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Aluminum hydroxide: Drug information

Aluminum hydroxide: Drug information
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For additional information see "Aluminum hydroxide: Patient drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Dermagran Skin Protectant [OTC] [DSC];
  • Dermagran [OTC] [DSC]
Pharmacologic Category
  • Antacid;
  • Antidote;
  • Protectant, Topical
Dosing: Adult
Antacid

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

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 (Ref).

Oral: Initial: 300 to 600 mg 3 times daily with meals (Ref).

Skin protectant

Skin protectant: Topical: Apply to affected area as needed or as directed.

Dosing: Kidney Impairment: Adult

Oral: There are no dosage adjustments provided in the manufacturer's labeling. Aluminum may accumulate in kidney impairment, increasing the risk of aluminum toxicity.

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; aluminum may accumulate in renal impairment and cause toxicity.

Dosing: Liver Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

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

Warnings/Precautions

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 heart failure, kidney failure, edema, cirrhosis, and low-sodium diets, and patients who have recently suffered GI 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. Older patients may be predisposed to constipation and fecal impaction. When used for self-medication (OTC use), consult with health care provider if needed for >14 days.

• Topical: Not for application over deep wounds, puncture wounds, infected areas, or lacerations. When used for self-medication (OTC use), consult with health care provider if needed for >7 days.

Warnings: Additional Pediatric Considerations

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]).

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Ointment, External:

Dermagran: 0.275% (113 g [DSC]) [latex free; contains methylparaben, propylene glycol, propylparaben]

Dermagran Skin Protectant: (113 g [DSC]) [latex free; contains methylparaben, propylparaben]

Suspension, Oral:

Generic: 320 mg/5 mL (473 mL)

Generic Equivalent Available: US

May be product dependent

Pricing: US

Suspension (Aluminum Hydroxide Gel Oral)

320 mg/5 mL (per mL): $0.02

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Oral: Shake suspension well before use. Administer with meals and at bedtime when used as an antacid. Administer with meals when used to decrease phosphorus. Follow dose with water, as needed.

Administration: Pediatric

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

Use: Labeled Indications

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.

Use: Off-Label: Adult

Hyperphosphatemia in chronic kidney disease, refractory (alternative agent)

Metabolism/Transport Effects

None known.

Drug Interactions

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 drug interactions program by clicking on the “Launch drug interactions program” link above.

Acalabrutinib: Antacids may decrease 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 serum concentration of Allopurinol. Management: Consider administering allopurinol 3 hours prior to aluminum hydroxide. Risk D: Consider Therapy Modification

Antipsychotic Agents (Phenothiazines): Antacids may decrease absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor

Ascorbic Acid: May increase 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 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 serum concentration of Baloxavir Marboxil. Risk X: Avoid

Belumosudil: Antacids may decrease 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 serum concentration of Bictegravir. Management: Administer bictegravir 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 decrease therapeutic effects 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 decrease therapeutic effects 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 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 serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider Therapy Modification

Bromperidol: Antacids may decrease absorption of Bromperidol. Risk C: Monitor

Cabotegravir: Polyvalent Cation Containing Products may decrease 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 increase adverse/toxic effects 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 serum concentration of Captopril. Risk C: Monitor

Cefdinir: Antacids may decrease 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 serum concentration of Cefditoren. Risk X: Avoid

Cefpodoxime: Antacids may decrease serum concentration of Cefpodoxime. Risk C: Monitor

Cefuroxime: Antacids may decrease serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Taking cefuroxime with food may lessen the magnitude of this interaction. Risk D: Consider Therapy Modification

Chenodiol: Aluminum Hydroxide may decrease serum concentration of Chenodiol. Risk C: Monitor

Chloroquine: Antacids may decrease 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 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 absorption of Aluminum Hydroxide. Risk C: Monitor

Corticosteroids (Oral): Antacids may decrease 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 decrease therapeutic effects of Cysteamine (Systemic). Risk C: Monitor

Dabigatran Etexilate: Antacids may decrease 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 serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. If combined, administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider Therapy Modification

Deferasirox: Aluminum Hydroxide may decrease therapeutic effects of Deferasirox. Risk X: Avoid

Deferiprone: Polyvalent Cation Containing Products may decrease 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

Diacerein: Antacids may decrease absorption of Diacerein. Risk C: Monitor

Dolutegravir: Aluminum Hydroxide may decrease 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

Elobixibat: Aluminum-Containing Products may decrease absorption of Elobixibat. Risk C: Monitor

Eltrombopag: Polyvalent Cation Containing Products may decrease 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: Polyvalent Cation Containing Products may decrease serum concentration of Elvitegravir. Management: Administer elvitegravir-containing products 2 hours before, or 2 to 6 hours after, the administration of polyvalent cation containing products. Risk D: Consider Therapy Modification

Erdafitinib: Serum Phosphate Level-Altering Agents may decrease therapeutic effects 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 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 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 serum concentration of Fexofenadine. Management: Separate the administration of fexofenadine and aluminum- or magnesium-containing antacids. Risk D: Consider Therapy Modification

Fluoride: Aluminum Hydroxide may decrease serum concentration of Fluoride. Management: To minimize the impact of this potential interaction, avoid administration of aluminum hydroxide within at least 2 hours of fluoride administration. Risk D: Consider Therapy Modification

Fosinopril: Antacids may decrease serum concentration of Fosinopril. Management: Separate administration of antacids and fosinopril by 2 hours. Risk D: Consider Therapy Modification

Gabapentin: Aluminum Hydroxide may decrease 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 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 serum concentration of Hyoscyamine. Management: Administer immediate release and sublingual oral hyoscyamine before meals, and antacids after meals, when these agents are given in combination. Risk D: Consider Therapy Modification

Iron Preparations: Antacids may decrease 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 absorption of Isoniazid. Risk C: Monitor

Itraconazole: Antacids may decrease serum concentration of Itraconazole. Antacids may increase 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 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 decrease therapeutic effects of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider Therapy Modification

Ledipasvir: Antacids may decrease serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider Therapy Modification

Levoketoconazole: Antacids may decrease absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider Therapy Modification

Levonadifloxacin: Antacids may decrease serum concentration of Levonadifloxacin. Risk X: Avoid

Mesalamine: Antacids may decrease therapeutic effects 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 decrease therapeutic effects 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

Moxifloxacin (Systemic): Aluminum Hydroxide may decrease absorption of Moxifloxacin (Systemic). Management: Administer moxifloxacin at least 4 hours before or 8 hours after aluminum hydroxide. Risk D: Consider Therapy Modification

Multivitamins/Fluoride (with ADE): May increase serum concentration of Aluminum Hydroxide. Aluminum Hydroxide may decrease serum concentration of Multivitamins/Fluoride (with ADE). Specifically, aluminum hydroxide may impair fluoride absorption. Management: Avoid administration of aluminum hydroxide within at least 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 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 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 serum concentration of Mycophenolate. Management: Simultaneous administration of aluminum hydroxide antacids with the Myfortic brand of mycophenolic acid is not recommended. Administer aluminum hydroxide at least 2 hours after a dose of the Cellcept or Myhibbin brands of mycophenolate mofetil. Risk D: Consider Therapy Modification

Neratinib: Antacids may decrease 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 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

Nirogacestat: Antacids may decrease serum concentration of Nirogacestat. Management: If acid-reducing therapy is required, separate nirogacestat administration from antacids by 2 hours. Risk D: Consider Therapy Modification

Octreotide: Antacids may decrease serum concentration of Octreotide. Risk C: Monitor

PAZOPanib: Antacids may decrease 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 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 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 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 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 serum concentration of QuiNINE. Risk X: Avoid

Quinolones: Antacids may decrease 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; see full monograph for details. Risk D: Consider Therapy Modification

Raltegravir: Aluminum Hydroxide may decrease 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

Rilpivirine: Antacids may decrease 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 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 serum concentration of Rosuvastatin. Risk C: Monitor

Roxadustat: Polyvalent Cation Containing Products may decrease 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 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 increase adverse/toxic effects of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may decrease therapeutic effects of Sodium Polystyrene Sulfonate. Risk C: Monitor

