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Aluminum Hydroxide Toxicity - Risk Factors, Symptoms, Diagnosis, Precautions, and Treatment

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Aluminum Hydroxide Toxicity - Risk Factors, Symptoms, Diagnosis, Precautions, and Treatment

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Aluminum hydroxide toxicity occurs when excess aluminum is accumulated in the bloodstream due to over absorption or ingestion. Read below to know more.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At August 8, 2022
Reviewed AtOctober 11, 2022


Aluminum hydroxide, also called hydrated alumina, is a commonly accessible aluminum compound. It is an over-the-counter drug. It is available in various forms and is used to treat multiple gastric problems, skin rashes, etc. In healthy people, aluminum hydroxide shows scarce aluminum absorption when inhaled, taken orally, or through the skin. But certain people show abnormalities in aluminum absorption due to overdose, any underlying illnesses, etc. Some people show hypersensitivity (allergic reactions) to aluminum hydroxide due to previously known intolerance to aluminum compounds.

What Are the Applications of Aluminum Hydroxide in Medicine?

Pharmacological applications of aluminum hydroxide are as follows,

  • Aluminum hydroxide is used to treat symptoms like heartburn, indigestion, upset stomach, etc., associated with peptic ulcers by neutralizing the excess stomach acids produced and protecting the stomach lining from acid secretions.

  • It is used to treat skin rashes, minor wounds, acne, irritated skin, etc.

  • It acts as a skin protectant drug against skin rashes caused due to diaper usage.

  • It helps to control hyperphosphatemia (higher phosphate levels in the blood).

  • It is used in the form of mouthwash to manage oral mucositis induced by chemotherapy.

  • Also, It is a broadly used adjuvant in several vaccines.

Other than its usage as a drug, aluminum hydroxide has roles in the manufacture of various medical equipment such as;

  • Abutments for dental implants.

  • Stents to treat tracheomalacia.

  • Artificial hip replacements.

  • It is also used as a color additive for polymethyl methacrylate cement and sutures.

What Are the Available Dosage Forms of Aluminum Hydroxide?

Pharmacologically, Aluminum hydroxide is available in various forms such as tablets, suspension, capsules, mouthwashes, ointments, etc. The recommended aluminum hydroxide dosage to treat peptic ulcers is 5 to 30 ml between meals or before bedtime, and for hyperphosphatemia, 300 to 600 mg three times a day in adults and 50 to 150 mg in children. Aluminum hydroxide should be taken only with a proper prescription as directed by the physician. The dosage varies with body weight, individual requirements, and the associated disease.

What Is the Mechanism of Action of Aluminum Hydroxide?

  • When taken as an antacid, it neutralizes the Ph of the secreted stomach acids such as pepsin and protects the stomach lining from damage and irritation.

  • When applied in a topical ointment form, it forms a hydrophilic layer on the skin surface and acts as a protective barrier against infection and bacterial buildup.

  • When used as an adjuvant in vaccines, it boosts the macrophages (a type of white blood cell present in the blood) to produce inflammatory reactions, thereby helping the body to develop better immunity against the antigen.

What Are the Modes of Aluminum Excretion From the Body?

The aluminum present in the body is in a steady-state majority of the time, so sequential aluminum excretion occurs with the ingestion of aluminum hydroxide. The orally administered aluminum is excreted primarily through feces, and systemically administered aluminum passes in the urine. When there is an underlying illness, this excretion process gets compromised.

Who Is at Risk for Aluminum Hydroxide Toxicity?

The most common risk factors associated with aluminum hydroxide toxicity include;

  • People with diminished kidney function.

  • Patients who take aluminum hydroxide as a long-term medication.

  • Working in an area with increased exposure to aluminum.

  • Drug overdose by accident.

What Are the Symptoms of Aluminum Hydroxide Toxicity?

Initial adverse effects associated with aluminum hydroxide include;

  • Nausea, vomiting, and constipation.

  • Lowering of the phosphate to abnormal levels.

  • Chalky taste.

  • Abdominal pain.

  • Pain on urination.

  • Black tarry stools.

  • Mental confusion.

  • Muscle weakness.

When the ingested aluminum hydroxide becomes toxic, the following symptoms occur;

  • Seizures.

  • Osteomalacia (softening of bones, making them brittle and weak).

  • Encephalopathy (diseases associated with the brain that compromise normal brain functions).

What Are the Measures to Be Taken to Prevent Aluminum Toxicity?

Before getting a prescription for aluminum hydroxide, you should inform your physician regarding the following;

  • Allergies to aluminum hydroxide.

  • History of hypersensitivity to aluminum salts.

  • Previous history or currently suffering kidney problems.

  • History of recent gastric bleeding, heart failure, cirrhosis, etc.

  • Pregnancy, or planning to get pregnant.

  • Aluminum causes drug interactions when taken with certain drugs, so it is important to mention the health care professional about the other medications taken.

  • Using aluminum hydroxide as a medication for a more extended period is not encouraged; instead, it should be taken only as a temporary measure.

  • It is advisable and safe to take aluminum hydroxide before or only after two hours of taking any other medications to prevent drug interactions, as aluminum hydroxide has shown interactions with various drugs and supplements.

How Is Aluminum Hydroxide Toxicity Diagnosed?

  • Risk assessment of aluminum toxicity by taking a proper history of the aluminum intake and any previous reactions to aluminum.

  • Blood tests show increased blood albumin levels.

  • An aluminum blood test or aluminum toxicity test is done to rule out the amount of excess aluminum in blood.

  • Urine test and stool test check the levels of aluminum excreted.

  • In a bone biopsy, the presence of aluminum in the bone marrow indicates toxicity.

How Is Aluminum Hydroxide Toxicity Treated?

  • The initial treatment for aluminum hydroxide toxicity is the discontinuation of the aluminum hydroxide intake, which usually brings the aluminum levels back to normal.

  • In some instances, when the serum albumin levels are very high, administering an antidote drug is necessary to eliminate excess aluminum. Deferoxamine (a medicine used commonly in iron and aluminum overdose) is administered as an antidote that undergoes a chelation process (a process that uses certain compounds to react with metal ions to form a water-soluble complex) which facilitates the excretion of excess aluminum.


Aluminum hydroxide toxicity is a non-serious condition that usually settles with drug withdrawal, though a proper diagnosis of the disease plays a significant role in treating this condition. Risk assessment before prescribing aluminum hydroxide can prevent toxicity to a great extent.

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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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