Aluminium

(rINN)

💊 Chemical information

Aluminio; Aluminum; E173; Glin.
Al = 26.9815386.
CAS — 7429-90-5.

Description.

Aluminium is a malleable and ductile soft silverywhite metal, becoming coated with a thin layer of oxide.

Pharmacopoeias.

Br. includes Aluminium Powder.

BP 2008

(Aluminium Powder). An odourless or almost odourless, silvery-grey powder. It consists mainly of metallic aluminium in very small flakes, usually with an appreciable quantity of aluminium oxide. It is lubricated with stearic acid to protect the metal from oxidation. Practically insoluble in water and in alcohol; it dissolves in dilute acids and in aqueous solutions of alkali hydroxides, with the evolution of hydrogen.

Handling.

Aluminium powder has been used for the illicit preparation of explosives or fireworks; care is required with its supply.

Incompatibility.

Incompatibilities have been reported between aluminium in injection equipment and metronidazole, 1,2 and between aluminium and various antineoplastics including cisplatin, daunorubicin, and doxorubicin. 3-6 The suitability of aluminium caps for sugar-containing liquids has also been questioned. Abrasion of the aluminium cap by sugar from Ceporex Syrup [cefalexin] has resulted in the formation of a black slime. 7 1. Schell KH, Copeland JR. Metronidazole hydrochloride-aluminum interaction. Am J Hosp Pharm 1985; 42: 1040, 1042. 2. Struthers BJ, Parr RJ. Clarifying the metronidazole hydrochloride-aluminum interaction. Am J Hosp Pharm 1985; 42: 2660. 3. Bohart RD, Ogawa G. An observation on the stability of cisdichlorodiammineplatinum (II): a caution regarding its administration. Cancer Treat Rep 1979; 63: 2117–18. 4. Gardiner WA. Possible incompatibility of doxorubicin hydrochloride with aluminum. Am J Hosp Pharm 1981; 38: 1276. 5. Williamson MJ, et al. Doxorubicin hydrochloride-aluminum interaction. Am J Hosp Pharm 1983; 40: 214. 6. Ogawa GS, et al. Dispensing-pin problems. Am J Hosp Pharm 1985; 42: 1042. 7. Tressler LJ. Medicine bottle caps. Pharm J 1985; 235: 99.

💊 Adverse Effects, Treatment, and Precautions

Aluminium toxicity is well recognised in patients with renal impairment. Patients undergoing dialysis have experienced encephalopathy, osteodystrophy, and anaemia associated with an aluminium salt taken as a phosphate binder or with aluminium present in the water supply. For this reason, aluminium-free phosphate binders are often used in dialysis patients and the concentration of aluminium in dialysis fluid has been limited to not more than 10 micrograms/litre. Serum-aluminium concentrations should be monitored regularly in patients undergoing dialysis. Aluminium toxicity has followed the use of parenteral fluids and infant feeds with a high concentration of aluminium. Aluminium toxicity may be treated by removal of the aluminium with desferrioxamine. The adverse effects of aluminium salts and precautions to be observed are described under Aluminium Hydroxide. It has been suggested that overthe-counter preparations of antacids, which can contain significant amounts of aluminium, represent the most important quantitative source of aluminium exposure.2 Toxicity tends to occur when the gastrointestinal barrier to aluminium absorption is circumvented, as in intravenous fluid use or dialysis, or if the excretion of aluminium is reduced, as in renal impairment. Infants, especially preterm infants, form a special risk group.3-6 Accidental deposition of 20 tonnes of aluminium sulfate in a reservoir in Cornwall, UK in 1988 led to contamination of a nearby town’s water supply.7 Symptoms reported included diarrhoea, mouth ulcers or blisters, malaise, joint symptoms (mainly deterioration of existing symptoms), and memory defects (usually beginning 2 to 3 months after the incident). Although some medical experts considered that no long-term toxic effects were to be expected,7 aluminium deposits were found in the bones of 2 individuals 6 to 7 months later.8 In a study9 undertaken 3 years after the incident, 55 adults who claimed to have suffered cerebral damage performed poorly in psychomotor testing. The authors attributed this to aluminium exposure, but the study’s design and conclusions have been criticised.10-12 An inquiry by the UK DoH13 does not anticipate that exposure to aluminium from this incident would have caused long-term health problems in people who were adults or toddlers at the time, although this possibility should be explored further in those who were bottle-fed infants (i.e. below one year of age) at that time. Further studies have also been recommended on the neuropsychological status and prevalence of joint problems in the population who consumed the contaminated water.
1. Monteagudo FSE, et al. Recent developments in aluminium toxicology. Med Toxicol 1989; 4: 1–16
2. Reinke CM, et al. Aluminium in over-the-counter drugs: risks outweigh benefits? Drug Safety 2003; 26: 1011–25
3. Bishop N, et al. Aluminium in infant formulas. Lancet 1989; i: 490
4. Lawson M, et al. Aluminium and infant formulae. Lancet 1989; i: 614–15
5. Anonymous. Aluminium content of parenteral drug products. WHO Drug Inf 1990; 4: 70
6. American Academy of Pediatrics Committee on Nutrition. Aluminum toxicity in infants and children. Pediatrics 1996; 97: 413–16
7. Anonymous. Camelford two years on. Lancet 1990; 336: 366
8. Eastwood JB, et al. Aluminium deposition in bone after contamination of drinking water supply. Lancet 1990; 336: 462–4
9. Altmann P, et al. Disturbance of cerebral function in people exposed to drinking water contaminated with aluminium sulphate: retrospective study of the Camelford water incident. BMJ 1999; 319: 807–11
10. David A. Cerebral dysfunction after water pollution incident in Camelford: results were biased by self selection of cases. BMJ 2000; 320: 1337
11. Esmonde TFG. Cerebral dysfunction after water pollution incident in Camelford: study has several methodological errors. BMJ 2000; 320: 1337–8
12. McMillan TM. Cerebral dysfunction after water pollution incident in Camelford: study may prolong the agony. BMJ 2000; 320: 1338
13. Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment. Subgroup Report on the Lowermoor Water Pollution Incident. DoH (issued 26th January, 2005). Available at: http://www.advisorybodies.doh.gov.uk/ cotnonfood/lsgreportjan05.pdf (accessed 04/04/08)

Burns.

Thermal burns have been reported in patients undergoing magnetic resonance imaging (MRI) procedures when wearing transdermal medication patches containing aluminium in the backing material.1 Aluminium is a conductive material and could induce a concentration of electrical currents sufficient to cause serious burns if placed in the MRI field; a similar phenomenon could also occur with external defibrillation.
1. Health Canada. Association of transdermal drug patches with thermal burns during magnetic resonance imaging procedures (issued 26th April 2005). Available at: http:// www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/ medeff/mri-irm_patch-timbre_nth-ah_e.pdf (accessed 03/04/08)

Effects on mental function.

Encephalopathy with seizures has been associated with the use of aluminium-containing materials used for bone reconstruction.1,2 In each case, reconstruction of areas of the skull resulted in high concentrations of aluminium in the CSF.
1. Renard JL, et al. Post-otoneurosurgery aluminium encephalopathy. Lancet 1994; 344: 63–4
2. Hantson P, et al. Encephalopathy with seizures after use of aluminium-containing bone cement. Lancet 1994; 344: 1647.
ALZHEIMER’S DISEASE. The role of aluminium in the aetiology of Alzheimer’s disease is, at best, unclear.1-4 Circumstantial evidence of a positive association arises from animal and in-vitro data, together with clinical observations that aluminium is present in senile plaques and neurofibrillary tangles occurring in Alzheimer’s disease, that giving aluminium chelators to Alzheimer patients may slow the progression of the disease, and that the risk of brain changes is increased in people living in areas with a high aluminium content in the drinking water supply. Some of these findings have been criticised, disproved, or not confirmed by other workers. Listed below are some of the studies which point to an association between aluminium intake and Alzheimer’s disease,5-8 some criticisms,9-13 and some negative findings.14,15 There does not appear to be a risk of aluminium accumulation from normal use of aluminium-containing antacids by patients with normal renal function; consequently use of these antacids by such patients should not be considered to put them at risk of Alzheimer’s disease.16,17
1. Crapper McLachlan DR, et al. Would decreased aluminum ingestion reduce the incidence of Alzheimer’s disease? Can Med Assoc J 1991; 145: 793–804
2. Anonymous. Is aluminium a dementing ion? Lancet 1992; 339: 713–14
3. Munoz DG. Is exposure to aluminium a risk factor for the development of Alzheimer disease?—No. Arch Neurol 1998; 55: 737–9
4. Forbes WF, Hill GB. Is exposure to aluminium a risk factor for the development of Alzheimer disease?—Yes. Arch Neurol 1998; 55: 740–1
5. Martyn CN, et al. Geographical relation between Alzheimer’s disease and aluminium in drinking water. Lancet 1989; i: 59–62
6. Crapper McLachlan DR, et al. Intramuscular desferrioxamine in patients with Alzheimer’s disease. Lancet 1991; 337: 1304–8
7. Good PF, et al. Selective accumulation of aluminum and iron in the neurofibrillary tangles of Alzheimer’s disease: a laser microprobe (LAMMA) study. Ann Neurol 1992; 31: 286–92
8. Harrington CR, et al. Alzheimer’s-disease-like changes in tau protein processing: association with aluminium accumulation in brains of renal dialysis patients. Lancet 1994; 343: 993–7
9. Ebrahim S. Aluminium and Alzheimer’s disease. Lancet 1989; i: 267
10. Schupf N, et al. Aluminium and Alzheimer’s disease. Lancet 1989; i: 267
11. Lindesay J. Aluminium and Alzheimer’s disease. Lancet 1989; i: 268
12. Birchall JD, Chappell JS. Aluminium, water chemistry, and Alzheimer’s disease. Lancet 1989; i: 953
13. Whalley LJ, et al. Aluminium and dementia. Lancet 1992; 339: 1235–6
14. Markesbery WR, et al. Instrumental neutron activation analysis of brain aluminum in Alzheimer’s disease and aging. Ann Neurol 1981; 10: 511–16
15. Wettstein A, et al. Failure to find a relationship between mnestic skills of octogenarians and aluminum in drinking water. Int Arch Occup Environ Health 1991; 63: 97–103
16. Anonymous. Aluminium salts and Alzheimer’s disease. Pharm J 1991; 246: 809
17. Flaten TP, et al. Mortality from dementia among gastroduodenal ulcer patients. J Epidemiol Community Health 1991; 45: 203–6.

💊 Uses and Administration

Aluminium is used in packaging and in injection equipment. The foil is also used as a dressing and for insulation. Aluminium may also be employed as a colouring agent for some foodstuffs. Aluminium powder alone and in paste form with zinc oxide has been used as a dressing. Astringent aluminium salts are used as antiperspirants. Aluminium hydroxide is used as an antacid. Aluminium oxide has been used as an abrasive agent.

Homoeopathy.

Aluminium has been used in homoeopathic medicines under the following names: Aluminium metallicum; Al. met.

💊 Preparations

BP 2008: Compound Aluminium Paste. Proprietary PreparationsMulti-ingredient: Arg.: Effidrate†; Braz.: Belagin; Fr.: Supro; Mex.: Dicentril; Gavicid†; Ulgel.
Published December 04, 2018.