aluminum hydroxide (OTC)

Brand and Other Names:AlternaGEL, Amphojel, more...Nephrox
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 320mg/5mL

Antacid

5-30 mL PO between meals and HS or as directed

Peptic Ulcer Disease

5-30 mL between meals and HS or as directed

Hyperphosphatemia

300-600 mg PO 3 times/day between meals and HS

Dosage Forms & Strengths

oral suspension

  • 320mg/5mL

Hyperphosphatemia

50-150 mg/kg/day PO divided q4-6hr; titrate dose to keep phosphorus within normal range

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Interactions

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            Contraindicated (2)

            • pazopanib

              aluminum hydroxide will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Contraindicated. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • raltegravir

              aluminum hydroxide decreases levels of raltegravir by cation binding in GI tract. Contraindicated. Not recommended with or without dose separation.

            Serious - Use Alternative (25)

            • atazanavir

              aluminum hydroxide will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

            • baloxavir marboxil

              aluminum hydroxide will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

            • ciprofloxacin

              aluminum hydroxide decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • dapsone

              aluminum hydroxide will decrease the level or effect of dapsone by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • dasatinib

              aluminum hydroxide will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • demeclocycline

              aluminum hydroxide decreases levels of demeclocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • digoxin

              aluminum hydroxide will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • doxycycline

              aluminum hydroxide decreases levels of doxycycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • eltrombopag

              aluminum hydroxide decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

            • fleroxacin

              aluminum hydroxide decreases levels of fleroxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • gemifloxacin

              aluminum hydroxide decreases levels of gemifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • indinavir

              aluminum hydroxide will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • infigratinib

              aluminum hydroxide will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

            • ketoconazole

              aluminum hydroxide will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • levofloxacin

              aluminum hydroxide decreases levels of levofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • minocycline

              aluminum hydroxide decreases levels of minocycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • moxifloxacin

              aluminum hydroxide decreases levels of moxifloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • nimodipine

              aluminum hydroxide will increase the level or effect of nimodipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • nisoldipine

              aluminum hydroxide will increase the level or effect of nisoldipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • nitrendipine

              aluminum hydroxide will increase the level or effect of nitrendipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • ofloxacin

              aluminum hydroxide decreases levels of ofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • oxytetracycline

              aluminum hydroxide decreases levels of oxytetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • ponatinib

              aluminum hydroxide decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • sotorasib

              aluminum hydroxide will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

            • tetracycline

              aluminum hydroxide decreases levels of tetracycline by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            Monitor Closely (118)

            • acalabrutinib

              aluminum hydroxide decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

            • acebutolol

              aluminum hydroxide decreases levels of acebutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • alendronate

              aluminum hydroxide decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • allopurinol

              aluminum hydroxide decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • atenolol

              aluminum hydroxide decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • azithromycin

              aluminum hydroxide decreases levels of azithromycin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bearberry

              aluminum hydroxide will increase the level or effect of bearberry by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • benazepril

              aluminum hydroxide decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor. May decrease absorption.

            • benzphetamine

              aluminum hydroxide will increase the level or effect of benzphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • betaxolol

              aluminum hydroxide decreases levels of betaxolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bictegravir

              aluminum hydroxide will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing Al, Mg, or Ca. Routine administration of bictegravir simultaneously with, or 2 hr after, antacids containing Al, Mg, or Ca is not recommended.

            • bisoprolol

              aluminum hydroxide decreases levels of bisoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bosutinib

              aluminum hydroxide decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

            • budesonide

              aluminum hydroxide decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

            • cabotegravir

              aluminum hydroxide will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer antacid products at least 2 hr before or 4 hr after taking oral cabotegravir.

            • capecitabine

              aluminum hydroxide increases levels of capecitabine by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • captopril

              aluminum hydroxide decreases effects of captopril by unspecified interaction mechanism. Use Caution/Monitor. Aluminum hydroxide may decrease absorption of captopril.

            • carbonyl iron

              aluminum hydroxide will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • carvedilol

              aluminum hydroxide decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • cefdinir

              aluminum hydroxide will decrease the level or effect of cefdinir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefditoren

              aluminum hydroxide will decrease the level or effect of cefditoren by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefpodoxime

              aluminum hydroxide will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefuroxime

              aluminum hydroxide will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • celecoxib

              aluminum hydroxide decreases levels of celecoxib by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • celiprolol

              aluminum hydroxide decreases levels of celiprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chenodiol

              aluminum hydroxide decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chloroquine

              aluminum hydroxide will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

              aluminum hydroxide will decrease the level or effect of chloroquine by Mechanism: inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely.

