aluminum hydroxide

Aluminum hydroxide is an antacid available over the counter and is used to relieve heartburn from gastrointestinal acidity associated with gastritis, peptic ulcers, ulcerative colitis, and gastroesophageal reflux disease (GERD).

Aluminum hydroxide is also used off-label to treat excessive phosphate levels in the blood (hyperphosphatemia) associated with chronic kidney disease.

Aluminum hydroxide works by neutralizing hydrochloric acid, the acid produced in the stomach, but it has no effect on acid production itself. Aluminum hydroxide reacts with hydrochloric acid producing water and aluminum chloride, which is excreted in the stools.

By neutralizing stomach acid, aluminum hydroxide raises the pH level in the stomach, making it more alkaline, which inhibits the production and activity of pepsin, a stomach enzyme that breaks down dietary proteins and damages the stomach lining in peptic ulcer disease.

Reduction in the acidity of the stomach and reduced pepsin activity help heal peptic ulcers and also reduce acid reflux in the esophagus. Aluminum hydroxide also binds to phosphates in the gastrointestinal tract and forms insoluble complexes that are eliminated in the feces. This prevents the absorption of dietary phosphate and helps reduce phosphate levels in the blood.

• Do not take aluminum hydroxide if you are hypersensitive to aluminum salts.
• Use with caution in patients with heart failure, cirrhosis, kidney disease or edema, who need to be on a sodium-restricted diet.
• Use with caution in patients who have had a recent gastrointestinal hemorrhage.
• Use with caution in patients with colostomy, diverticulitis, or ileostomy, because aluminum hydroxide increases the risk of electrolyte imbalance.
• The risk of constipation and fecal impaction with aluminum hydroxide is higher in elderly patients.
• Avoid long-term use of aluminum hydroxide in patients with chronic kidney disease stages 3 to 5, it may cause aluminum toxicity and related bone softening (osteomalacia) and brain damage (encephalopathy).
• Systemic absorption of aluminum has been reported both with short and long-term antacid therapy in infants. Use with caution and monitor for adverse effects.
• Over-the-counter use of aluminum hydroxide is not recommended as an antacid in infants younger than 2 years of age without supervision of a physician.
• Prolonged use of aluminum hydroxide may lead to excessively low phosphate levels in blood (hypophosphatemia).
• Use with caution in patients with chronic diarrhea, there is a higher risk for hypophosphatemia.

Common side effects of aluminum hydroxide include:

• Constipation
• Hemorrhoids
• Fecal discoloration (white speckles)
• Fecal impaction
• Gastrointestinal obstruction
• Chalky taste
• Nausea
• Vomiting
• Stomach cramps
• Loss of appetite (anorexia)
• Weakness
• Feeling unwell (malaise)
• Rebound hyperacidity
• Low phosphate levels in the blood (hypophosphatemia)
• Low magnesium in the blood (hypomagnesemia)
• Softening of bones (osteomalacia)
• Brittle bones (osteoporosis)
• Aluminum intoxication
• Milk-alkali syndrome, a condition with
  • High calcium in the blood (hypercalcemia)
  • High alkalinity of tissues (metabolic alkalosis)
  • Kidney injury
• Kidney stones (nephrolithiasis)
• Cognitive impairment
• Brain damage (encephalopathy)

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug.

Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Oral suspension

• 320 mg/5 mL

Adult:

Antacid

• 5-30 mL orally between meals and at bedtime or as directed

Peptic Ulcer Disease

• 5-30 mL between meals and at bedtime or as directed

Hyperphosphatemia

• 300-600 mg orally 3 times/day between meals and at bedtime

Pediatric:

Hyperphosphatemia

• 50-150 mg/kg/day orally divided every 4-6 hours; titrate dose to keep phosphorus within normal range

• Aluminum hydroxide overdose can cause severe constipation, confusion, mood changes, and reduced urination.
• Chronic use can lead to weight loss, softening of bones (osteomalacia), brain damage (encephalopathy), and seizures.
• In case of overdose discontinue aluminum hydroxide and if symptoms don’t resolve, seek medical help or contact Poison Control.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Severe interactions of aluminum hydroxide include:
  • pazopanib
  • raltegravir
• Aluminum Hydroxide has serious interactions with at least 26 different drugs.
• Aluminum Hydroxide has moderate interactions with at least 119 different drugs.
• Mild interactions of aluminum hydroxide include:
  • ascorbic acid
  • aspirin
  • aspirin rectal
  • aspirin/citric acid/sodium bicarbonate
  • balsalazide
  • blessed thistle
  • choline magnesium trisalicylate
  • chromium
  • devil's claw
  • diflunisal
  • mesalamine
  • rose hips
  • salicylates (non-asa)
  • salsalate
  • strontium ranelate
  • sucralfate
  • sulfasalazine
  • willow bark

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information.

Check with your doctor or health care provider if you have any questions about the medication.

• There are no well-controlled studies on aluminum hydroxide in pregnant women. Restrict to occasional use during pregnancy and only if clearly needed.
• It is not known if aluminum hydroxide is excreted in breast milk. Use with caution in nursing mothers and monitor the breastfed infant for adverse effects.

• Take aluminum hydroxide exactly as directed on the label.
• Check with your doctor before taking aluminum hydroxide if you are on a sodium-restricted diet.
• Do not self-medicate with aluminum hydroxide for longer than 2 weeks. If symptoms don’t resolve check with your physician.
• Store safely out of reach of children.