Aluminum Hydroxide is a phosphorus binder for cats and dogs with renal failure. Aluminum Hydroxide powder is the most popular form of this medication and currently has an expiration in 2014. Aluminum Hydroxide Capsules and Suspension require a prescription. Aluminum Hydroxide powder does not require a prescription. Aluminum Hydroxide suspension is sold in multiples of 30 mls and expires 3 months from the date it is compounded. Aluminum Hydroxide capsules are sold individually and expire in 1 year. Aluminum Hydroxide should be administered with food. This is a dose-to-effect medication.

A 2001 study by Peter Markewell (BSc, BVetMed, MRCVS) for the Waltham Centre for Pet Nutrition found that "...using a phosphate- and protein-restricted diet, in combination with oral phosphorus-binding agents in those cats in which control of hyperphosphatemia [high phosphorus] and RHPTH [renal secondary hyperparathyroidism] was not achieved by diet alone, resulted in more than doubling of average survival time from the commencement of treatment."

Dosing

Aluminum Hydroxide should be administered with food. This is a dose-to-effect medication, the dose should be adjusted to achieve the desired phosphorus level with the typical target of 4.0. Use as directed by veterinarian.

Drug Interactions (Source: https://felinecrf.org/treatments/phosphorus-binders/#Aluminium_Hydroxide)

Citrates 

As Prescribers' Digital Reference mentions, products containing citrate may increase the absorption of aluminium, which could increase the risk of aluminium toxicity (though apparently these findings have not been replicated in cats). The most commonly used citrate-containing products in CKD cats are potassium citrate (perhaps to treat metabolic acidosis), and many therapeutic kidney diets.

If you are using potassium citrate, give this at least two hours apart from aluminium-based binders.

Other Interactions

• According to Plumb's Veterinary Drug Handbook, aluminium hydroxide should be given two hours apart from enrofloxacin (Baytril), an antibiotic. It is probably wise to keep aluminium hydroxide away from antibiotics generally, particularly those in the same family as Baytril (this includes marbofloxacin (Zeniquin).

• Plumb's also recommends separating aluminium hydroxide from corticosteroids.

• Aluminium hydroxide should ideally be given separately from oral iron supplements because the aluminium hydroxide may reduce the absorption of the iron.

• Plumb's Veterinary Drug Handbook also advises giving aluminium hydroxide two hours apart from famotidine (Pepcid AC), which is used to treat excess stomach acid, because it may interfere with the absorption of the treatment, which would make it less effective. However, RX Med states that "concomitant use of aluminum hydroxide/magnesium hydroxide at commonly used doses, does not influence the pharmacodynamics or bioavailability of Pepcid AC." I would try to err on the side of caution and still separate famotidine from phosphorus binders and ACE inhibitors if you can, but if this is difficult for you, e.g. because of work commitments, just do the best you can.

• Aluminium hydroxide binders should be given two hours apart from ACE inhibitors, because the binder may reduce the bioavailability of the ACE inhibitors. Drugs has more information about this.

• Pennstate Hershey mentions that vitamin C may interact adversely with products containing aluminium, such as phosphorus binders. Cats do not need vitamin C supplements anyway, because their bodies can manufacture all the Vitamin C they need.