            • cholic acid

              aluminum hydroxide will decrease the level or effect of cholic acid by drug binding in GI tract. Use Caution/Monitor. Take cholic acid at least 1 hr before or 4-6 hr (or as great an interval as possible) after a aluminum-based antacid.

            • crizotinib

              aluminum hydroxide decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

            • cyclosporine

              aluminum hydroxide decreases levels of cyclosporine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • dabrafenib

              aluminum hydroxide will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

            • deferasirox

              aluminum hydroxide will decrease the level or effect of deferasirox by Other (see comment). Use Caution/Monitor. Avoid combination. Although deferasirox has a lower affinity for aluminum than for iron, do not administer deferasirox with aluminum-containing antacid preparations.

            • deferiprone

              aluminum hydroxide decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

            • deferoxamine

              deferoxamine decreases levels of aluminum hydroxide by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

            • delafloxacin

              aluminum hydroxide will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

            • dextroamphetamine

              aluminum hydroxide will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • dolutegravir

              aluminum hydroxide will decrease the level or effect of dolutegravir by cation binding in GI tract. Use Caution/Monitor. Administer dolutegravir 2 hr before or 6 hr after taking medications containing polyvalent cations; use alternative therapy if available

            • elvitegravir

              aluminum hydroxide will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              aluminum hydroxide decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

            • enalapril

              aluminum hydroxide decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ephedrine

              aluminum hydroxide will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • erythromycin base

              aluminum hydroxide increases levels of erythromycin base by unknown mechanism. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              aluminum hydroxide increases levels of erythromycin ethylsuccinate by unknown mechanism. Use Caution/Monitor.

            • erythromycin lactobionate

              aluminum hydroxide increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

            • erythromycin stearate

              aluminum hydroxide increases levels of erythromycin stearate by unknown mechanism. Use Caution/Monitor.

            • esmolol

              aluminum hydroxide decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ethambutol

              aluminum hydroxide increases levels of ethambutol by cation binding in GI tract. Use Caution/Monitor. Avoid administering aluminum hydroxide containing antacids for at least 4 hr following ethambutol dose.

            • etidronate

              aluminum hydroxide decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ferric maltol

              aluminum hydroxide will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous fumarate

              aluminum hydroxide will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous gluconate

              aluminum hydroxide will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous sulfate

              aluminum hydroxide will decrease the level or effect of ferrous sulfate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • flecainide

              aluminum hydroxide will increase the level or effect of flecainide by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • fosamprenavir

              aluminum hydroxide will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • fosinopril

              aluminum hydroxide decreases effects of fosinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • gabapentin

              aluminum hydroxide decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gabapentin enacarbil

              aluminum hydroxide decreases levels of gabapentin enacarbil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gefitinib

              aluminum hydroxide decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

            • glipizide

              aluminum hydroxide will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • glyburide

              aluminum hydroxide will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ibandronate

              aluminum hydroxide decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • imidapril

              aluminum hydroxide decreases effects of imidapril by unspecified interaction mechanism. Use Caution/Monitor.

            • iron dextran complex

              aluminum hydroxide will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • iron sucrose

              aluminum hydroxide will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • isoniazid

              aluminum hydroxide decreases levels of isoniazid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • itraconazole

              aluminum hydroxide will decrease the level or effect of itraconazole by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Administer acid neutralizing medicines at least 2 hours before or 2 hours after itraconazole.

            • ketoconazole

              aluminum hydroxide decreases levels of ketoconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • labetalol

              aluminum hydroxide decreases levels of labetalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • lactulose

              aluminum hydroxide decreases effects of lactulose by pharmacodynamic antagonism. Use Caution/Monitor.

            • lanthanum carbonate

              lanthanum carbonate, aluminum hydroxide. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • ledipasvir/sofosbuvir

              aluminum hydroxide decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

            • lisdexamfetamine

              aluminum hydroxide will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • lisinopril

              aluminum hydroxide decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • memantine

              aluminum hydroxide will increase the level or effect of memantine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • methscopolamine

              aluminum hydroxide decreases levels of methscopolamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • methylphenidate

              aluminum hydroxide decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • metoprolol

              aluminum hydroxide decreases levels of metoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • mexiletine

              aluminum hydroxide will increase the level or effect of mexiletine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • moexipril

              aluminum hydroxide decreases effects of moexipril by unspecified interaction mechanism. Use Caution/Monitor.

