Antacid: Oral: 640 mg 5 to 6 times daily after meals and at bedtime (maximum: 3,840 mg in 24 hours).
Hyperphosphatemia in chronic kidney disease, refractory (alternative agent) (off-label use):
Note: For short-term use (≤4 weeks) in patients with severe hyperphosphatemia (eg, serum phosphorus levels >7 mg/dL) despite treatment with other nonaluminum phosphate binders. Long-term use has been associated with aluminum toxicity (KDIGO 2017; NKF 2003).
Oral: Initial: 300 to 600 mg 3 times daily with meals (Hudson 2014).
Skin protectant: Topical: Apply to affected area as needed or as directed.
Oral: Aluminum may accumulate in renal impairment, increasing the risk of aluminum toxicity.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Aluminum hydroxide: Pediatric drug information")
Antacid: Note: Chronic antacid therapy not recommended for management of GERD in pediatric patients; if antacid therapy required, consider combination product of magnesium/aluminum hydroxide (AAP [Lightdale 2013]; NASPGHAN/ESPGHAN [Vandenplas 2009]).
Children and Adolescents: Limited data available: Oral: (Liquid 320 mg/5 mL): 5 to 15 mL (320 to 960 mg) every 6 hours (Nelson 1996).
Hyperphosphatemia associated with chronic renal failure: Note: The use of aluminum hydroxide should be reserved for serum phosphorus levels >7 mg/dL and limited to a single short-term use (4 to 6 weeks) given the toxicities associated with long-term use (KDOQI 2005).
Children and Adolescents: Oral: Liquid (320 mg/5 mL): Dose should be individualized; dose dependent upon phosphate intake/absorption and dialysis clearance; therefore, a specific dose range is not available. Mean phosphorous binding power: 22.3 mg phosphorous/5 mL of aluminum hydroxide (KDOQI 2005).
There are no dosage adjustments provided in the manufacturer's labeling; aluminum may accumulate in renal impairment and cause toxicity.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Ointment, External:
DermaMed: (113 g [DSC])
Suspension, Oral:
Generic: 320 mg/5 mL (473 mL)
May be product dependent
Oral: Shake suspension well before use. Dose should be followed with water. Administer with meals when used to decrease phosphorus
Oral: Shake suspension well before use; dose should be followed with water
Antacid: Administer after meals and at bedtime
To decrease phosphorus: Administer with meals
Topical: For external use only; avoid contact with eyes
Oral: Antacid: For the temporary relief of heartburn, acid indigestion, and sour stomach
Topical: Temporary protection and relief of chafed and abraded skin, minor burns and wounds, and skin irritations resulting from friction and rubbing.
Hyperphosphatemia in chronic kidney disease, refractory (alternative agent)
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Gastrointestinal: Constipation, fecal discoloration (white speckles), fecal impaction, nausea, stomach cramps, vomiting
Endocrine & metabolic: Hypomagnesemia, hypophosphatemia
Dosage form specific issues:
• 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 HF, 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. When used as an antacid in ulcer treatment, consider buffer capacity (mEq/mL) to calculate dose. Elderly may be predisposed to constipation and fecal impaction. Careful evaluation of possible drug interactions must be done.