Sotalol: Antacids may decrease 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 serum concentration of Sotorasib. Management: Avoid use with PPIs, PCABs, or H2RAs. If use of a gastric acid suppressing medication is needed, use antacids and administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider Therapy Modification

Sparsentan: Antacids may decrease serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. Risk D: Consider Therapy Modification

Strontium Ranelate: Aluminum Hydroxide may decrease serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and aluminum hydroxide by at least 2 hours when possible, in order to minimize this interaction. Risk D: Consider Therapy Modification

Sucralfate: Antacids may decrease therapeutic effects of Sucralfate. Management: Consider separating the administration of antacids and sucralfate by at least 30 minutes. Risk D: Consider Therapy Modification

Sulpiride: Antacids may decrease 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 serum concentration of Tacrolimus (Systemic). Particularly, maximum concentration may decrease. Aluminum Hydroxide may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Taurursodiol: Aluminum Hydroxide may decrease absorption of Taurursodiol. Risk X: Avoid

Tetracyclines: Antacids may decrease 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

Thyroid Products: Antacids may decrease absorption of Thyroid Products. Risk C: Monitor

Trientine: Polyvalent Cation Containing Products may decrease 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 decrease therapeutic effects of Polyvalent Cation Containing Products. Risk X: Avoid

Ursodiol: Aluminum Hydroxide may decrease 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 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 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 active vitamin D analogs. If coadministered, monitor aluminum status and for signs and symptoms of aluminum-related toxicities. Risk D: Consider Therapy Modification

Pregnancy Considerations

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).

Breastfeeding Considerations

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).

Dietary Considerations

When used to decrease phosphorus, should be taken with meals.

Monitoring Parameters

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).

Mechanism of Action

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).

Pharmacokinetics (Adult Data Unless Noted)

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

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AR) Argentina: Pepsamar;
  • (AT) Austria: Anti phosphat;
  • (BF) Burkina Faso: Hydroxyde d'aluminium;
  • (BR) Brazil: Aludroxil | Aluflex | Alumimec | Azigel | Aziol | Aziram | Gascol | Gastromax | Gastropept | Gastrox | Gelnat | Haloxin | Hidrotheo | Hidroxido de aluminio | Hidroximed | Hidroxizol | Noacid | Pepgastrin | Peptgel | Santigel;
  • (CH) Switzerland: Anti-phosphat;
  • (CL) Chile: Aluminio Hidroxido | Pepsamar;
  • (CO) Colombia: Aci biogel | Aluminio Hidroxido | Hidroxido de aluminio | Pepsamar;
  • (DE) Germany: Additiva alugel | Aludrox | Antacidum opt | Anti-phosphat | Gastrocaps a;
  • (ES) Spain: Alugel | Pepsamar;
  • (GB) United Kingdom: Alu | Aludrox;
  • (GR) Greece: Alu | Alu cap;
  • (ID) Indonesia: Aluminium Hydroxid;
  • (IL) Israel: Alu;
  • (IN) India: Aludrox;
  • (JP) Japan: A.g. | Aluminium hyd.gel aventis;
  • (KR) Korea, Republic of: Amphojel | Dagel | Gelusam | Gelusam M;
  • (LT) Lithuania: Aludrox | Alugastril;
  • (LV) Latvia: Alugastril;
  • (MX) Mexico: Aluquim;
  • (NO) Norway: Alu cap;
  • (PL) Poland: Alusal;
  • (PR) Puerto Rico: Aluminum hydroxide;
  • (PT) Portugal: Almigastrico | Pepsamar;
  • (SG) Singapore: Alutacid;
  • (TH) Thailand: Al-minum | Alumed | Aluminum | Newgel;
  • (TW) Taiwan: Alumigel | Aluminum gel | Aluminum hydroxide | Dried Aluminum Hydroxide | Juweilon | Neo vis | Weil;
  • (UY) Uruguay: Gelal | Pepsamar;
  • (ZW) Zimbabwe: Novacid
  1. Aluminum hydroxide gel [prescribing information]. Livonia MI: Rugby Laboratories; November 2023.
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