sucralfate, Carafate
GENERIC NAME: sucralfate
BRAND NAME: Carafate
DRUG CLASS AND MECHANISM: Sucralfate is a unique oral
drug.
Chemically, it is a complex of the disaccharide sugar, sucrose,
combined
with sulfate and aluminum. It is minimally absorbed into the
body, and its
actions are entirely on the lining of the stomach and duodenum.
Although
its mechanism is not entirely understood, the following actions
are
thought to be important for its beneficial effects:
- sucralfate binds to the surface of ulcers (attaching
to exposed proteins) and coats the ulcer, thus protecting the ulcer surface to
some extent from further injury by acid and pepsin;
- sucralfate directly inhibits pepsin (an enzyme that
breaks apart proteins) in the presence of stomach acid;
- sucralfate binds bile salts coming from the liver via
the bile thus protecting the stomach lining from injury caused by the bile
acids;
- sucralfate may increase prostaglandin production, and
prostaglandins
are known to protect the lining of the stomach. Sucralfate
was approved
by the FDA in 1981.
PRESCRIPTION: yes
GENERIC AVAILABLE: yes
PREPARATIONS: Oblong tablets (pink): 1 gram; pink-
colored
suspension (1 gram per 2 teaspoonsful).
STORAGE: Tablets and suspension should be kept at room
temperature, between 15° and 30°C (59-86°F). The
suspension
should not be frozen and should be shaken prior to each use.
PRESCRIBED FOR: Sucralfate is used for the treatment of
peptic
ulcer disease and to prevent recurrent ulcers after healing of
the ulcer
has been achieved. It also has been used to relieve or prevent
the ulcers
caused by nonsteroidal anti-inflammatory drugs (NSAIDs) but is
less
effective than misoprostol (Cytotec). Sucralfate also is used
in the
treatment of patients with gastroesophageal reflux disease
(GERD) who are
prone to get ulcers in the esophagus, and to prevent ulcers
associated
with high degrees of physical stress (e.g. extensive burns,
surgery, and
overwhelming infection.) among hospitalized patients.
DOSING: Sucralfate generally is given four times daily
for
treating ulcerations and twice daily for preventing ulcers. It
is
recommended that it be taken on an empty stomach, at least one
hour prior
to meals, for best coating of the ulcers.
DRUG INTERACTIONS: Sucralfate reduces the absorption of
many
drugs when taken at the same time as the other drugs. These
drugs include:
cimetidine (Tagamet), digoxin (Lanoxin), ketoconazole (Nizoral),
levothyroxine (Synthroid), phenytoin (Dilantin), quinidine (Quinidex, Quinaglute), ranitidine
(Zantac), tetracycline, theophylline
(Theo-Dur, Uniphyl, others), and all of the fluoroquinolone antibiotics,
including
ciprofloxacin (Cipro), norfloxacin (Noroxin), ofloxacin (Floxin), and
lomefloxacin (Maxaquin). All of these medications should be
taken at least
two hours prior to the sucralfate. It is possible, if not
likely, that
many other drugs will interact similarly with sucralfate.
Therefore, it
probably is prudent to take all medications at least 2 hours
prior to
sucralfate.
PREGNANCY: Sucralfate itself is not teratogenic in
animals, even
in doses considerably higher than those used in humans.
Although some
animal data demonstrate concern for the effects of aluminum
during
pregnancy, all human data show no ill-effect on the fetus.
Sucralfate is
considered safe during pregnancy.
NURSING MOTHERS: Minimal if
any sucralfate penetrates into breast milk because so little is absorbed from the
gastrointestinal tract.
Although there is no data, sucralfate is considered safe in
nursing
mothers.
SIDE EFFECTS: Sucralfate is well tolerated.
Constipation is the
most frequent side effect and occurs in 1 of every 50 patients
who take
sucralfate.
Reference: FDA Prescribing Information
Last Editorial Review: 4/5/1999
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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