime, or as needed for symptomatic relief.
## Pediatric Dosing
* **Hyperphosphatemia:** Dosing in pediatric patients is less well-established and requires careful titration. Consult specialized pediatric nephrology resources. A common starting point may be 50-150 mg/kg/day of elemental aluminium divided into 3-6 doses.
* **Antacid:** Not typically recommended for routine use as an antacid in children. Safety and efficacy have not been established.
## Dose Adjustments
* **Renal Impairment:** Use with extreme caution in patients with severe renal impairment due to risk of aluminium accumulation. Monitor aluminium levels.
## Contraindications
* Hypersensitivity to aluminium hydroxide.
* Patients with a history of bowel obstruction.
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, anorexia.
* **Serious:** Aluminium accumulation leading to osteomalacia, encephalopathy, and anemia. Hypercalcemia (rare, usually with calcium-containing antacids).
## Key Drug Interactions
* **Tetracyclines, fluoroquinolones, bisphosphonates, digoxin, iron salts, levothyroxine:** Aluminium hydroxide can bind to these drugs in the gastrointestinal tract, reducing their absorption and efficacy. Separate administration by at least 2 hours (before or after) the interacting drug.
* **Citrates:** Can increase absorption of aluminium, potentially leading to toxicity.
## Monitoring
* **Hyperphosphatemia:** Serum phosphate levels regularly (e.g., weekly to monthly, depending on control). Aim to maintain serum phosphate < 5.5 mg/dL.
* **Renal Function:** Serum creatinine, BUN.
* **Electrolytes:** Calcium, magnesium, phosphate.
* **Aluminium Levels:** In patients with impaired renal function or long-term therapy, particularly if symptoms of toxicity arise.
* **Signs of bone disease:** In patients with CKD on long-term therapy.
## Clinical Pearls
* For hyperphosphatemia, it is crucial to administer with meals to effectively bind dietary phosphate.
* Patients often experience constipation; consider stool softeners if needed.
* Liquid formulations may provide faster onset of action as an antacid.
* Be aware of the "bezoar" formation risk, especially in patients with decreased gastrointestinal motility.
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*Disclaimer: This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product labeling or a reliable drug reference before making clinical decisions.*
