Aluminum Hydroxide and Carbonate
Aluminum hydroxide and aluminum carbonate are alternative aluminum-containing agents, rather than a required two-ingredient combination.
Group
Antacid; intestinal phosphate binder
Mechanism of Action
Bind intestinal phosphate and neutralize gastric acid. Antacid effects are relatively brief.
Dose Rates
Dogs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Phosphate binding – aluminum hydroxide | 10–30 mg/kg | PO | Every 8 h | Give with meals; amount is aluminum hydroxide. |
| Phosphate binding – aluminum carbonate | 10–30 mg/kg | PO | Every 8 h | Give with meals; amount is aluminum carbonate. Separate ingredient basis prevents linking to aluminum hydroxide strengths. |
| Phosphate binding – twice-daily hydroxide | 15–45 mg/kg | PO | Every 12 h | Aluminum hydroxide amount; give with meals and individualize to serum phosphate. |
| Phosphate binding – total daily hydroxide | 30–100 mg/kg | PO | Total daily amount to distribute with meals, not a specified one-time dose. A dried-powder alternative uses 30–90 mg/kg/day. | |
| Gastric ulcer adjunct – suspension | Reference only | PO | 2–10 mL PO every 2–4 hours of aluminum hydroxide or aluminum/magnesium hydroxide suspension; concentration and formulation must be identified. |
Cats
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Phosphate binding – aluminum hydroxide | 10–30 mg/kg | PO | Every 8 h | Give with meals; amount is aluminum hydroxide. |
| Phosphate binding – aluminum carbonate | 10–30 mg/kg | PO | Every 8 h | Give with meals; amount is aluminum carbonate. Separate ingredient basis prevents linking to aluminum hydroxide strengths. |
| Phosphate binding – twice-daily hydroxide | 15–45 mg/kg | PO | Every 12 h | Aluminum hydroxide amount; give with meals and individualize to serum phosphate. |
| Phosphate binding – total daily hydroxide | 30–90 mg/kg | PO | Total daily amount to distribute with meals, not a specified one-time dose. A dried-powder alternative uses 30–90 mg/kg/day. |
Horses
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Antacid treatment | 60 mg/kg | PO | Every 8 h | The equine entry does not identify which aluminum salt supplies the stated amount. |
| Foal gastroduodenal ulcer adjunct | Reference only | PO | 15 mL aluminum/magnesium hydroxide suspension orally four times daily in foals; active concentrations are not supplied. |
Chinchilla
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Antacid treatment | Reference only | PO | 1 mL aluminum hydroxide gel orally as needed; identify concentration before converting to an amount. |
Guinea pigs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Antacid treatment | Reference only | PO | 0.5–1 mL gel orally as needed; concentration is not specified. |
Cattle
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Antacid treatment | 30 g/animal | PO | Aluminum hydroxide; no repeat interval is specified. |
Indications
- Hyperphosphatemia associated with chronic renal disease.
- Antacid treatment for gastrointestinal ulcer management.
Contraindications
- Potential aluminum accumulation warrants caution during prolonged treatment.
- Use cautiously with gastric outlet obstruction because gastric emptying may slow.
Interactions
- Chelates tetracyclines and fluoroquinolones, reducing absorption; separate oral administration.
- Aluminum can reduce absorption of allopurinol, chloroquine, corticosteroids, digoxin, ethambutol, H2 blockers, iron, isoniazid, penicillamine, phenothiazines and thyroid hormones; separate oral doses by 2 hours.
Adverse effects
- Constipation.
- Hypophosphatemia during chronic treatment, particularly with phosphate restriction.
- Aluminum toxicity is documented in dogs with renal failure; watch for weakness, ataxia and microcytosis.
Toxicity
Aluminum toxicosis is a potential concern with prolonged exposure.
Preparations
| Preparation | Form | Strength | Route |
|---|---|---|---|
| Aluminum hydroxide gel 64 mg/mL | Oral Liquid | 64 mg / mL | PO |
| Aluminum hydroxide 600 mg tablet | Tablet | 600 mg / tablet | PO |
| Aluminum hydroxide 500 mg capsule | Capsule | 500 mg / capsule | PO |
| Aluminum hydroxide 450 mg per 5 mL suspension | Oral Liquid | 450 mg / 5 mL | PO |
| Aluminum hydroxide 675 mg per 5 mL suspension | Oral Liquid | 675 mg / 5 mL | PO |
| Aluminum hydroxide 600 mg per 5 mL suspension | Oral Liquid | 600 mg / 5 mL | PO |
Monitoring and Administration
Give phosphate-binding treatment with meals and titrate to plasma phosphate.
Keep tightly closed, protected from light, at room temperature. Aluminum carbonate capsules described as equivalent to 500 mg aluminum hydroxide must not be treated as 500 mg carbonate.
Aluminum carbonate capsules are described by a 500 mg aluminum-hydroxide-equivalent claim, without the actual carbonate mass. Iron oxide/hydroxide complex (Lenziaren), calcium citrate and calcium carbonate are alternative binders, not interchangeable aluminum ingredients.
Tablet antacid alternatives are one-half to one tablet orally every 6 hours in dogs and one-quarter tablet every 6 hours in cats; the tablet strength is not identified, so these cannot define a milligram regimen.
Check serum phosphate after a 12-hour fast every 10–14 days initially and every 4–6 weeks once stable. Monitor neuromuscular signs, MCV and microcytosis for aluminum accumulation.