Aluminum Hydroxide

Pronunciation

(a LOO mi num hye DROKS ide)

U.S. Brand Names

ALternaGel® [OTC]; Alu-Cap® [OTC]

Generic Available

Yes: Suspension

Canadian Brand Names

Amphojel®; Basaljel®

Use

Treatment of hyperacidity; hyperphosphatemia

Pregnancy Risk Factor

Pregnancy Implications

No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.

Lactation

Excretion in breast milk unknown

Contraindications

Hypersensitivity to aluminum salts or any component of the formulation

Warnings/Precautions

Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with CHF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion.

Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose.

Adverse Reactions

Frequency not defined.

Gastrointestinal: Constipation, stomach cramps, fecal impaction, nausea, vomiting, discoloration of feces (white speckles)

Endocrine & metabolic: Hypophosphatemia, hypomagnesemia

Overdosage/Toxicology

Aluminum antacids may cause constipation, phosphate depletion, and bezoar or fecalith formation. In patients with renal failure, aluminum may accumulate to toxic levels. Deferoxamine, traditionally used as an iron chelator, has been shown to increase urinary aluminum output. Deferoxamine chelation of aluminum has resulted in improvement of clinical symptoms and bone histology; however, this remains an experimental treatment for aluminum poisoning and has significant potential for adverse effects.

Drug Interactions

Decreased effect: Aluminum hydroxide may decrease the absorption of allopurinol, antibiotics (tetracyclines, quinolones, some cephalosporins), bisphosphonate derivatives, corticosteroids, cyclosporine, delavirdine, iron salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine, phosphate supplements, phenytoin, phenothiazines, trientine.

Absorption of aluminum hydroxide may be decreased by citric acid derivatives.

Mechanism of Action

Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O

Dosage

Oral:

Hyperphosphatemia:

Children: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range

Adults: Initial: 300-600 mg 3 times/day with meals

Antacid: Adults: 600-1200 mg between meals and at bedtime

Administration

Oral: Dose should be followed with water.

Monitoring Parameters

Monitor phosphorous levels periodically when patient is on chronic therapy

Test Interactions

Decreased phosphorus, inorganic (S)

Dietary Considerations

Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.

Patient Education

Take as directed, preferably 1-3 hours after meals (when used as an antacid) or with any other medications. When used to decrease phosphorus, take within 20 minutes of a meal. Do not increase sodium intake and maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience constipation (increased exercise, fluids, fruit, or fiber may help; if unresolved, contact prescriber). Report unresolved nausea, malaise, muscle weakness, blood in stool or black stool, or abdominal pain. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Dental Health: Effects on Dental Treatment

Key adverse event(s) related to dental treatment: Chalky taste. Aluminum and magnesium ions prevent GI absorption of tetracycline by forming a large ionized chelated molecule with the aluminum ion and tetracyclines in the stomach. Aluminum hydroxide prevents GI absorption of ketoconazole and itraconazole by increasing the pH in the GI tract. Any of these drugs should be administered at least 1 hour before Al(OH)3.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

None reported

Mental Health: Effects on Psychiatric Treatment

Constipation is common and may be additive when used with psychotropics; may decrease the absorption of benzodiazepines and phenothiazines

Dosage Forms

Capsule (Alu-Cap®): 400 mg

Suspension, oral: 320 mg/5 mL (473 mL)

ALternaGel®: 600 mg/5 mL (360 mL)

References

Bohannon AD and Lyles KW, "Drug-Induced Bone Disease," Clin Geriatr Med , 1994, 10(4):611-23.

Cumming RG and Klineberg RJ, "Aluminum in Antacids and Cooking Pots and the Risk of Hip Fractures in Elderly People," Age Ageing , 1994, 23:468-72.

Gupta S and Ahlawat SK, "Aluminum Phosphide Poisoning - A Review," J Toxicol Clin Toxicol , 1995, 33(1):19-24.

Maher ER, Brown EA, Curtis JR, et al, "Accumulation of Aluminum in Chronic Renal Failure Due to Administration of Albumin Replacement Solutions," Br Med J (Clin Res Ed) , 1986, 292(6516):306.

Monteagudo FS, Cassidy MJ, and Folb PI, "Recent Developments in Aluminum Toxicity," Med Toxicol Adverse Drug Exp , 1989, 4(1):1-16.

Robertson JA, Salusky IB, Goodman WG, et al, "Sucralfate, Intestinal Aluminum Absorption, and Aluminum Toxicity in a Patient on Dialysis," Ann Intern Med , 1989, 111(2):179-81.

U.S. Department of Health and Human Services, "Toxicological Profile for Aluminum TP-91/01," Agency for Toxic Substances and Diseases Registry, July 1992.

International Brand Names

Amphojel® (CA); Basaljel® (CA)

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