            • mycophenolate

              aluminum hydroxide will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • nadolol

              aluminum hydroxide decreases levels of nadolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • nebivolol

              aluminum hydroxide decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • neratinib

              aluminum hydroxide will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

            • nilotinib

              aluminum hydroxide decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

            • nitrofurantoin

              aluminum hydroxide decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • omadacycline

              aluminum hydroxide will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

            • pamidronate

              aluminum hydroxide decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • penbutolol

              aluminum hydroxide decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • penicillamine

              aluminum hydroxide decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • perindopril

              aluminum hydroxide decreases effects of perindopril by unspecified interaction mechanism. Use Caution/Monitor.

            • pexidartinib

              aluminum hydroxide will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

            • pindolol

              aluminum hydroxide decreases levels of pindolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • polysaccharide iron

              aluminum hydroxide will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • posaconazole

              aluminum hydroxide will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • propranolol

              aluminum hydroxide decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • pseudoephedrine

              aluminum hydroxide will increase the level or effect of pseudoephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Caution advised with frequent or high dose antacids

            • quinapril

              aluminum hydroxide decreases effects of quinapril by unspecified interaction mechanism. Use Caution/Monitor.

            • quinidine

              aluminum hydroxide will increase the level or effect of quinidine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • ramipril

              aluminum hydroxide decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • rifampin

              aluminum hydroxide will decrease the level or effect of rifampin by Other (see comment). Use Caution/Monitor. Concomitant antacid administration may reduce absorption of rifampin; daily doses of rifampin should be given at least 1 hr before ingestion of antacids

            • rilpivirine

              aluminum hydroxide decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

            • riociguat

              aluminum hydroxide decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

            • risedronate

              aluminum hydroxide decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • rose hips

              aluminum hydroxide will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • rosuvastatin

              aluminum hydroxide decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sarecycline

              aluminum hydroxide will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sofosbuvir/velpatasvir

              aluminum hydroxide will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

            • sotalol

              aluminum hydroxide decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • tiludronate

              aluminum hydroxide decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • timolol

              aluminum hydroxide decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • tolbutamide

              aluminum hydroxide will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • trandolapril

              aluminum hydroxide decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ursodiol

              aluminum hydroxide decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.

            • vismodegib

              aluminum hydroxide will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

            • vitamin D

              vitamin D increases levels of aluminum hydroxide by Other (see comment). Use Caution/Monitor. Comment: Avoid coadministration. Chronic use of aluminum-containing antacids in conjunction with vitamin D can lead to aluminum retention and possible toxicity.

            • zoledronic acid

              aluminum hydroxide decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            Minor (18)

            • ascorbic acid

              ascorbic acid increases levels of aluminum hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • aspirin

              aluminum hydroxide, aspirin. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin rectal

              aluminum hydroxide, aspirin rectal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin/citric acid/sodium bicarbonate

              aluminum hydroxide, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • balsalazide

              aluminum hydroxide, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • blessed thistle

              blessed thistle decreases effects of aluminum hydroxide by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

            • choline magnesium trisalicylate

              aluminum hydroxide, choline magnesium trisalicylate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • chromium

              aluminum hydroxide decreases levels of chromium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

            • devil's claw

              devil's claw decreases effects of aluminum hydroxide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • diflunisal

              aluminum hydroxide, diflunisal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • mesalamine

              aluminum hydroxide, mesalamine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • rose hips

              rose hips increases levels of aluminum hydroxide by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • salicylates (non-asa)

              aluminum hydroxide, salicylates (non-asa). Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • salsalate

              aluminum hydroxide, salsalate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • strontium ranelate

              aluminum hydroxide decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hr when possible.

            • sucralfate

              sucralfate increases levels of aluminum hydroxide by pharmacodynamic synergism. Minor/Significance Unknown. Additive aluminum content.

            • sulfasalazine

              aluminum hydroxide, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • willow bark

              aluminum hydroxide, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

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            Adverse Effects

            Frequency Not Defined

            Nausea

            Vomiting

            Rebound hyperacidity

            Aluminum-intoxication

            Hypophosphatemia

            Chalky taste

            Constipation

            Fecal impaction

            Stomach cramps

            Milk-alkali syndrome

            Osteomalacia

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            Warnings

            Contraindications

            Hypersensitivity to aluminum salts

            Cautions

            Aluminum toxicity may occur in renal failure patients

            Hypophosphatemia may occur

            Use caution in patients with heart failure, cirrhosis, edema, or renal failure

            Will bind calcium if given at same time

            Elderly may be predisposed to fecal impaction

            Use caution in patients who have recently suffered massive gastrointestinal hemorrhage

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: Not known whether aluminum hydroxide is excreted in breast milk

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Antacid: Neutralizes HCl in the stomach to form soluble aluminum chloride

            Phosphate binder: binds phosphate in the GI tract to form insoluble complexes and reduces phosphate absorption

            Pharmacokinetics

            Excretion

            • Absorbed aluminum is eliminated in the urine (0.1-0.5 mg of Al in aluminum-containing antacid is absorbed from standard daily doses of antacid)
            • Insoluble, poorly absorbed Al salts in the intestines: hydroxides, carbonates, phosphates and fatty acid derivatives, are excreted in feces
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            Administration

            Oral Administration

            Drink plenty of water following dose

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            aluminum hydroxide gel oral
            -
            320 mg/5 mL suspension

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            aluminum hydroxide gel oral

            ALUMINUM HYDROXIDE SUSPENSION - ORAL

            (a-LOO-mi-num hye-DROX-ide)

            COMMON BRAND NAME(S): Alternagel, Amphojel

            USES: This medication is used to treat the symptoms of too much stomach acid such as stomach upset, heartburn, and acid indigestion. Aluminum hydroxide is an antacid that works quickly to lower the acid in the stomach. Liquid antacids usually work faster/better than tablets or capsules.This medication works only on existing acid in the stomach. It does not prevent acid production. It may be used alone or with other medications that lower acid production (including H2 blockers such as cimetidine/ranitidine and proton pump inhibitors such as omeprazole).

            HOW TO USE: Take this medication by mouth between meals and at bedtime. Follow all the directions on the product package or use as directed by your doctor. If you have any questions, ask your doctor or pharmacist.Shake the bottle well before each dose. Refrigerating the suspension may improve the flavor. Do not freeze. This medication works best if taken without other fluids. You can mix your dose with a little water if needed.This product contains aluminum, which may react with other medications (including digoxin, iron, tetracycline antibiotics, pazopanib, quinolone antibiotics such as ciprofloxacin), preventing them from being fully absorbed by your body. Talk with your doctor or pharmacist about how to schedule your medications to prevent this problem.If your acid problems persist or worsen after you have used this product for 1 week, or if you think you have a serious medical problem, seek immediate medical attention. If you are using this medication regularly on a daily basis for more than 2 weeks, you may have a medical problem that needs different treatment. Ask your doctor if this is the right medication for you.

            SIDE EFFECTS: Constipation may occur. This could lead to other problems such as hemorrhoids and bowel obstruction. If constipation persists or worsens, contact your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.To minimize constipation, drink plenty of fluids and exercise. Using an antacid that contains magnesium along with this product can help prevent constipation. Stool softeners may also be helpful. Ask your doctor or pharmacist about other antacids, stool softeners and laxatives.Aluminum-containing antacids bind to phosphate, an important body chemical, in the gut. This can cause low phosphate levels if your kidneys are normal, especially if you use large doses for a long time. Tell your doctor right away if you have any of the following symptoms of low phosphate: loss of appetite, unusual tiredness, muscle weakness.Seek immediate medical attention if any of these rare but very serious side effects or symptoms of a serious medical problem occur: black/tarry stools, mental/mood changes (e.g., confusion, deep sleep), pain with urination, stomach/abdominal pain, vomit that looks like coffee grounds.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking aluminum hydroxide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this product: frequent alcohol use, dehydration/fluid restriction, problems with constipation, kidney problems (including kidney stones).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication may pass into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Antacids can interfere with the absorption of many other drugs. Be sure to check with your pharmacist before taking antacids with any other medication.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

            NOTES: Keep all regular medical and laboratory appointments.Lifestyle changes such as stress reduction programs, stopping smoking, limiting alcohol, and diet changes (e.g., avoiding caffeine, fatty foods, certain spices) may increase the effectiveness of this medication. Talk to your doctor or pharmacist about lifestyle changes that might benefit you.

            MISSED DOSE: If you are taking this product on a regular schedule and miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Refer to storage information printed on the package. Protect from light and moisture. Do not store in the bathroom. If you have any questions about storage, ask your pharmacist. Keep all drug products away from children and pets. This product may be stored in the refrigerator to improve taste. Do not freeze.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.