Aluminum Hydroxide, An Over-The-Counter Medication For Kidney Disease
Just What is Aluminum Hydroxide?
ALUMINUM HYDROXIDE (brand names: Alternagel, Amphojel) is an over-the-counter oral antacid and phosphate binder, more commonly used to treat high phosphate levels secondary to kidney dysfunction. It can also be used to reduce stomach acid production.
Its use in cats, dogs, or small mammals to treat high phosphate levels is ‘off label’ or ‘extra label’. Many drugs are commonly prescribed for off label use in veterinary medicine. When these instances occur, follow your veterinarian’s directions and caution very carefully as their directions may be significantly different from those on the label.
So How Is Aluminum Hydroxide Given?
It is given by mouth in the form of a liquid gel or in powder form mixed with food. Also, it can be compounded into capsules. The medication should be given immediately before food or mixed with the food. This medication should take effect within 1 to 2 hours; however, effects may not be visibly obvious and therefore laboratory tests may be needed to evaluate this medication’s effectiveness.
What Happens If The Pet Doesn’t Get His Medication?
When a dose is missed, give it when you can, but if it is close to the time for the next dose, just skip the dose that was missed and give it at the next scheduled time, and return to the regular dosing schedule. NEVER, give your pet two doses at once or extra doses.
What Are The Potential Side Effects?
One of the most common side effects is constipation. If the dose is too high, a low blood phosphate level can occur. Rarely, aluminum toxicity can occur with its long-term use and may cause signs such as weakness, walking difficulty, or stumbling. This is a short-acting medication and should stop working within 24 hours.
Are There Any Risk Factors Associated with this medication?
It is recommended that you use this medication cautiously in pets that have a gastrointestinal obstruction or are prone to constipation. Other than that it is generally considered a safe medication because it is poorly absorbed systemically.
What About Any Drug Interactions I Should Be Aware Of?
Aluminum Hydroxide can affect the number of other medications that are absorbed, so be cautious when giving this medication with the following medications:
- Allopurinol
- Aspirin
- Chloroquine
- chlorpromazine
- Corticosteroids
- Digoxin
- Ethambutol
- Fluoroquinolones
- Gabapentin
- H2 Antagonists
- Iron Salts
- Isoniazid
- Penicillamine
- Phenothiazines
- Phenytoin
- Tetracyclines
- Thyroid Hormones
- Quinidine
To offset this interaction, give aluminum hydroxide two hours before or after administering any other medication. And be sure to tell your veterinarian about any other medications ( including vitamins, supplements, or herbal therapies ) that your pet is taking.
Is There Any Monitoring That Needs To Be Done With This Medication?
Your dog should be monitored for side effects of aluminum toxicity as described above. Blood phosphate levels should be monitored monthly, in the beginning, to make sure the medication is working and that the dose is appropriate. Once stable, your veterinarian will monitor your dog’s blood phosphate level; this usually is every 3 months. A complete blood count may also be monitored for signs related to aluminum toxicity.
How Is Aluminum Hydroxide Stored?
The liquid gel should be stored at room temperature, taking care to avoid freezing. The powder and compounded capsules should be stored in a sealed container, away from moisture and at room temperature.
In Case Of An Emergency, What Do I Do?
If an overdose is suspected or an adverse reaction to aluminum hydroxide, call your veterinarian immediately. If he is not available, follow their directions in contacting an emergency facility.
Are There Other Ingredients In Aluminum Hydroxide products?
In some of the brands, there are thickening agents, flavors, and sweeteners, combined with water. The inactive ingredients are benzyl alcohol (solvent but partially a preservative), butylparaben (flavoring and anti-bacterial), glycerin (thickener and somewhat sweet), hydroxyethylcellulose (thickener), propylparaben (preservative; anti-fungal), water, saccharin (sweetener), simethicone (anti-foaming agent and anti-gas ingredient), sorbitol (sweetener).