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Pronunciation |
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(a
LOO mi num hye DROKS
ide) |
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U.S. Brand
Names |
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ALternaGEL®[OTC]; Alu-Cap®[OTC];
Alu-Tab®[OTC]; Amphojel®[OTC]; Dialume®[OTC]; Nephrox
Suspension [OTC] |
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Generic
Available |
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Yes |
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Pharmacological Index |
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Antacid; Antidote |
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Use |
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Treatment of hyperacidity; hyperphosphatemia |
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Pregnancy Risk
Factor |
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C |
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Pregnancy/Breast-Feeding
Implications |
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Clinical effects on the fetus: No data available; available evidence suggests
safe use during pregnancy and breast-feeding
Breast-feeding/lactation: No data available |
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Contraindications |
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Hypersensitivity to aluminum salts or drug components |
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Warnings/Precautions |
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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. |
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Adverse
Reactions |
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>10%: Gastrointestinal: Constipation, chalky taste, stomach cramps, fecal
impaction
1% to 10%: Gastrointestinal: Nausea, vomiting, discoloration of feces (white
speckles)
<1%: Hypophosphatemia, hypomagnesemia |
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Overdosage/Toxicology |
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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
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Drug
Interactions |
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Decreased effect: Tetracyclines, digoxin, indomethacin, or iron salts,
isoniazid, allopurinol, benzodiazepines, corticosteroids, penicillamine,
phenothiazines, ranitidine, ketoconazole, itraconazole |
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Mechanism of
Action |
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Neutralizes hydrochloride in stomach to form Al (Cl)3 salt +
H2O |
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Usual Dosage |
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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
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Dietary
Considerations |
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Should be administered 1-3 hours after meals |
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Monitoring
Parameters |
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Monitor phosphorous levels periodically when patient is on chronic
therapy |
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Test
Interactions |
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Decreases phosphorus, inorganic (S) |
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Mental Health: Effects
on Mental Status |
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None reported |
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Mental Health:
Effects on Psychiatric
Treatment |
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Constipation is common and may be additive when used with psychotropics; may
decrease the absorption of benzodiazepines and
phenothiazines |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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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. |
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Patient
Information |
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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. |
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Nursing
Implications |
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Used primarily as a phosphate binder; dose should be given within 20 minutes
of a meal and followed with water |
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Dosage Forms |
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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 |
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References |
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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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