ALUMINUM HYDROXIDE

(a-lu'mi-num)
ALternaGEL, Alu-Cap, Alugel, Alu-Tab, Amphojel, Dialume
ALUMINUM CARBONATE, BASIC
Basaljel
ALUMINUM PHOSPHATE
Phosphaljel
Classifications: gastrointestinal agent; antacid; adsorbent
Pregnancy Category: C

Availability

Aluminum Hydroxide 300 mg, 400 mg, 500 mg, 600 mg tablets; 300 mg, 400 mg, 500 mg, 600 mg capsules; 320 mg/5 mL, 450 mg/5 mL, 600 mg/5 mL, 675 mg/5 mL suspension

Aluminum Carbonate, Basic 608 mg tablets; 608 mg capsules; 400 mg/5 mL suspension

Aluminum Phosphate 608 mg tablets; 608 mg capsules; 400 mg/5 mL suspension

Actions

Nonsystemic antacid with moderate neutralizing action. Decreases rate of gastric emptying and has demulcent, adsorbent, and mild astringent properties. Reduces acid concentration and pepsin activity by raising pH of gastric and intraesophageal secretions.

Therapeutic Effects

Reduces gastric acidity by neutralizing the stomach acid content. Aluminum carbonate lowers serum phosphate by binding dietary phosphate to form insoluble aluminum phosphate, which is excreted in feces.

Uses

Symptomatic relief of gastric hyperacidity associated with gastritis, esophageal reflux, and hiatal hernia; adjunct in treatment of gastric and duodenal ulcer. More commonly used in combination with other antacids. Aluminum carbonate is used primarily in conjunction with a low phosphate diet to reduce hyperphosphatemia in patients with renal insufficiency and for prophylaxis and treatment of phosphatic renal calculi.

Contraindications

Prolonged use of high doses in presence of low serum phosphate; pregnancy (category C).

Cautious Use

Renal impairment; gastric outlet obstruction; older adults; decreased bowel activity (e.g., patients receiving anticholinergic, antidiarrheal, or antispasmodic agents); patients who are dehydrated or on fluid restriction.

Route & Dosage

Antacid (hydroxide & phosphate)
Adult: PO 600 mg t.i.d. or q.i.d.

Antacid (carbonate)
Adult: PO 10–30 mL of regular suspension or 5–15 mL of extra strength suspension or 2 capsules or tablets q2h

Phosphate Lowering (carbonate)
Adult: PO 10–30 mL of regular suspension or 5–15 mL of extra strength suspension or 2–6 capsules or tablets 1h p.c. and h.s.

Administration

Oral

Tablet must be chewed until it is thoroughly wetted before swallowing.
Note for antacid use: Follow well-chewed tablet with one-half glass of water or milk; follow liquid preparation (suspension) with water to ensure passage into stomach. For phosphate lowering: follow tablet, capsule, or suspension with full glass of water or fruit juice.
Store between 15°–30° C (59°–86° F) in tightly closed container.

Adverse Effects (1%)

GI: Constipation, fecal impaction, intestinal obstruction. CNS: Dialysis dementia (thought to be due to aluminum intoxication). Metabolic: Hypophosphatemia, hypomagnesemia.

Interactions

Drug: Aluminum will decrease absorption of chloroquine, cimetidine, ciprofloxacin, digoxin, isoniazid, iron salts, nsaids, norfloxacin, ofloxacin, phenytoin, phenothiazines, quinidine, tetracycline, thyroxine. Sodium polystyrene sulfonate may cause systemic alkalosis.

Pharmacokinetics

Absorption: Minimal absorption. Peak: Slow onset. Duration: 2 h when taken with food; 3 h when taken 1 h after food. Elimination: Excreted in feces as insoluble phosphates.

Nursing Implications

Assessment & Drug Effects

Note number and consistency of stools. Constipation is common and dose related. Intestinal obstruction from fecal concretions has been reported.
Lab tests: Monitor periodic serum calcium and phosphorus levels with prolonged high-dose therapy or impaired renal function.

Patient & Family Education

Increase phosphorus in diet when taking large doses of these antacids for prolonged periods; hypophosphatemia can develop within 2 wk of continuous use of these antacids. The older adult in a poor nutritional state is at high risk.
Note: Antacid may cause stools to appear speckled or whitish.
Report epigastric or abdominal pain; it is a clinical guide for adjusting dosage. Keep physician informed. Pain that persists beyond 72 h may signify serious complications.
Seek medical help if indigestion is accompanied by shortness of breath, sweating, or chest pain, if stools are dark or tarry, or if symptoms are recurrent when taking this medication.
Seek medical advice and supervision if self-prescribed antacid use exceeds 2 wk.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug