Sucralfate
Generic Name: Sucralfate
Brand Names: Carafate
Sucralfate is a mucosal protectant that forms a protective barrier over ulcers to promote healing.
Drug Class
GI Mucosal Protectant (Cytoprotective Agent)
Pregnancy
Category B — No evidence of fetal harm in animal studies; limited human data
Available Forms
1 g oral tablet, 1 g/10 mL oral suspension
What It's Used For
Dosage Quick Reference
These are general dosage guidelines. Your doctor will determine the appropriate dose for your specific situation.
| Condition | Starting Dose | Typical Maintenance Dose |
|---|---|---|
| Active duodenal ulcer (treatment) | 1 g four times daily (1 hour before meals and at bedtime) | 1 g four times daily for 4–8 weeks |
| Duodenal ulcer (maintenance / prevention of recurrence) | 1 g twice daily | 1 g twice daily |
| Stress ulcer prophylaxis (off-label, ICU) | 1 g every 6 hours via NG tube or oral | 1 g every 6 hours |
Side Effects
Common Side Effects:
- Constipation (most common)
- Dry mouth
- Nausea
- Stomach discomfort
- Diarrhea
- Headache
- Dizziness
Serious Side Effects:
- Aluminum toxicity (in renal impairment)
- Bezoar formation
- Hypersensitivity reactions (rare)
Drug Interactions
Major Drug & Food Interactions
- Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin): Sucralfate drastically reduces fluoroquinolone absorption (by up to 90%); take fluoroquinolones at least 2 hours before sucralfate.
- Phenytoin: Sucralfate reduces phenytoin absorption; separate dosing by at least 2 hours and monitor phenytoin levels.
- Tetracycline antibiotics (doxycycline, tetracycline): Significantly reduced absorption; separate by at least 2 hours.
- Levothyroxine: Sucralfate can bind thyroid hormone in the GI tract, reducing absorption; take levothyroxine at least 4 hours before sucralfate.
- Warfarin: May reduce warfarin absorption in some patients; monitor INR when starting or stopping sucralfate.
- Antacids (aluminum/magnesium): Taking antacids within 30 minutes before or after sucralfate may reduce sucralfate's ability to bind to the ulcer site; separate by at least 30 minutes.
Additional Information
Sucralfate is a unique gastrointestinal medication that forms a protective barrier over ulcerated mucosa. It is used to treat and prevent duodenal ulcers and maintain healed ulcers, working through local cytoprotective mechanisms rather than acid suppression.
Mechanism of Action
Sucralfate provides mucosal protection through multiple mechanisms:
- Barrier formation: In acidic environment, forms a viscous, adhesive paste that binds to ulcer base
- Selective binding: Adheres to ulcerated tissue with higher affinity than normal mucosa
- Protects from acid and pepsin: Physical barrier prevents further damage
- Stimulates prostaglandin synthesis: Enhances mucosal defense
- Binds bile salts: Reduces mucosal injury from refluxed bile
- Promotes growth factor binding: Concentrates EGF and FGF at ulcer site
Sucralfate is a complex of sulfated sucrose and aluminum hydroxide.
Available Formulations
Sucralfate is available as:
- Tablets: 1 g
- Oral suspension: 1 g/10 mL
Medical Uses
FDA-Approved Indications:
- Short-term treatment (up to 8 weeks) of active duodenal ulcer
- Maintenance therapy of healed duodenal ulcer
Off-Label Uses:
- Stress ulcer prophylaxis in critically ill patients
- GERD
- Radiation-induced esophagitis or proctitis
- Mucositis
- Gastric ulcers
Dosing Guidelines
Active Duodenal Ulcer:
- 1 g four times daily on an empty stomach (1 hour before meals and at bedtime)
- Treatment duration: 4-8 weeks
Maintenance Therapy:
- 1 g twice daily on an empty stomach
Administration:
- Take on empty stomach for optimal efficacy
- Do not crush or chew tablets
- Shake suspension well before use
Important Safety Information
Contraindications:
- Known hypersensitivity to sucralfate or any component
Warnings and Precautions:
- Aluminum toxicity: Use with caution in chronic renal failure (aluminum accumulation)
- Bezoar formation: Cases reported, especially in critically ill patients with tube feeding
- Duodenal ulcer is a chronic disease: Successful healing requires follow-up
- Drug binding: May interfere with absorption of many medications
Drug Interactions
Sucralfate can bind to and reduce absorption of many drugs. Separate administration by at least 2 hours:
- Fluoroquinolones (ciprofloxacin, levofloxacin): Significantly reduced absorption
- Tetracyclines: Reduced absorption
- Phenytoin: Reduced absorption
- Warfarin: May reduce absorption
- Digoxin: May reduce absorption
- Ketoconazole: May reduce absorption
- Levothyroxine: May reduce absorption
- Quinidine: Reduced serum levels
Antacids: May interfere with sucralfate binding; separate by 30 minutes
Special Populations
- Renal Impairment: Use with caution due to aluminum absorption risk; avoid in severe/dialysis patients if possible
- Hepatic Impairment: No specific adjustment
- Pregnancy: Limited data; use only if clearly needed
- Lactation: Unknown if excreted in milk; likely minimal absorption
- Elderly: Consider renal function; monitor for aluminum toxicity in long-term use
- Pediatric: Safety and efficacy not established
Frequently Asked Questions
Questions to Ask Your Doctor
Consider discussing these topics at your next appointment:
- ✓How should I time my other medications around sucralfate to avoid absorption problems?
- ✓Is sucralfate or a proton pump inhibitor a better option for my condition?
- ✓Given my kidney function, is long-term sucralfate safe for me?
- ✓Should I also be tested for H. pylori as the underlying cause of my ulcer?
Medical Disclaimer: This information is for educational purposes only and should not be considered medical advice. Always consult with your healthcare provider before starting, stopping, or changing any medication. Your doctor can provide personalized recommendations based on your specific health condition and medical history.
Related Medications
Other medications in the same category
Questions About This Medication?
Talk to your doctor or pharmacist about whether Sucralfate is right for you.
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