Aluminum hydroxide

*phosphate binder; antacid

Brands/Synonyms : AlternaGEL, Alu-Cap, Aludrox, Amphojel, Dialume, Gaviscon, Nephrox, 

Therapeutics 

Interactions  In dogs, has interfered with absorption of other medications such as beta-blockers, tetracyclines, and fluoroquinolones

Antidote/Reversal Agent : Deferoxamine

Indications

*Chronic kidney disease 

Dosage (Cat) 27.5-40.5 mg/kg PO q 12h , Duration : As needed based on duration of hyperphosphatemia, 

Expected Effects Reduction of serum phosphate level.

* Chronic kidney disease due to renal dysplasia

Dosage (Dog) 50 mg/kg PO q 12h, Duration : 4 months in reported case; usually as needed

Expected Effects Reduction of serum phosphate level

* Primary hypoparathyroidism

Dosage (Cat) 20-130 mg/kg PO q 8-12h,  Duration : Indefinite, according to persistence of hyperphosphatemia (17 months in this case)

Expected Effects Reduction of serum phosphate level

Available Formulations 

Oral solution 60 mg/mL

Tab 300 mg

Precautions

Contraindications : Hypophosphatemia,  Hypersensitivity to the drug

Adverse Side Effects : In dogs, has caused aluminum toxicosis when given in doses of 145-200 mg/kg/day during chronic kidney disease.

Pearls

Generally begun low and titrated up according to response (serum phosphates level), while avoiding aluminum toxicosis

May decrease appetite

Aluminum toxicosis in dogs manifests as central neurologic signs progressing to obtundation and microcytosis, and is confirmed with a serum aluminum level (normal: 0.008-0.012 ppm)

References 

PubMed – 19000253

PubMed – 6681962