Aluminum Hydroxide
Aluminum hydroxide is an orally administered compound primarily used in veterinary medicine as an **enteric phosphate binder** to manage hyperphosphatemia in patients with **chronic kidney disease (CKD)**. * It is also utilized as a **gastric antacid** to treat or prevent gastrointestinal ulcers. * > **Clinical Pearl:** While human liquid antacids (like mint-flavored suspensions) are available over-the-counter, they are often highly unpalatable to dogs and cats. Compounded dried powders are virtually tasteless and much easier to administer when mixed with canned food.
Mecanismo: * **Phosphate Binding:** In the gastrointestinal tract, **aluminum** binds to dietary **phosphate** → forms insoluble **aluminum phosphate** → excreted in the feces. This prevents the systemic absorption of phosphorus, thereby lowering serum phosphorus levels. * **Antacid:** Neutralizes gastric hydrochloric acid → increases gastric pH → reduces pepsin activity, providing a protective effect on the gastric mucosa.
Dosificación por especie
- Hyperphosphatemia · Initially at 30-90 mg/kg per day · PO · divided with meals · Dosage must be individualized. Capsules or suspension are preferred as they are more easily mixed with food and dispersed throughout ingesta.
- Hyperphosphatemia · 15-45 mg/kg · PO · q12h
- As an antacid · ¼ tablet · PO · q6h · Aluminum hydroxide tablets
- As an antacid · 30 grams/animal · PO · as needed
- Adjunctive gastroduodenal ulcer therapy in foals · 15 mL (total dose) · PO · 4 times a day · Aluminum/magnesium hydroxide suspension
- General · 1 mL/animal · PO · as needed · Chinchillas; Aluminum hydroxide gel
- General · 0.5-1 mL/animal · PO · as needed · Guinea pigs
- Hyperphosphatemia · 30-100 mg/kg/day · PO · with meals
- Hyperphosphatemia · 30-90 mg/kg/day · PO · prior to meals · Aluminum hydroxide gel, dried powder. The dried powder is virtually tasteless and accepted readily by most cats when mixed with canned food.
Vías de administración
Contraindicaciones
- Use with caution in patients with delayed gastric emptying or severe constipation
- Use with caution in patients with severe renal failure due to risk of aluminum accumulation
Efectos adversos
- Constipation
- Aluminum toxicity (neuromuscular weakness, microcytosis) with chronic use or severe renal impairment
- Hypophosphatemia (if over-supplemented)
Interacciones farmacológicas
- Isoniazid · Decreased absorption; separate oral doses by two hours
- Penicillamine · Decreased absorption; separate oral doses by two hours
- Phenothiazines · Decreased absorption; separate oral doses by two hours
- Tetracyclines · Decreased absorption; separate oral doses by two hours
- Thyroid Hormones · Decreased absorption; separate oral doses by two hours
Monitoreo
- Serum phosphorus (after a 12-hour fast), initially at 10-14 day intervals; once 'stable', at 4-6 week intervals
- Neuromuscular effects (signs of aluminum toxicity)
- Progressive decreases in mean cell volume (MCV) and microcytosis
Sobredosis
Chronic overdosage or accumulation in patients with severe renal failure can lead to **aluminum toxicity**. * Signs of toxicity include neuromuscular effects (weakness, stumbling, difficulty walking) and hematological changes (progressive decreases in mean cell volume [MCV] and microcytosis).
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