Aluminum Hydroxide

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Also indexed as:

Algedrate, Alternagel, Alu-Tab, Alugel, Amphojel, Di-Gel, Metapharma Aluminum Hydroxide Gel, Riopan

Combination List

Combination drugs:

• Co-Magaldrox
• Maalox
• Maalox Plus
• Mylanta
• Tempo Tablets

Aluminum hydroxide acts as an antacid and is most commonly used in the treatment of heartburn, gastritis, and peptic ulcer. This drug is also sometimes used to reduce absorption of phosphorus for people with kidney failure.

Aluminum hydroxide is found in a variety of antacids. People should read the ingredient label for over-the-counter (OTC) drugs carefully before purchase to know exactly what they contain.

Herbs

Summary of Interactions for Aluminum Hydroxide

Depletion or interference	Calcium Folic acid Phosphorus
Adverse interaction	Citrate
Side effect reduction/prevention	None known
Supportive interaction	Alginates
Reduced drug absorption/bioavailability	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Alginates

A thick gel derived from algae has been used together with aluminum antacids to treat heartburn. Together, alginate gel and antacid were more effective at relieving symptoms¹ and improving healing.² Alginate is believed to work by physically blocking stomach acid from touching the esophagus. According to these studies, two tablets containing 200 mg alginic acid should be chewed before each meal and at bedtime.

Calcium

Aluminum hydroxide may increase urinary and stool loss of calcium.³ Also, aluminum is a toxic mineral, and a limited amount of aluminum absorption from aluminum-containing antacids does occur.⁴ As a result, most doctors do not recommend routine use of aluminum-containing antacids.⁵ Other types of antacids containing calcium or magnesium instead of aluminum are available.

Citrate

Several studies have shown that combination of citrate, either as calcium citrate supplements or from orange and lemon juice, with aluminum-containing antacids increases aluminum levels in the body.^{6, 7, 8} Calcium in forms other than calcium citrate has been shown to not increase aluminum absorption.⁹ Drinking 7-10 ounces of orange juice provides sufficient citrate to be problematic.^{10, 11} Intake of 950 mg calcium citrate greatly elevates aluminum absorption.¹² People with renal failure may be at particular risk of kidney damage due to elevated aluminum levels if they combine aluminum hydroxide with citrate.¹³

Folic acid

Folic acid is needed by the body to utilize vitamin B12. Antacids,¹⁴ including aluminum hydroxide, inhibit folic acid absorption. People taking antacids are advised to supplement with folic acid.

Phosphorus

Depletion of phosphorus may occur as a result of taking aluminum hydroxide. For those with kidney failure, reducing phosphorus absorption is the purpose of taking the drug, as excessive phosphorus levels can result from kidney failure. However, when people with normal kidney function take aluminum hydroxide for extended periods of time, it is possible to deplete phosphorus to unnaturally low levels.

References

1. McHardy G. A multicentric, randomized clinical trial of Gaviscon in reflux esophagitis. South Med J 1978;71(suppl 1):16-21.
2. Graham DY, Lanza F, Dorsch ER. Symptomatic reflux esophagitis: A double-blind controlled comparison of antacids and alginate. Curr Ther Res 1977;22:653-8.
3. Spencer H, Kramer L. Antacid-induced calcium loss. Arch Intern Med 1983;143:657-8 [editorial].
4. Anonymous. Is aluminum harmless? Nutr Rev 1980;38:242-3 [review].
5. Gaby AR. Aluminum: The ubiquitous poison. Nutr Healing 1997;4:3,4,11.
6. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037-9.
7. Weberg R, Berstad A. Gastrointestinal absorption of aluminum from single doses of aluminum containing antacids in man. Eur J Clin Invest 1986;16:428-32.
8. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71-3.
9. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937-41.
10. Anonymous. Preliminary findings suggest calcium citrate supplements may raise aluminum levels in blood, urine. Family Practice News 1992;22:74-5.
11. Fairweather-Tait S, Hickson K, McGaw B, Redi M. Orange juice enhances aluminum absorption from antacid preparation. Eur J Clin Nutr 1994;48:71-3.
12. Nolan CR, Califano JR, Butzin CA. Influence of calcium acetate or calcium citrate on intestinal aluminum absorption. Kidney Int 1990;38:937-41.
13. Walker JA, Sherman RA, Cody RP. The effect of oral bases on enteral aluminum absorption. Arch Intern Med 1990;150:2037-9.
14. Russell RM, Golner BB, Krasinski SD, et al. Effect of antacid and H2 receptor antagonists on the intestinal absorption of folic acid. J Lab Clin Med 1988;112:458-63.

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Last Review: 09-01-2007

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