• 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
Systemic absorption of aluminum has been reported in infants receiving both short-term and long-term antacid therapy; use with caution; consider monitoring serum aluminum concentrations to monitor for toxicity (Tsou 1991; Woodard-Knight 1992). Avoid long-term use of aluminum containing phosphate binders in patients with CKD stages 3 to 5 due to risk of aluminum related bone disease and encephalopathy (KDIGO 2009; KDOQI [Uhlig 2010]).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib capsules from the administration of any antacid by at least 2 hours in order to minimize the potential for a significant interaction. Acalabrutinib tablets are not expected to interact with antacids. Risk D: Consider therapy modification
Allopurinol: Aluminum Hydroxide may decrease the serum concentration of Allopurinol. Management: Consider administering allopurinol 3 hours prior to aluminum hydroxide. Risk D: Consider therapy modification
Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy
Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy
Ascorbic Acid: May increase the absorption of Aluminum Hydroxide. Management: In patients with severe renal dysfunction, consider avoiding this combination. Administering agents at least 2 hours apart may help minimize effects. Monitor for toxic effects of aluminum (from antacid) if ascorbic acid is coadministered. Risk D: Consider therapy modification
Atazanavir: Antacids may decrease the absorption of Atazanavir. Management: Administer antacids 1 to 2 hours before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Risk D: Consider therapy modification
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination
Belumosudil: Antacids may decrease the serum concentration of Belumosudil. Management: Consider separating administration of belumosudil and antacids by 2 hours and monitor for reduced belumosudil efficacy. Risk D: Consider therapy modification
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider therapy modification
Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider therapy modification
Bismuth Subcitrate: Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Risk D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification
Bosutinib: Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider therapy modification
Bromperidol: Antacids may decrease the absorption of Bromperidol. Risk C: Monitor therapy
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Calcium Polystyrene Sulfonate: May enhance the adverse/toxic effect of Aluminum Hydroxide. More specifically, concomitant use of these agents may increase the risk for intestinal obstruction. Management: Monitor for signs/symptoms of intestinal obstruction with concomitant use of calcium polystyrene sulfonate and aluminum hydroxide. Adequate fluid intake, laxative use, alternative antacid agents, and/or limiting duration of therapy may help reduce risks. Risk D: Consider therapy modification
Captopril: Antacids may decrease the serum concentration of Captopril. Risk C: Monitor therapy
Cefdinir: Antacids may decrease the absorption of Cefdinir. Management: Administer cefdinir 2 hours before or 2 hours after aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification
Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Risk X: Avoid combination
Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy
Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Risk D: Consider therapy modification
Chenodiol: Aluminum Hydroxide may decrease the serum concentration of Chenodiol. Risk C: Monitor therapy
Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Risk D: Consider therapy modification
Cholic Acid: Aluminum Hydroxide may decrease the absorption of Cholic Acid. Management: Administer cholic acid at least 1 hour before or 4 to 6 hours after administration of any aluminum hydroxide-containing products to minimize the potential for a significant interaction. Risk D: Consider therapy modification
Citric Acid Derivatives: May increase the absorption of Aluminum Hydroxide. Risk C: Monitor therapy
Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification
Cysteamine (Systemic): Antacids may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy
Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Risk D: Consider therapy modification
Dasatinib: Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider therapy modification
Deferasirox: Aluminum Hydroxide may diminish the therapeutic effect of Deferasirox. Risk X: Avoid combination
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy modification
Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Risk D: Consider therapy modification
Diacerein: Antacids may decrease the absorption of Diacerein. Risk C: Monitor therapy
Dolutegravir: Aluminum Hydroxide may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral aluminum hydroxide. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral aluminum hydroxide. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification
Elvitegravir: Antacids may decrease the serum concentration of Elvitegravir. Management: Separate administration of aluminum and magnesium containing antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction. Risk D: Consider therapy modification
Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Risk D: Consider therapy modification
Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Ethambutol: Aluminum Hydroxide may decrease the serum concentration of Ethambutol. Management: Avoid concurrent administration of ethambutol and aluminum hydroxide. If coadministration cannot be avoided administer ethambutol first and then wait at least 4 hours before administering aluminum hydroxide-containing products. Risk D: Consider therapy modification
Fexofenadine: Antacids may decrease the serum concentration of Fexofenadine. Management: Separate the administration of fexofenadine and aluminum- or magnesium-containing antacids. Risk D: Consider therapy modification
Fosinopril: Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Risk D: Consider therapy modification
Gabapentin: Aluminum Hydroxide may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after administration of antacids containing aluminum hydroxide or magnesium hydroxide. Risk D: Consider therapy modification
Gefitinib: Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of an antacid, and closely monitor clinical response to gefitinib. Risk D: Consider therapy modification
Hyoscyamine: Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release hyoscyamine before meals and antacids after meals when these agents are given in combination. Risk D: Consider therapy modification
Infigratinib: Antacids may decrease serum concentrations of the active metabolite(s) of Infigratinib. Antacids may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with antacids or other gastric acid-lowering agents. If antacids cannot be avoided, administer infigratinib 2 hours before or after administration of antacids. Risk D: Consider therapy modification
Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider therapy modification
Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk C: Monitor therapy
Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Risk D: Consider therapy modification
Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer antacids at least 1 hour prior to, or 2 hours after, ketoconazole. Additionally, administer ketoconazole with an acidic beverage (eg, non-diet cola) and monitor patients closely for signs of inadequate clinical response to ketoconazole. Risk D: Consider therapy modification
Lanthanum: Antacids may diminish the therapeutic effect of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider therapy modification
Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider therapy modification
Levoketoconazole: Antacids may decrease the absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider therapy modification
Levothyroxine: Aluminum Hydroxide may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and aluminum hydroxide by at least 4 hours. Risk D: Consider therapy modification
Mequitazine: Aluminum Hydroxide may decrease the absorption of Mequitazine. Management: Administer mequitazine at least 2 hours before or 2 hours after administration of any aluminum hydroxide-containing products to minimize the potential for a significant interaction. Risk D: Consider therapy modification
Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with the Apriso brand of mesalamine extended-release capsules. The optimal duration of dose separation is unknown. Other mesalamine products do not contain this interaction warning. Risk D: Consider therapy modification
Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding the concomitant use of medications that alkalinize the urine, such as antacids, and methenamine. Monitor for decreased therapeutic effects of methenamine if used concomitant with antacids. Risk D: Consider therapy modification
Multivitamins/Fluoride (with ADE): May increase the serum concentration of Aluminum Hydroxide. Aluminum Hydroxide may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, aluminum hydroxide may impair fluoride absorption. Management: Avoid administration of aluminum hydroxide within at least 1-2 hours of fluoride administration. In patients with severe renal dysfunction, consider avoiding this combination altogether. Risk D: Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Aluminum Hydroxide. Management: In patients with severe renal dysfunction, consider avoiding this combination of agents. Administering agents at least 2 hours apart may help minimize the interaction(s). If combined, monitor for toxic effects of aluminum. Risk D: Consider therapy modification
Multivitamins/Minerals (with AE, No Iron): May increase the serum concentration of Aluminum Hydroxide. Specifically, vitamin C may enhance aluminum absorption. Management: In patients with severe renal dysfunction, consider avoiding this combination of agents. Administering agents at least 2 hours apart may help minimize the interaction(s). If coadministered, monitor for toxic effects of aluminum. Risk D: Consider therapy modification
Mycophenolate: Aluminum Hydroxide may decrease the serum concentration of Mycophenolate. Management: Simultaneous administration of aluminum hydroxide antacids with the Myfortic brand of mycophenolic acid is not recommended. Administrater aluminum hydroxide at least 2 hours after a dose of the Cellcept brand of mycophenolate mofetil. Risk D: Consider therapy modification
Naproxen: Antacids may decrease the absorption of Naproxen. Risk X: Avoid combination
Neratinib: Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Risk D: Consider therapy modification
Nilotinib: Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification
Octreotide: Antacids may decrease the serum concentration of Octreotide. Risk C: Monitor therapy
PAZOPanib: Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Risk D: Consider therapy modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification
