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# Aluminium Hydroxide
## Overview
Aluminium hydroxide is an inorganic salt used as an antacid and phosphate binder.
## Primary Indications
* Management of hyperphosphatemia in patients with chronic kidney disease (CKD).
* Symptomatic relief of heartburn, indigestion, and upset stomach due to excess stomach acid.
## Adult Dosing
* **Antacid:** 300-600 mg orally as needed, typically within 1 hour after meals and at bedtime. Maximum daily dose typically 2000 mg.
* **Phosphate Binder (CKD):** Dosing is highly individualized based on serum phosphate levels. Typical starting doses range from 300-600 mg orally with meals, taken multiple times daily. Titrate to achieve target serum phosphate levels (e.g., < 5.5 mg/dL). Maximum daily dose is often limited to 2000 mg to minimize aluminum accumulation.
## Pediatric Dosing
* **Antacid:** Limited data. Conservative doses may be used under specialist guidance.
* **Phosphate Binder (CKD):** Not typically recommended in children younger than 6 years due to risk of aluminum toxicity. For older children, dosing should be individualized and guided by clinical response and aluminum levels, under specialist care.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is crucial. Aluminium hydroxide is renally excreted, and accumulation can lead to toxicity. Monitor aluminum levels closely.
## Contraindications
* Known hypersensitivity to aluminium hydroxide.
* Patients with severe renal impairment or receiving dialysis without adequate monitoring for aluminum toxicity.
* Concurrent use with certain medications that bind to aluminium hydroxide (e.g., tetracyclines, fluoroquinolones).
## Adverse Effects
Common: Constipation, nausea, vomiting, abdominal pain.
Serious: **Aluminum toxicity** (may occur with prolonged use, especially in renal impairment), characterized by bone disease (osteomalacia), anemia, dementia, and encephalopathy.
## Key Drug Interactions
* **Decreased absorption of:** Tetracyclines, fluoroquinolones, bisphosphonates, digoxin, iron supplements, ketoconazole, itraconazole, certain antiretrovirals. Separate administration by at least 2-4 hours.
* **May bind to:** Citrate-containing products, potentially increasing aluminum absorption.
## Monitoring
* Serum phosphate levels (for phosphate binder indication).
* Serum calcium and magnesium levels (can be affected by long-term use).
* Serum aluminum levels (especially in patients with renal impairment or prolonged therapy).
* Signs and symptoms of aluminum toxicity (bone pain, neurological changes, anemia).
## Clinical Pearls
* Administer phosphate binder formulations with meals to effectively bind dietary phosphate.
* Liquid formulations may be preferred for better binding capacity over tablet formulations.
* Counsel patients on the importance of staggered dosing with other medications.
* Long-term use, particularly in patients with impaired renal function, carries a significant risk of aluminum accumulation and toxicity.
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***Disclaimer:** This information is intended for clinical decision support and does not replace individual patient assessment or professional judgment. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
