sucralfate

Therapeutic Classification: antiulcer agents

Pharmacologic Classification: gi protectants

Indications ⬆ ⬇

REMS

Short-term management of duodenal ulcers.
Maintenance (preventive) therapy of duodenal ulcers.

Unlabeled Use:

Management of gastric ulcer or gastroesophageal reflux.
Prevention of gastric mucosal injury caused by high-dose aspirin or other NSAIDs in patients with rheumatoid arthritis or in high-stress situations (e.g., intensive care unit). Suspension: Mucositis/stomatitis/rectal or oral ulcerations from various etiologies.

Action ⬆ ⬇

Aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste, which selectively adheres to the ulcer surface.

Therapeutic effects:

Protection of ulcers, with subsequent healing.

Pharmacokinetics ⬆ ⬇

Absorption: Systemic absorption is minimal (<5%).

Distribution: Unknown.

Metabolism/Excretion: >90% is eliminated in the feces.

Half-Life: 6–20 hr.

Time/Action Profile ⬆ ⬇

(mucosal protectant effect)

ROUTE	ONSET	PEAK	DURATION
PO	1–2 hr	unknown	6 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Renal failure (accumulation of aluminum can occur);
Diabetes (↑ risk of hyperglycemia with suspension);
Impaired swallowing (↑ risk of tablet aspiration).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: pruritus, rash

Endo: hyperglycemia (with suspension)

GI: constipation, diarrhea, dry mouth, gastric discomfort, indigestion, nausea

Neuro: dizziness, drowsiness

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of phenytoin, fat-soluble vitamins, or tetracycline.
↓effectiveness when used with antacids or cimetidine.
↓absorption of fluoroquinolones (separate administration by 2 hr).

Route/Dosage ⬆ ⬇

Treatment of Ulcers

PO (Adults ): 1 g 4 times daily, given 1 hr before meals and at bedtime; or 2 g twice daily, on waking and at bedtime.
PO (Adults ): 1 g twice daily, given 1 hr before a meal.

Gastroesophageal Reflux

PO (Adults ): 1 g 4 times daily, given 1 hr before meals and at bedtime.
PO (Children ): 40–80 mg/kg/day divided every 6 hr, given 1 hr before meals and at bedtime.

Stomatitis

PO (Adults and Children ): 5–10 mL of suspension, swish and spit or swish and swallow 4 times daily.

Proctitis

(Adults ): 2 g of suspension given as an enema once or twice daily.

Availability ⬆ ⬇

(Generic available)

Oral suspension cherry flavor: 1 g/10 mL; 200 mg/mL
Tablets: 1 g

Assessment ⬆ ⬇

Assess patient routinely for abdominal pain and frank or occult blood in the stool.

Implementation ⬆ ⬇

PO: Administer on an empty stomach, 1 hr before meals and at bedtime. Tablet may be broken or dissolved in water before ingestion. Shake suspension well before administration.
- Oral suspension is only for oral use; do not administer IV. Shake well before use. Store at room temperature, do not freeze.
- If antacids are also required for pain, administer 30 min before or after sucralfate dose.

Patient/Family Teaching ⬆ ⬇

Advise patient to continue with course of therapy for 4–8 wk, even if feeling better, to ensure ulcer healing. If a dose is missed, take as soon as remembered unless almost time for next dose; do not double doses.
Advise patient that increase in fluid intake, dietary bulk, and exercise may prevent drug-induced constipation.
Emphasize the importance of routine examinations to monitor progress.

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Pronunciation ⬇

Classifications ⬆ ⬇