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Vitamin A (Retinol)
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Look Up > Drugs > Aluminum Hydroxide
Aluminum Hydroxide
Pronunciation
U.S. Brand Names
Generic Available
Pharmacological Index
Use
Pregnancy Risk Factor
Pregnancy/Breast-Feeding Implications
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Mechanism of Action
Usual Dosage
Dietary Considerations
Monitoring Parameters
Test Interactions
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(a LOO mi num hye DROKS ide)

U.S. Brand Names
ALternaGEL®[OTC]; Alu-Cap®[OTC]; Alu-Tab®[OTC]; Amphojel®[OTC]; Dialume®[OTC]; Nephrox Suspension [OTC]

Generic Available

Yes


Pharmacological Index

Antacid; Antidote


Use

Treatment of hyperacidity; hyperphosphatemia


Pregnancy Risk Factor

C


Pregnancy/Breast-Feeding Implications

Clinical effects on the fetus: No data available; available evidence suggests safe use during pregnancy and breast-feeding

Breast-feeding/lactation: No data available


Contraindications

Hypersensitivity to aluminum salts or drug components


Warnings/Precautions

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 congestive heart failure, 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.


Adverse Reactions

>10%: Gastrointestinal: Constipation, chalky taste, stomach cramps, fecal impaction

1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white speckles)

<1%: Hypophosphatemia, hypomagnesemia


Overdosage/Toxicology

Aluminum antacids may cause constipation, phosphate depletion, and bezoar or fecalith formation; in patients with renal failure, aluminum may accumulate to toxic levels

Deferoxamine, traditionally used as an iron chelator, has been shown to increase urinary aluminum output

Deferoxamine chelation of aluminum has resulted in improvements of clinical symptoms and bone histology; however, remains an experimental treatment for aluminum poisoning and has a significant potential for adverse effects


Drug Interactions

Decreased effect: Tetracyclines, digoxin, indomethacin, or iron salts, isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine, phenothiazines, ranitidine, ketoconazole, itraconazole


Mechanism of Action

Neutralizes hydrochloride in stomach to form Al (Cl)3 salt + H2O


Usual Dosage

Oral:

Children: 5-15 mL/dose every 3-6 hours or 1 and 3 hours after meals and at bedtime

Adults: 15-45 mL every 3-6 hours or 1 and 3 hours after meals and at bedtime

Prophylaxis against gastrointestinal bleeding:

Infants: 2-5 mL/dose every 1-2 hours

Children: 5-15 mL/dose every 1-2 hours

Adults: 30-60 mL/dose every hour

Titrate to maintain the gastric pH >5

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: 500-1800 mg, 3-6 times/day, between meals and at bedtime; best taken with a meal or within 20 minutes of a meal

Antacid: Adults: 30 mL 1 and 3 hours postprandial and at bedtime


Dietary Considerations

Should be administered 1-3 hours after meals


Monitoring Parameters

Monitor phosphorous levels periodically when patient is on chronic therapy


Test Interactions

Decreases phosphorus, inorganic (S)


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


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

Aluminum and magnesium ions prevent gastrointestinal 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.


Patient Information

Take as directed, preferably 2 hours before or 2 hours after meals and any other medications. Dilute liquid dose with water or juice and shake well. Do not increase sodium intake and maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). Chew tablet thoroughly before swallowing with full glass of water. You may experience constipation (increased exercise or dietary fluids, fiber, and fruit may help). If unrelieved, see 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 be pregnant. Consult prescriber if breast-feeding.


Nursing Implications

Used primarily as a phosphate binder; dose should be given within 20 minutes of a meal and followed with water


Dosage Forms

Capsule:

Alu-Cap®: 400 mg

Dialume®: 500 mg

Liquid: 600 mg/5 mL

ALternaGEL®: 600 mg/5 mL

Suspension, oral: 320 mg/5 mL; 450 mg/5 mL; 675 mg/5 mL

Amphojel®: 320 mg/5 mL

Tablet:

Amphojel®: 300 mg, 600 mg

Alu-Tab®: 500 mg


References

Bohannon AD and Lyles KW, "Drug-Induced Bone Disease," Clin Geriatr Med, 1994, 10(4):611-23.

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.


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