Please check your internet connection and try again.
# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an inorganic salt that acts as a phosphate binder and antacid.
## Primary Indications
* Management of hyperphosphatemia in patients with chronic kidney disease (CKD).
* Relief of heartburn, indigestion, and upset stomach associated with excess stomach acid.
## Adult Dosing
**Phosphate Binder:** Dosing is highly individualized and titrate to achieve serum phosphate goal (typically < 4.6 mg/dL or 1.5 mmol/L).
* **Usual starting dose:** 164 mg to 325 mg taken with meals.
* **Maximum dose:** Not well-defined, but typically guided by efficacy and tolerability, with concerns for aluminium accumulation at higher doses.
**Antacid:**
* **Usual dose:** 300 mg to 600 mg taken 1 to 3 hours after meals and at bedtime, or as needed.
* **Maximum dose:** Up to 1200 mg per dose, not to exceed 7200 mg in 24 hours.
## Pediatric Dosing
* **Phosphate Binder:** Dosing in pediatric CKD patients is not well-established and requires careful individualization under specialist guidance. Lower doses are generally used.
* **Antacid:** Dosing for children is not routinely recommended due to risks. Specific pediatric formulations and dosing should be guided by a pediatrician.
## Dose Adjustments
* **Renal Impairment:** Dose and frequency reduction may be necessary in patients with severe renal impairment to avoid aluminium accumulation.
## Contraindications
* Hypersensitivity to aluminium hydroxide.
* Individuals with very low serum phosphate levels (hypophosphatemia).
* Caution in patients with bowel obstruction.
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, loss of appetite.
* **Serious:** Hyperaluminemia (especially in renal impairment, leading to bone disease, encephalopathy, and anemia), hypophosphatemia (with prolonged use).
## Key Drug Interactions
* **Tetracyclines, fluoroquinolones, bisphosphonates, iron supplements, levothyroxine, azole antifungals:** Decreased absorption due to binding. Separate administration by at least 2-4 hours.
* **Proton pump inhibitors, H2-receptor antagonists:** May decrease the efficacy of aluminium hydroxide as an antacid.
## Monitoring
* **Phosphate Binder:** Regular monitoring of serum phosphate levels.
* **All Patients:** Serum calcium, magnesium, and aluminium levels, particularly in patients with renal impairment or on prolonged therapy. Monitor for signs of hypophosphatemia.
* Monitor for signs of constipation or bowel obstruction.
## Clinical Pearls
* Administer phosphate binder formulations with meals to maximize phosphate binding.
* For antacid use, liquids may provide faster relief than tablets.
* Aluminium hydroxide can cause significant constipation; ensure adequate fluid and fiber intake.
* Prolonged use, especially in patients with impaired renal function, can lead to aluminium toxicity.
**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete details and to verify dosing and safety information before initiating or modifying therapy.
