Aluminum-Containing Antacids in Moderate Renal Impairment
Patients with an eGFR of 48 mL/min/1.73m² should avoid Mylanta (aluminum hydroxide) due to the risk of aluminum accumulation and toxicity in impaired renal function.
Rationale for Avoiding Aluminum-Containing Antacids
Aluminum hydroxide, a key ingredient in Mylanta, poses significant risks in patients with renal impairment:
- According to the British Association of Dermatologists' guidelines, patients with eGFR between 20-50 mL/min/1.73m² should receive reduced doses of medications primarily eliminated by the kidneys 1
- Aluminum is normally excreted by the kidneys, but accumulates in body tissues when renal function is impaired 2
- In chronic kidney disease, accumulated aluminum can lead to:
eGFR-Based Recommendations
The patient's eGFR of 48 mL/min/1.73m² places them in the moderate renal impairment category:
| eGFR (mL/min/1.73m²) | Aluminum-Containing Antacid Recommendation |
|---|---|
| >50 | May use with caution and monitoring |
| 20-50 | Avoid or use with extreme caution |
| <20 | Contraindicated |
Alternative Antacid Options
For patients with moderate renal impairment (eGFR 48 mL/min/1.73m²), safer alternatives include:
- Calcium-containing phosphate binders instead of aluminum-containing compounds 3
- H2-receptor antagonists (with appropriate dose adjustments)
- Proton pump inhibitors (with appropriate dose adjustments)
Monitoring Recommendations
If an aluminum-containing antacid must be used despite the risks (which is not recommended):
- Monitor serum aluminum levels regularly
- Watch for early signs of aluminum toxicity:
- Bone pain
- Muscle weakness
- Confusion or cognitive changes
- Anemia resistant to erythropoietin
Clinical Implications
The risk of aluminum toxicity increases with:
- Duration of exposure to aluminum-containing compounds
- Degree of renal impairment
- Concomitant use of citrate-containing medications (which enhance aluminum absorption) 3
Even in patients with normal or slightly impaired renal function receiving aluminum-containing antacids, studies have shown significant rises in serum aluminum levels 4. With an eGFR of 48, this risk is substantially higher.