Pexidartinib: Antacids may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib at least 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification
Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administration of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Risk D: Consider therapy modification
Potassium Phosphate: Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Risk D: Consider therapy modification
QuiNINE: Antacids may decrease the serum concentration of QuiNINE. Risk X: Avoid combination
Quinolones: Antacids may decrease the absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone. Risk D: Consider therapy modification
Raltegravir: Aluminum Hydroxide may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral aluminum hydroxide with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Risk X: Avoid combination
Rilpivirine: Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after oral rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Risk D: Consider therapy modification
Riociguat: Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Monitor clinical response to riociguat more closely in patients using this combination. Risk D: Consider therapy modification
Rosuvastatin: Antacids may decrease the serum concentration of Rosuvastatin. Risk C: Monitor therapy
Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification
Selpercatinib: Antacids may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and antacids should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification
Sodium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may diminish the therapeutic effect of Sodium Polystyrene Sulfonate. Risk C: Monitor therapy
Sotalol: Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider therapy modification
Sotorasib: Antacids may decrease the serum concentration of Sotorasib. Management: Avoid coadministration of sotorasib and antacids. If use of a gastric acid suppressing medication cannot be avoided, administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider therapy modification
Strontium Ranelate: Aluminum Hydroxide may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and aluminum hydroxide by at least 2 hours whenever possible in order to minimize this interaction. Risk D: Consider therapy modification
Sulpiride: Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Risk D: Consider therapy modification
Tacrolimus (Systemic): Aluminum Hydroxide may decrease the serum concentration of Tacrolimus (Systemic). Particularly, maximum concentration may decrease. Aluminum Hydroxide may increase the serum concentration of Tacrolimus (Systemic). Risk C: Monitor therapy
Taurursodiol: Aluminum Hydroxide may decrease the absorption of Taurursodiol. Risk X: Avoid combination
Tetracyclines: Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification
Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination
Ursodiol: Aluminum Hydroxide may decrease the serum concentration of Ursodiol. Management: Separate administration of ursodiol and aluminum-containing antacid products to prevent adsorption in the gastrointestinal tract. Risk D: Consider therapy modification
Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider therapy modification
Vitamin D Analogs: May increase the serum concentration of Aluminum Hydroxide. Specifically, the absorption of aluminum may be increased, leading to increased serum aluminum concentrations. Management: Consider avoiding chronic use of aluminum and aluminum-containing products in patients who are also taking vitamin D analogs. If coadministered, monitor aluminum status and for signs and symptoms of aluminum-related toxicities. Risk D: Consider therapy modification
When dietary changes and lifestyle modifications are insufficient, aluminum hydroxide may be used for the treatment of heartburn or gastroesophageal reflux in pregnant women when used in usual recommended doses (Body 2016; Dağlı 2017; Gomes 2018; Thélin 2020). High doses of aluminum containing antacids should be avoided (Gomes 2018).
Aluminum is endogenous to breast milk (Chao 2014; Fanni 2014). Information specific to the quantification of aluminum in breast milk following the administration of aluminum hydroxide-containing antacids in breastfeeding females has not been located.
Aluminum hydroxide is considered compatible with breastfeeding when used in usual recommended doses; monitor the breastfeeding infant for adverse effects (WHO 2002).
When used to decrease phosphorus, should be taken with meals.
Hyperphosphatemia in chronic kidney disease: Calcium and phosphorus levels periodically; serum aluminum levels if signs and symptoms of aluminum toxicity develop (eg, altered consciousness, seizures, coma, osteomalacia, microcytic anemia) (KDIGO 2009; NKF 2003).
As an antacid, aluminum hydroxide neutralizes hydrochloride in the stomach to form Al (Cl)3 salt + H2O, resulting in increased gastric pH and inhibition of pepsin activity (Weberg 1998). As an agent for the short term treatment of hyperphosphatemia (off-label use), aluminum hydroxide binds phosphate in the gastrointestinal tract preventing absorption of phosphate (Schucker 2005).
Duration: Dependent on gastric emptying time: Fasting state: 20 to 60 minutes; One hour after meals: Up to 3 hours
Excretion: Urine (normal renal function): 17% to 30%; combines with dietary phosphate in the intestine and is excreted in the feces
Suspension (Aluminum Hydroxide Gel Oral)
320 mg/5 mL (per mL): $0.02
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