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## Aluminium Hydroxide
### Overview
Aluminium hydroxide is an antacid that neutralizes gastric acid. It is also a phosphate binder used in patients with chronic kidney disease (CKD) to reduce phosphate absorption.
### Primary Indications
* **Antacid:** Symptomatic relief of heartburn, indigestion, and upset stomach associated with excess gastric acid.
* **Phosphate Binder:** Management of hyperphosphatemia in patients with end-stage renal disease.
### Adult Dosing
* **Antacid:** 500-1200 mg (liquid or chewable tablets) taken by mouth 1 to 3 hours after meals and at bedtime. Doses can be repeated every 1 to 2 hours if needed. Maximum daily dose: 7800 mg.
* **Phosphate Binder:** Start with 500 mg (approximately 25 mL liquid or 2 chewable tablets) by mouth with each meal. Titrate dose based on serum phosphate levels. Maximum daily dose: 23400 mg (approximately 1170 mL liquid or 117 chewable tablets).
### Pediatric Dosing
* **Antacid:** Limited data. Dosing generally extrapolated from adult data based on weight. Consult institutional guidelines.
* **Phosphate Binder:** Limited data in pediatrics. Dosing is typically based on age and weight, and titrated to serum phosphate. Consult institutional guidelines.
### Dose Adjustments
* **Renal Impairment:** Use with caution. Aluminium can accumulate, leading to toxicity. Reduced doses may be necessary, especially in patients with severe renal impairment.
### Contraindications
* Hypersensitivity to aluminium hydroxide.
* Severe renal impairment (for phosphate binding due to risk of aluminium accumulation).
### Adverse Effects
* **Common:** Constipation.
* **Serious:** Aluminium toxicity (osteomalacia, encephalopathy, anemia) with chronic use, especially in patients with renal impairment. Hypophosphatemia with prolonged high-dose use.
### Key Drug Interactions
* **Tetracyclines and Quinolones:** Decreases absorption. Separate administration by at least 2 hours.
* **Bisphosphonates:** Decreases absorption. Separate administration by at least 2 hours.
* **Iron Supplements:** Decreases absorption. Separate administration by at least 2 hours.
* **Ketoconazole, Itraconazole:** Decreases absorption. Separate administration by at least 2 hours.
### Monitoring
* **Antacid use:** Monitor for signs of constipation.
* **Phosphate binder use:** Monitor serum phosphate, calcium, and aluminium levels regularly, especially in patients with renal impairment. Monitor for signs of osteomalacia and encephalopathy.
### Clinical Pearls
* Aluminium hydroxide is a slow-acting antacid but has a prolonged effect.
* Chewable tablets should be chewed thoroughly before swallowing.
* Ensure adequate fluid intake to help prevent constipation.
* For phosphate binding, administer with meals to be effective.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a qualified healthcare provider for any medical advice.*
