Aluminum Hydroxide (Alu-Cap, Amphojel)

Category:

• Gastrointestinal

Description:

• Weak antacid, phosphate binder

Indications:

• Duodenal ulcer

• Peptic ulcer

• Hyperphosphatremia

• Stress gastritis prophylaxis

Contraindications:

• GI bleeding, constipation, fecal impaction, GI obstruction

• Hypophosphatemia, renal disease

Precautions:

• Dehydrated patients

• Patients with preexisting decreased bowel motility

• Hemorrhoids

Adverse Reactions (Side Effects):

• CNS: dementia, malaise, encephalopathy

• GI: bowel obstruction, constipation, hemorrhoids

• METAB: hypercalcemia, hypophosphatemia

• GU: nephrolithiasis

• MISC: weakness, osteomalacia, osteoporosis

Dosage:

Administered orally

• Hyperacidity (as an antacid) associated with gastritis, peptic ulcer disease including duodenal ulcer and possibly gastric ulcer, reflux esophagitis, and hiatal hernia:

  • Adult:   PO 40-60ml every 3-6 hours, or 1 and 3 hours after meals and at bedtime as tablet, capsule, or suspension.  For the acute management of reflux esophagitis, doses may be administered every hour if necessary.  The OTC recommended dose for oral suspension is 10ml taken 5-6 times daily, between meals and at bedtime.  The recommended OTC dose for Amphojel tablets is 600mg PO 5-6 times per day, between meals and at bedtime.

  • Child:   PO 5-15ml oral suspension given every 3-6 hours, or 1 and 3 hours after meals and at bedtime

  • Infant:   PO 1-2 ml/kg oral suspension given every 4 hours as needed

• Stress gastritis prophylaxis:

  • Adult:   PO 40-60ml every 3-6 hours, or 1 and 3 hours after meals and at bedtime.  Dosage should be titrated according to intragastric pH

  • Child:   PO 5-15ml suspension given every 1-2 hours; titrate to gastric pH > 3.5

  • Infant:   PO 2-5ml suspension given every 1-2 hours; titrate to gastric pH > 3.5

  • Neonate: PO 1 ml/kg suspension given every 4 hours as needed

• Management of hyperphosphatemia secondary to renal osteodystrophy in patients with end stage renal disease:

  • Adult:   PO 30-40ml suspension administered with each meal or snack. NOTE: Some clinicians prefer to avoid aluminum salts for this indication.  Although calcium salts are preferred, aluminum salts may be desirable when serum calcium is also high.  When the serum phosphate has been lowered sufficiently, aluminum salts can be replaced by calcium salts.

  • Child:   PO 50-150 mg/kg/day divided in 4-6 daily doses