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AlternaGEL, Alu-Cap, Alu-Tab
Pharmacologic class: Inorganic salt
Therapeutic class: Antacid
Pregnancy risk category NR
Dissolves in acidic gastric secretions, releasing anions that partially neutralize gastric hydrochloric acid. Also elevates gastric pH, inhibiting the action of pepsin (an effect important in peptic ulcer disease).
Capsules: 400 mg, 475 mg, 500 mg
Oral suspension: 320 mg/5 ml, 450 mg/5 ml, 600 mg/5 ml, 675 mg/5 ml
Tablets: 300 mg, 500 mg, 600 mg
⊘Indications and dosages
Adults: 500 to 1,500 mg (tablet or capsule) P.O. 1 hour after meals and at bedtime; or 5 to 30 ml (oral suspension) between meals and at bedtime, as needed or directed
• Bleeding from stress ulcers
• Gastroesophageal reflux disease
• Signs or symptoms of appendicitis or inflamed bowel
Use cautiously in:
• gastric outlet obstruction, hypercalcemia, hypophosphatemia, massive upper GI hemorrhage
• patients using other aluminum products concurrently
• patients on dialysis
• pregnant or breastfeeding patients.
• Administer with water or fruit juice.
• Give 1 hour after meals and at bedtime.
• In reflux esophagitis, administer 20 to 40 minutes after meals and at bedtime.
• Don't give within 1 to 2 hours of antibiotics, histamine2 (H2) blockers, iron preparations, corticosteroids, or enteric-coated drugs.
• Provide care as appropriate if patient becomes constipated.
CNS: malaise (with prolonged use), neurotoxicity, encephalopathy
GI: constipation, anorexia (with prolonged use), intestinal obstruction
Metabolic: hypophosphatemia (with prolonged use)
Musculoskeletal: osteomalacia and chronic phosphate deficiency with bone pain, malaise, muscle weakness (with prolonged use)
Other: aluminum toxicity
Drug-drug.Allopurinol, anti-infectives (including quinolones, tetracyclines), corticosteroids, diflunisal, digoxin, ethambutol, H2 blockers, hydantoins, iron salts, isoniazid, penicillamine, phenothiazines, salicylates, thyroid hormone, ticlopidine: decreased effects of these drugs
Enteric-coated drugs: premature release of these drugs in stomach
Drug-diagnostic tests.Gastrin: increased level
Phosphate: decreased level
Some imaging studies: test interference
Drug-food.Milk, other foods high in vitamin D: milk-alkali syndrome (nausea, vomiting, distaste for food, headache, confusion, hypercalcemia, hypercalciuria)
• Monitor long-term use of high doses if patient is on sodium-restricted diet. (Drug contains sodium.)
• Assess for GI bleeding.
• Watch for constipation.
• With long-term use, monitor blood phosphate level and assess for signs and symptoms of hypophosphatemia (anorexia, malaise, muscle weakness). Also monitor bone density.
• Tell patient to take drug 1 hour after meals and at bedtime.
• Caution patient not to take drug within 1 to 2 hours of anti-infectives, H2 blockers, iron, corticosteroids, or enteric-coated drugs.
• Advise patient to take drug with water or fruit juice.
• Instruct patient to report signs and symptoms of GI bleeding and hypo-phosphatemia (appetite loss, malaise, muscle weakness).
• Recommend increased fiber and fluid intake and regular physical activity to help ease constipation.
• Inform patient that drug contains sodium, so he should discuss drug therapy with health care providers if he's later told to consume a low-sodium diet.
• Advise patient that he'll need to undergo periodic blood testing and bone mineral density tests if he's receiving long-term therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.
ClassificationTherapeutic: antiulcer agents
|PO‡||15–30 min||30 min||30 min–3 hr|
Adverse Reactions/Side Effects
- constipation (most frequent)
Fluid and Electrolyte
Drug-Drug interactionAbsorption 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)
- Assess location, duration, character, and precipitating factors of gastric pain.
- Lab Test Considerations: Monitor serum phosphate and calcium levels periodically during chronic use of aluminum hydroxide.
- May cause increased serum gastrin and decreased serum phosphate concentrations.
- In treatment of severe ulcer disease, guaiac stools, and emesis, monitor pH of gastric secretions.
Potential Nursing DiagnosesAcute pain (Indications)
Constipation (Side Effects)
- Antacids cause premature dissolution and absorption of enteric-coated tablets and may interfere with absorption of other oral medications. Separate administration of aluminum hydroxide and oral medications by at least 1–2 hr.
- Tablets must be chewed thoroughly before swallowing to prevent their entering small intestine in undissolved form. Follow with a glass of water.
- Shake liquid preparations well before pouring. Follow administration with water to ensure passage into stomach.
- Liquid dosage forms are considered more effective than tablets.
- Hypophosphatemic: For phosphate lowering, follow dose with full glass of water or fruit juice.
- Antacid: May be given in conjunction with magnesium-containing antacids to minimize constipation, except in patients with renal failure. Administer 1 and 3 hr after meals and at bedtime for maximum antacid effect.
- For treatment of peptic ulcer, aluminum hydroxide may be administered every 1–2 hr while the patient is awake or diluted with 2–3 parts water and administered intragastrically every 30 min for 12 or more hr per day. Physician may order NG tube clamped after administration.
- For reflux esophagitis, administer 15 mL 20–40 min after meals and at bedtime.
- 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.
- Decrease in serum phosphate levels.
- Decrease in GI pain and irritation.
- Increase in the pH of gastric secretions. In treatment of peptic ulcer, antacid therapy should be continued for at least 4–6 wk after symptoms have disappeared because there is no correlation between disappearance of symptoms and healing of ulcers.