aluminum hydroxide

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Indications ⬇

REMS

Lowering of phosphate levels in patients with chronic renal failure.
Adjunctive therapy in the treatment of peptic, duodenal, and gastric ulcers.
Hyperacidity, indigestion, reflux esophagitis.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Severe abdominal pain of unknown cause.

Use Cautiously in:

Hypercalcemia
Hypophosphatemia
OB: Generally considered safe; chronic high-dose therapy should be avoided.

Adv. Reactions/Side Effects ⬆ ⬇

F and E: hypophosphatemia.

GI: constipation.

Interactions ⬆ ⬇

Drug-Drug:

Absorption of tetracyclines, chlorpromazine, iron salts, isoniazid, digoxin, or fluoroquinolones may be decreased.
Salicylate blood levels may be decreased.
Quinidine, mexiletine, and amphetamine levels may be increased if enough antacid is ingested such that urine pH is increased.

Availability ⬆ ⬇

(Generic available)

Capsules: 475 mg^OTC; 500 mg^OTC;
Tablets: 300 mg^OTC; 500 mg^OTC; 600 mg^OTC;
Suspension: 320 mg/5 mL^OTC; 450 mg/5 mL^OTC; 600 mg/5 mL^OTC; 675 mg/5 mL^OTC;
In combination with: magnesium carbonate, calcium carbonate, simethicone, and mineral oil. See Appendix [not included in this PDA edition].

Route/Dosage ⬆ ⬇

Hypophosphatemia
PO (Adults): 1.9–4.8 g (30–40 mL of regular suspension or 15–20 mL of concentrated suspension) 3–4 times daily.
PO (Children): 50–150 mg/kg/24 hr in 4–6 divided doses; titrate to normal serum phosphate levels.
Antacid
PO (Adults): 500–1500 mg (5–30 mL) 3–6 times daily.

US Brand Names ⬆ ⬇

AlternaGEL, Alu-Cap, Aluminet, Alu-Tab, Amphojel, Basalgel, Dialume

Action ⬆ ⬇

Binds phosphate in the GI tract.
Neutralizes gastric acid and inactivates pepsin.
Therapeutic Effects:
Lowering of serum phosphate levels.
Healing of ulcers and decreased pain associated with ulcers or gastric hyperacidity.
Constipation limits use alone in the treatment of ulcer disease.
Frequently found in combination with magnesium-containing compounds.

Classifications ⬆ ⬇

Therapeutic Classification: antiulcer agents, hypophosphatemics
Pharmacologic Classification: antacids, phosphate binders

Pharmacokinetics ⬆ ⬇

Absorption: With chronic use, small amounts of aluminum are systemically absorbed.
Distribution: If absorbed, aluminum distributes widely, crosses the placenta, and enters breast milk. Concentrates in the CNS with chronic use.
Metabolism/Excretion: Mostly excreted in feces. Small amounts absorbed are excreted by the kidneys.
Half-life: Unknown.

Canadian Brand Names ⬆ ⬇

Alugel

Time/Action Profile ⬆ ⬇

ROUTE ONSET PEAK DURATION
PO† hr–days days–wk days
PO† 15–30 min 30 min 30 min–3 hr
†Hypophosphatemic effect.
†Antacid effect.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take aluminum hydroxide exactly as directed. If on a regular dosing schedule and a dose is missed, take as soon as remembered if not almost time for next dose; do not double doses.
Advise patient not to take aluminum hydroxide within 1–2 hr of other medications without consulting health care professional.
Advise patients to check label for sodium content. Patients with HF or hypertension, or those on sodium restriction, should use low-sodium preparations.
Inform patients of potential for constipation from aluminum hydroxide.

Hypophosphatemia: Patients taking aluminum hydroxide for hyperphosphatemia should be taught the importance of a low-phosphate diet.
Antacid: Caution patient to consult health care professional before taking antacids for more than 2 wk if problem is recurring, if taking other medications, if relief is not obtained, or if symptoms of gastric bleeding (black tarry stools, coffee-ground emesis) occur.

Code ⬆

NDC Code^*
0536- Rugby Laboratories
0536-0091- Aluminum Hydroxide 0536-0091-85- 473 mL in 1 BOTTLE (0536-0091-85)
17856- Atlantic Biologicals Corps
17856-0091- Aluminum Hydroxide 17856-0091-3- 30 mL in 1 CUP (17856-0091-3)
54162- GERITREX LLC
54162-221- Dermadrox 54162-221-04- 113 g in 1 JAR (54162-221-04)
54162- GERITREX LLC
54162-221- Dermadrox 54162-221-01- 113 g in 1 TUBE (54162-221-01)

ROUTE	ONSET	PEAK	DURATION
PO†	hr–days	days–wk	days
PO†	15–30 min	30 min	30 min–3 hr