Carafate (sucralfate) vs. Prilosec (omeprazole)

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

Carafate vs. omeprazole: What's the difference?

What is Carafate? What is omeprazole?

Carafate (sucralfate) is an anti-ulcer drug used to treat ulcers of the upper gastrointestinal tract, peptic ulcer disease, to prevent recurrent ulcers after the ulcer has healed, to relieve or prevent ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs), and to treat gastroesophageal reflux disease (GERD). Chemically, Carafate is a complex of the disaccharide sugar, sucrose, combined with sulfate and aluminum. It is minimally absorbed into the body, and it acts solely on the lining of the stomach and duodenum. Carafate is thought to work by attaching to exposed proteins on the surface of ulcer and coating the ulcer, protecting the surface from further injury by acid and pepsin (an enzyme that breaks apart proteins). Carafate also inhibits pepsin in the presence of stomach acid, binds bile salts from the liver via the bile thus protecting the stomach lining from injury caused by the bile acids, and it may increase prostaglandin production which can also protect the lining of the stomach.

Omeprazole is a proton pump inhibitor (PPI) that blocks the production of acid by the stomach used to treat ulcers, gastroesophageal reflux disease (GERD), Zollinger-Ellison syndrome, duodenitis, erosive esophagitis, heartburn, and H. pylori infection. Other drugs in the class include lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), and esomeprazole (Nexium). Proton pump inhibitors are used for the treatment of conditions such as ulcers, gastroesophageal reflux disease (GERD) and the Zollinger-Ellison syndrome, which are all caused by stomach acid. Omeprazole, like other proton-pump inhibitors, blocks the enzyme in the wall of the stomach that produces acid. By blocking the enzyme, the production of acid is decreased, and this allows the stomach and esophagus to heal.

QUESTION

GERD is the back up of stomach acid into the esophagus. See Answer

What are the side effects of Carafate and omeprazole?

Carafate

Carafate is well tolerated. Constipation is the most frequent side effect.

Other side effects include:

Omeprazole

Omeprazole like other PPIs is well-tolerated. The most common side effects are:

Other important side effects include:

  • Nervousness,
  • abnormal heartbeat,
  • muscle pain,
  • weakness,
  • leg cramps and water retention occur infrequently.

Each packet of Zegerid powder for oral suspension contains 460 mg of sodium and each capsule contains 304 mg of sodium. This should be taken into consideration in patients who need a sodium-restricted diet.

Proton pump inhibitors may increase the risk of Clostridium difficile infection. High doses and long-term use (1 year or longer) may increase the risk of osteoporosis-related fractures of the hip, wrist, or spine. Prolonged use also reduces absorption of vitamin B12 (cyanocobalamin).

Long-term use of PPIs has also been associated with low levels of magnesium (hypomagnesemia). Analysis of patients taking PPIs for long periods of time showed an increased risk of heart attacks.

Therefore, it is important to use the lowest doses and shortest duration of treatment necessary for the condition being treated.

What is the dosage of Carafate vs. omeprazole?

Carafate

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

Omeprazole

For ulcers, GERD, erosive esophagitis and eradication of H. pylori the recommended dose for adults is 20-40 mg daily. Ulcer healing usually occurs within 4-8 weeks.

H. pylori infections are treated for 10-28 days.

The usual dose for prevention of upper gastrointestinal bleeding in critically ill patients is 40 mg daily for 14 days.

Prilosec OTC is used for treating heartburn for up to two weeks, and the usual dose is 20 mg daily.

For the management of Zollinger-Ellison syndrome the starting dose for adults is 60 mg daily, and the dose is adjusted based on either the response of symptoms or the actual measurement of acid production. Doses greater than 80 mg should be divided. Doses up to 120 mg three times a day have been used in the treatment of Zollinger-Ellison Syndrome.

For maximal efficacy, omeprazole tablets should be taken before meals, swallowed whole and should not be crushed, chewed or opened.

SLIDESHOW

Digestive Disorders: Common Misconceptions See Slideshow

What drugs interact with Carafate and omeprazole?

Carafate

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:

All of these medications should be taken at least two hours prior to 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.

Omeprazole

Omeprazole potentially can increase the concentrations in blood of diazepam (Valium), warfarin (Coumadin), and phenytoin (Dilantin) by decreasing the elimination of these drugs by the liver.

The absorption of certain drugs may be affected by stomach acidity. Therefore, omeprazole as well as other PPIs reduce the absorption and concentration in blood of ketoconazole (Nizoral) and increase the absorption and concentration in blood of digoxin (Lanoxin). This may reduce the effectiveness of ketoconazole or increase digoxin toxicity.

Through unknown mechanisms, omeprazole may increase blood levels of saquinavir and reduce blood levels of nelfinavir and atazanavir, drugs that are used for treating patients with infection caused by the human immunodeficiency virus (HIV). Accordingly, the dose of saquinavir may need to be reduced to avoid toxicity, and the doses of nelfinavir and atazanavir may need to be increased to maintain efficacy.

Clopidogrel (Plavix) is converted to its active form by enzymes in the liver. Omeprazole reduces the activity of these enzymes and potentially can reduce the activity of clopidogrel. Omeprazole should not be used with clopidogrel.

Omeprazole increases the concentration of cilostazol (Pletal). The dose of cilostazol should be reduced from 100 mg twice daily to 50 mg twice daily when given with omeprazole.

Omeprazole may increase blood levels of methotrexate (Rheumatrex, Trexall) and tacrolimus (Prograf).

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Are Carafate and omeprazole safe to use while pregnant or breastfeeding?

Carafate

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.

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.

Omeprazole

Use of omeprazole in pregnant women has not been adequately evaluated. Omeprazole should be used during pregnancy only if the benefits justify the unknown risks.
Omeprazole is excreted in breast milk and potentially could cause adverse effects in the infant.

Summary

Carafate (sucralfate) and Prilosec (omeprazole) are used to treat ulcers and gastroesophageal reflux disease (GERD). Omeprazole is also used to treat Zollinger-Ellison syndrome, duodenitis, erosive esophagitis, heartburn, and H. pylori infection.

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Medically Reviewed on 6/7/2019
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