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Pronunciation
(a LOO mi num hye DROKS ide)
Generic Available (U.S.)
Yes: Suspension
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Use: Labeled Indications
Treatment of hyperacidity; hyperphosphatemia; temporary protection of minor cuts, scrapes, and burns
Pregnancy Risk Factor
C
Pregnancy Considerations
No data available on clinical effects on the fetus; available evidence suggests safe use during pregnancy and breast-feeding.
Lactation
Excretion in breast milk unknown
Contraindications
Hypersensitivity to aluminum salts or any component of the formulation
Warnings/Precautions
Oral: Hypophosphatemia may occur with prolonged administration or large doses; aluminum intoxication and osteomalacia may occur in patients with uremia. Use with caution in patients with CHF, renal failure, edema, cirrhosis, and low sodium diets, and patients who have recently suffered gastrointestinal hemorrhage; uremic patients not receiving dialysis may develop osteomalacia and osteoporosis due to phosphate depletion.
Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose.
Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self medication (OTC use), consult with healthcare provider if needed for >7 days or for use in children <6 months of age.
Adverse Reactions
Frequency not defined.
Gastrointestinal: Constipation, stomach cramps, fecal impaction, nausea, vomiting, discoloration of feces (white speckles)
Endocrine & metabolic: Hypophosphatemia, hypomagnesemia
Drug Interactions
Decreased effect: Aluminum hydroxide may decrease the absorption of allopurinol, antibiotics (tetracyclines, quinolones, some cephalosporins), bisphosphonate derivatives, corticosteroids, cyclosporine, delavirdine, iron salts, imidazole antifungals, isoniazid, mycophenolate, penicillamine, phosphate supplements, phenytoin, phenothiazines, trientine.
Absorption of aluminum hydroxide may be decreased by citric acid derivatives.
Mechanism of Action
Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O
Dosage
Oral:
Hyperphosphatemia:
Children: 50-150 mg/kg/24 hours in divided doses every 4-6 hours, titrate dosage to maintain serum phosphorus within normal range
Adults: Initial: 300-600 mg 3 times/day with meals
Antacid: Adults: 600-1200 mg between meals and at bedtime
Topical: Apply to affected area as needed; reapply at least every 12 hours
Administration: Oral
Dose should be followed with water.
Administration: Topical
Apply as needed to affected area; reapply at least every 12 hours.
Monitoring Parameters
Monitor phosphorus levels periodically when patient is on chronic therapy.
Test Interactions
Decreased phosphorus, inorganic (S)
Dietary Considerations
Should be taken 1-3 hours after meals when used as an antacid. When used to decrease phosphorus, should be taken within 20 minutes of a meal.
Patient Education
Take as directed, preferably 1-3 hours after meals (when used as an antacid) or with any other medications. When used to decrease phosphorus, take within 20 minutes of a meal. Do not increase sodium intake and maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience constipation (increased exercise, fluids, fruit, or fiber may help; if unresolved, contact prescriber). Report unresolved nausea, malaise, muscle weakness, blood in stool or black stool, or abdominal pain. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.
Geriatric Considerations
Elderly, due to disease and/or drug therapy, may be predisposed to constipation and fecal impaction. This may be managed with a stool softener or laxatives. Careful evaluation of possible drug interactions must be done. Consider renal insufficiency (<30 mL/minute) as predisposition to aluminum toxicity.
Dental Health: Effects on Dental Treatment
Key adverse event(s) related to dental treatment: Chalky taste. Aluminum and magnesium ions prevent GI absorption of tetracycline by forming a large ionized chelated molecule with the aluminum ion and tetracyclines in the stomach. Aluminum hydroxide prevents GI absorption of ketoconazole and itraconazole by increasing the pH in the GI tract. Any of these drugs should be administered at least 1 hour before Al(OH)3.
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
None reported
Mental Health: Effects on Psychiatric Treatment
Constipation is common and may be additive when used with psychotropics; may decrease the absorption of benzodiazepines and phenothiazines
Nursing: Physical Assessment/Monitoring
Assess results of laboratory tests and therapeutic effectiveness. Assess for constipation and treat accordingly.
Dosage Forms
Ointment:
Dermagran®: 0.275% (120 g)
Suspension, oral: 320 mg/5 mL (473 mL)
ALternaGel®: 600 mg/5 mL (360 mL)
References
Bohannon AD and Lyles KW, “Drug-Induced Bone Disease,” Clin Geriatr Med, 1994, 10(4):611-23.
Cumming RG and Klineberg RJ, “Aluminum in Antacids and Cooking Pots and the Risk of Hip Fractures in Elderly People,” Age Ageing, 1994, 23:468-72.
Gupta S and Ahlawat SK, “Aluminum Phosphide Poisoning - A Review,” J Toxicol Clin Toxicol, 1995, 33(1):19-24.
Maher ER, Brown EA, Curtis JR, et al, “Accumulation of Aluminum in Chronic Renal Failure Due to Administration of Albumin Replacement Solutions,” Br Med J (Clin Res Ed), 1986, 292(6516):306.
Monteagudo FS, Cassidy MJ, and Folb PI, “Recent Developments in Aluminum Toxicity,” Med Toxicol Adverse Drug Exp, 1989, 4(1):1-16.
Robertson JA, Salusky IB, Goodman WG, et al, “Sucralfate, Intestinal Aluminum Absorption, and Aluminum Toxicity in a Patient on Dialysis,” Ann Intern Med, 1989, 111(2):179-81.
U.S. Department of Health and Human Services, “Toxicological Profile for Aluminum TP-91/01,” Agency for Toxic Substances and Diseases Registry, July 1992.
International Brand Names
Lexi-Comp.com
Last full review/revision May 2006
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