Amphojel

aluminum hydroxide

,

AlternaGEL

(trade name),

Alu-Cap

(trade name),

Alugel

(trade name),

Aluminet

(trade name),

Alu-Tab

(trade name),

Amphojel

(trade name),

Basalgel

(trade name),

Dialume

(trade name) Pregnancy Category: UK

Indications

Action

Pharmacokinetics

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO†	hr–days	days–wk	days
PO‡	15–30 min	30 min	30 min–3 hr

†Hypophosphatemic effect‡Antacid effect

Contraindications/Precautions

Adverse Reactions/Side Effects

Gastrointestinal

• constipation (most frequent)

Fluid and Electrolyte

• hypophosphatemia

Interactions

Drug-Drug interaction

Absorption of tetracyclines, chlorpromazine, iron salts, isoniazid, digoxin, or fluoroquinolones may be decreased.Salicylate blood levels may be decreased.Quinidine, mexiletine, and amphetamine levels may be increased if enough antacid is ingested such that urine pH is increased.

Route/Dosage

Hypophosphatemia

Antacid

Availability (generic available)

In combination with: magnesium carbonate, calcium carbonate, simethicone, and mineral oil. See combination drugs.

Nursing implications

Nursing assessment

• Assess location, duration, character, and precipitating factors of gastric pain.
• Lab Test Considerations: Monitor serum phosphate and calcium levels periodically during chronic use of aluminum hydroxide.
  • May cause increased serum gastrin and decreased serum phosphate concentrations.
  • In treatment of severe ulcer disease, guaiac stools, and emesis, monitor pH of gastric secretions.

Potential Nursing Diagnoses

Acute pain (Indications)
Constipation (Side Effects)

Implementation

• Antacids cause premature dissolution and absorption of enteric-coated tablets and may interfere with absorption of other oral medications. Separate administration of aluminum hydroxide and oral medications by at least 1–2 hr.
  • Tablets must be chewed thoroughly before swallowing to prevent their entering small intestine in undissolved form. Follow with a glass of water.
  • Shake liquid preparations well before pouring. Follow administration with water to ensure passage into stomach.
  • Liquid dosage forms are considered more effective than tablets.
• Hypophosphatemic: For phosphate lowering, follow dose with full glass of water or fruit juice.
• Antacid: May be given in conjunction with magnesium-containing antacids to minimize constipation, except in patients with renal failure. Administer 1 and 3 hr after meals and at bedtime for maximum antacid effect.
  • For treatment of peptic ulcer, aluminum hydroxide may be administered every 1–2 hr while the patient is awake or diluted with 2–3 parts water and administered intragastrically every 30 min for 12 or more hr per day. Physician may order NG tube clamped after administration.
  • For reflux esophagitis, administer 15 mL 20–40 min after meals and at bedtime.

Patient/Family Teaching

• Instruct patient to take aluminum hydroxide exactly as directed. If on a regular dosing schedule and a dose is missed, take as soon as remembered if not almost time for next dose; do not double doses.
  • Advise patient not to take aluminum hydroxide within 1–2 hr of other medications without consulting health care professional.
  • Advise patients to check label for sodium content. Patients with HF or hypertension, or those on sodium restriction, should use low-sodium preparations.
  • Inform patients of potential for constipation from aluminum hydroxide.
• Hypophosphatemia: Patients taking aluminum hydroxide for hyperphosphatemia should be taught the importance of a low-phosphate diet.
• Antacid: Caution patient to consult health care professional before taking antacids for more than 2 wk if problem is recurring, if taking other medications, if relief is not obtained, or if symptoms of gastric bleeding (black tarry stools, coffee-ground emesis) occur.

Evaluation/Desired Outcomes

• Decrease in serum phosphate levels.
• Decrease in GI pain and irritation.
  • Increase in the pH of gastric secretions. In treatment of peptic ulcer, antacid therapy should be continued for at least 4–6 wk after symptoms have disappeared because there is no correlation between disappearance of symptoms and healing of ulcers.