Generic Name: aluminum hydroxide

Brand Name: Alu-Cap, Alugel, Alu-Tab, Amphogel, Dialume

Classifications: gastrointestinal agent; antacid; adsorbent

Actions

Nonsystemic antacid with moderate neutralizing action. Decreases rate of gastric emptying and has demulcent, adsorbent, and mild astringent properties. Reduces acid concentration and pepsin activity by raising pH of gastric and intraesophageal secretions.

Therapeutic Effects

Reduces gastric acidity by neutralizing the stomach acid content. Aluminum hydroxide lowers serum phosphate by binding dietary phosphate to form insoluble aluminum phosphate, which is excreted in feces.

Uses

Symptomatic relief of gastric hyperacidity associated with gastritis, esophageal reflux, and hiatal hernia; adjunct in treatment of gastric and duodenal ulcer. More commonly used in combination with other antacids. Aluminum hydroxide is used primarily in conjunction with a low phosphate diet to reduce hyperphosphatemia in patients with renal insufficiency and for prophylaxis and treatment of phosphatic renal calculi.

Cautious Use

Renal impairment; gastric outlet obstruction; older adults; decreased bowel activity (e.g., patients receiving anticholinergic, antidiarrheal, or antispasmodic agents); patients who are dehydrated or on fluid restriction.

Dosage

Adult: PO 600 mg t.i.d. or q.i.d.

Administration

Oral

• Tablet must be chewed until it is thoroughly wetted before swallowing.
• Note for antacid use: Follow well-chewed tablet with one-half glass of water or milk; follow liquid preparation (suspension) with water to ensure passage into stomach. For phosphate lowering: follow tablet, capsule, or suspension with full glass of water or fruit juice.
• Store between 15°–30° C in tightly closed container.

Adverse Effects

GI: Constipation, fecal impaction, intestinal obstruction.

Interactions

Drug: Aluminum will decrease absorption of chloroquine, cimetidine, ciprofloxacin, digoxin, isoniazid, iron salts, NSAIDs, norfloxacin, ofloxacin, phenytoin, phenothiazines, quinidine, tetracycline, thyroxine. Sodium polystyrene sulfonate may cause systemic alkalosis.

Nursing Considerations

Assessment & Drug Effects

• Note number and consistency of stools. Constipation is common and dose related. Intestinal obstruction from fecal concretions has to be reported.
• Lab tests: Monitor periodic serum calcium and phosphorus levels with prolonged high-dose therapy or impaired renal function.

Patient & Family Education

• Increase phosphorus in diet when taking large doses of these antacids for prolonged periods; hypophosphatemia can develop within 2 wk of continuous use of these antacids. The older adult in a poor nutritional state is at high risk.
• Antacid may cause stools to appear speckled or whitish.
• Report epigastric or abdominal pain; it is a clinical guide for adjusting dosage. Keep physician informed. Pain that persists beyond 72 h may signify serious complications.
• Seek medical help if indigestion is accompanied by shortness of breath, sweating, or chest pain, if stools are dark or tarry, or if symptoms are recurrent when taking this medication.
• Seek medical advice and supervision if self-prescribed antacid use exceeds 2 weeks