aluminum hydroxide

aluminum

(Al) [ah-loo´mĭ-num] a chemical element, atomic number 13, atomic weight 26.982. (See Appendix 6.) It occurs naturally in many foods in low concentrations and is also present in many pharmaceuticals and drinking water. High levels in the body can be toxic; see aluminum poisoning.aluminum acetate solution Burow's solution.basic aluminum carbonate gel an aluminum hydroxide–aluminum carbonate gel, used as an antacid, for treatment of hyperphosphatemia in renal insufficiency, and to prevent phosphate urinary calculi.aluminum chloride a topical astringent solution and antiperspirant.aluminum chlorohydrate an antiperspirant; called also aluminum hydroxychloride.aluminum hydroxide the hydroxide of aluminum, used as an antacid and binder" >phosphate binder; the official preparation is aluminum hydroxide gel.aluminum hydroxide gel a preparation of aluminum hydroxide in suspension or dried form, used as an antacid in the treatment of peptic ulcer and gastric hyperacidity and as a binder" >phosphate binder in treatment of phosphate nephrolithiasis.aluminum hydroxychloride aluminum chlorohydrate.aluminum oxide Al₂O₃, occurring naturally as various minerals; used in the production of abrasives, refractories, ceramics, catalysts, to strengthen dental ceramics, and in chromatography.aluminum phosphate gel a water suspension of aluminum phosphate and some flavoring agents; used as a gastric antacid, astringent, and soothing agent.aluminum poisoning the toxic effects of high levels of aluminum or its compounds in the body. In the gastrointestinal tract aluminum inhibits absorption of electrolytes; inhalation of aluminum fumes may cause fibrosis" >pulmonary fibrosis; and aluminum in the bloodstream may lead to serious neurological symptoms, such as in encephalopathy" >dialysis encephalopathy.aluminum silicate the silicate salt of aluminum, found in nature in several different hydrated forms that have pharmaceutical or dental uses; see attapulgite, fuller's earth, and kaolin.aluminum subacetate a compound used as an astringent, diluted with water.aluminum sulfate a compound used as an astringent solution and antiperspirant.

aluminum hydroxide

AlternaGEL, Alu-Cap, Alu-Tab

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.