aluminum hydroxide
Pharmacologic class: Inorganic salt
Therapeutic class: Antacid
Pregnancy risk category NR
Action
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).
Availability
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
➣ Hyperacidity
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
Off-label uses
• Bleeding from stress ulcers
• Gastroesophageal reflux disease
Contraindications
• Signs or symptoms of appendicitis or inflamed bowel
Precautions
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.
Administration
• 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.
Adverse reactions
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
Interactions
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)
Patient monitoring
• 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.
Patient teaching
• 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.