Sucralfate; Uses, Dosage, Side Effects, Drug Interactions

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Sucralfate is a medication primarily taken to treat active duodenal ulcers. Sucralfate is also used for the treatment of gastroesophageal reflux disease (GERD) and stress ulcers. Sucralfate is a sucrose sulfate-aluminum complex that binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus. It also promotes bicarbonate production and acts as an acid buffer with cytoprotective properties.

Mechanism of action of Sucralfate

Although sucralfate’s mechanism is not entirely understood, there are several factors that most likely contribute to its action. Sucralfate, with its strong negative charge, binds to exposed positively-charged proteins at the base of ulcers. In this way, it coats the ulcer and forms a physical barrier that protects the ulcer surface from further injury by acid and pepsin. It directly inhibits pepsin (an enzyme that breaks apart proteins) in the presence of stomach acid and 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. Prostaglandins are known to protect the lining of the stomach and may also bind epithelial growth factor and fibroblast growth factor, both of which enhance the growth and repair mechanism of the stomach lining.

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Indications of Sucralfate

Sucralfate has also been used for the following conditions

  • Active duodenal ulcer not related to NSAID use
  • Maintenance therapy for resolved duodenal ulcers
  • Gastric ulcer not related to NSAID use and gastritis due to GERD—Triple combination therapy with lansoprazole + cisapride + sucralfate can significantly improve symptoms and quality of life and was more cost-effective than ranitidine combination group.
  • Aphthous ulcer and stomatitis due to radiation or chemotherapy—The 2013 guidelines of the International Society of Oral Oncology does not recommend sucralfate for the prevention of oral mucositis in head and neck cancer patients receiving radiotherapy or chemoradiation due to a lack of efficacy found in a well-designed, randomized controlled trial.
  • Proctitis from radiation or ulcerative colitis
  • Gastro-esophageal reflux disease during pregnancy—First-line drug therapy combined with lifestyle and diet modification.
  • Stress ulcer prophylaxis—The use of sucralfate rather than H2 antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as continuous subglottic suctioning, have been shown to reduce the risk of ventilator-associated pneumonia (VAP).
  • Prevention of stricture formation—Sucralfate has an inhibitory effect on stricture formation in experimental corrosive burns and can be used in the treatment of corrosive esophageal burns to enhance mucosal healing and suppress stricture formation

Rectal bleeding and its management after irradiation for uterine cervical cancer

  • Grade 1 bleeding experienced immediate relief with sucralfate enema for 1 month.
  • Grade 2 bleeding, sucralfate enema and/or coagulation were effective.
  • Grade 3 bleeding lasted for 1 year despite frequent transfusions and coagulation.
  • Grade 2 and 3 rectal bleeding occurred in 8.5% of people. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucralfate enema and coagulation is effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture.
  • Treatment of anastomotic ulcer after gastric bypass surgery

Contra-Indications of Sucralfate

  • High Blood Sugar
  • Aluminum Poisoning
  • Chronic kidney disease stage 5 (failure)
  • Allergies to sucralfate

Dosage of Sucralfate

Strengths: 1 g/10 mL; 1 g

Duodenal Ulcer

  • 1 g orally 4 times a day
  • Duration of therapy: 4 to 8 weeks
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Duodenal Ulcer Prophylaxis

  • Oral Tablets: 1 g orally 2 times a day
  • Duration of therapy: Up to 1 year

Side Effects of Sucralfate

The most common

 Common

Less common

Drug Interactions of Sucralfate

Pregnancy & Lactation

FDA pregnancy category B

Pregnancy

This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

The safety and effectiveness of using this medication have not been established for children and adolescents under 18 years of age. The use of sucralfate by this age group is not recommended.

References

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