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Aluminum hydroxide may increase urinary and stool loss of calcium. Also, aluminum is a toxic mineral, and a limited amount of aluminum absorption from aluminum-containing antacids does occur. As a result, most doctors do not recommend routine use of aluminum-containing antacids. Other types of antacids containing calcium or magnesium instead of aluminum are available.
Folic acid is needed by the body to utilize vitamin B12. Antacids, including aluminum hydroxide, inhibit folic acid absorption. However, folic acid supplementation can mask a vitamin B12 deficiency. Therefore, people taking antacids are advised to supplement with folic acid and vitamin B12.
Depletion of phosphorus may occur as a result of taking aluminum hydroxide. For those with kidney failure, reducing phosphorus absorption is the purpose of taking the drug, as excessive phosphorus levels can result from kidney failure. However, when people with normal kidney function take aluminum hydroxide for extended periods of time, it is possible to deplete phosphorus to unnaturally low levels.
A thick gel derived from algae has been used together with aluminum antacids to treat heartburn. Together, alginate gel and antacid were more effective at relieving symptoms and improving healing. Alginate is believed to work by physically blocking stomach acid from touching the esophagus. According to these studies, two tablets containing 200 mg alginic acid should be chewed before each meal and at bedtime.
Several studies have shown that combination of citrate, either as calcium citrate supplements or from orange and lemon juice, with aluminum-containing antacids increases aluminum levels in the body. Calcium in forms other than calcium citrate has been shown to not increase aluminum absorption. Drinking 7–10 ounces of orange juice provides sufficient citrate to be problematic. Intake of 950 mg calcium citrate greatly elevates aluminum absorption. People with renal failure may be at particular risk of kidney damage due to elevated aluminum levels if they combine aluminum hydroxide with citrate.
Last Review: 03-24-2015
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