sucralfate, Carafate

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Pharmacy Author:

Omudhome Ogbru, PharmD

Omudhome Ogbru, PharmD

Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

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Medical and Pharmacy Editor:

Jay W. Marks, MD

Jay W. Marks, MD

Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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GENERIC NAME: sucralfate

BRAND NAME: Carafate

DRUG CLASS AND MECHANISM: Sucralfate is a unique oral drug that is used for treating ulcers of the upper gastrointestinal tract. 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 of action is not entirely understood, the following actions are thought to be important for its beneficial effects:

1. 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;
2. sucralfate directly inhibits pepsin (an enzyme that breaks apart proteins) in the presence of stomach acid;
3. sucralfate binds bile salts coming from the liver via the bile thus protecting the stomach lining from injury caused by the bile acids;
4. 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: Tablets: 1 g; Suspension: 500 mg/5ml.

STORAGE: Tablets and suspension should be kept at room temperature, between 15-30 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 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) and to prevent ulcers associated with high degrees of physical stress (for example, extensive burns, surgery, and overwhelming infection) in hospitalized patients.

DOSING: The recommended dose for treatment of active ulcers is 1 gram four times daily for 4-8 weeks. Sucralfate is administered on an empty stomach, at least one hour prior to meals, for best results. The dose for preventing recurrent ulcers is 1 gram twice daily.

DRUG INTERACTIONS: When administered with other drugs sucralfate may bind to the drugs in the stomach and reduce absorption of the drugs. Sucralfate reduces the absorption of 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 (causing congenital deformities) 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 are no data, sucralfate is considered safe in nursing mothers.

SIDE EFFECTS: Sucralfate is well tolerated. Constipation is the most frequent side effect. Headache, dizziness, insomnia, diarrhea, vomiting, and flatulence also may occur.

Reference: FDA Prescribing Information

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