Recommended Dosage of Aluminum Hydroxide and Magnesium Hydroxide
For aluminum hydroxide, the recommended dose is 1.425-2.85 g per day, while for magnesium hydroxide, the standard dose is 2,400 mg (30 mL) to 4,800 mg (60 mL) per day for adults. 1, 2
Aluminum Hydroxide Dosing
- The standard dose of aluminum hydroxide is 1.425-2.85 g daily, based on extensive clinical experience in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients 1
- Each 5 mL teaspoonful of aluminum hydroxide contains 320 mg of the active ingredient 3
- Long-term use should be avoided due to risk of aluminum accumulation in bone and neural tissue 1
- A study in children with CKD showed that even "safe" doses of aluminum hydroxide (30 mg/kg body weight) led to significant increases in serum aluminum levels after 12 months 1
Magnesium Hydroxide Dosing
- For adults and children over 12 years, the recommended dose is 30 mL (one unit dose containing 2,400 mg) to 60 mL (two unit doses containing 4,800 mg total) 2
- Doses may be taken once daily (preferably at bedtime), in divided doses, or as directed by a physician 2
- Each dose should be taken with a full glass (8 oz) of liquid 2
- For children under 12 years, consultation with a physician is required before administration 2
Special Considerations and Precautions
- The ratio of aluminum hydroxide to magnesium hydroxide in combination products varies widely (1:0.6 to 1:3.5) to balance the constipating effect of aluminum hydroxide with the laxative effect of magnesium hydroxide 4
- Patients with renal impairment should use caution with aluminum-containing antacids due to risk of aluminum accumulation 5
- Magnesium hydroxide should be avoided in individuals with creatinine clearance <20 mg/dL due to risk of hypermagnesemia 1
- Elderly patients may require lower doses due to increased risk of side effects 5
- Aluminum hydroxide should not be taken with citrate-containing compounds as citrate significantly enhances aluminum absorption 1
Monitoring and Safety
- For patients on long-term aluminum hydroxide therapy, serum aluminum levels should be monitored at 6-month intervals 1
- Serum aluminum levels >60 μg/L are associated with increased risk of aluminum bone disease 1
- Long-term use of aluminum-containing antacids without medical supervision may lead to phosphate depletion 5
- The maximum recommended daily dose should not be exceeded in a 24-hour period 2
Efficacy Considerations
- In studies evaluating antacid effectiveness, a dose of 30 g aluminum hydroxide/15 g magnesium hydroxide resulted in significant increases in gastric pH (>4.0) for at least 2 hours 6
- Combination products containing both aluminum hydroxide and magnesium hydroxide have shown effectiveness in controlling dyspeptic symptoms, with average intake of approximately 7 tablets per day 7