Official reprint from UpToDate

www.uptodate.com 2015 UpToDate

Sucralfate:Druginformation
Copyright19782015Lexicomp,Inc.Allrightsreserved.
(Foradditionalinformationsee"Sucralfate:Patientdruginformation"andsee"Sucralfate:Pediatricdrug
information")
ForabbreviationsandsymbolsthatmaybeusedinLexicomp(showtable)

BrandNames:US Carafate
BrandNames:Canada ApoSucralfateDomSucralfateNovoSucralateNuSucralatePMS
SucralateSucralfate1SulcrateSulcrateSuspensionPlusTevaSucralfate

PharmacologicCategory GastrointestinalAgent,Miscellaneous
Dosing:Adult Treatmentofduodenalulcer:Oral:
Initialtreatment:1g4timesdailyonanemptystomachfor48weeks
Maintenance/prophylaxisofduodenalulcer:1gtwicedaily

Dosing:Pediatric
(Foradditionalinformationsee"Sucralfate:Pediatricdruginformation")
Dosesof4080mg/kg/daydividedevery6hourshavebeenused

Dosing:Geriatric Refertoadultdosing.
Dosing:RenalImpairment Nodosageadjustmentprovidedinmanufacturer'slabeling.Aluminum
saltisminimallyabsorbedhowever,mayaccumulateinrenalimpairmentusewithcautioninpatientswith
chronicrenalfailure.

Dosing:HepaticImpairment Nodosageadjustmentprovidedinmanufacturer'slabeling.
DosageForms:US Excipientinformationpresentedwhenavailable(limited,particularlyforgenerics)
consultspecificproductlabeling.
Suspension,Oral:
Carafate:1g/10mL(420mL)[containsfd&cred#40,methylparabencherryflavor]
Tablet,Oral:
Carafate:1g[scoredcontainsfd&cblue#1aluminumlake]
Generic:1g

GenericEquivalentAvailable:US Maybeproductdependent
Administration Administerwithwateronanemptystomach.Toreducethepotentialofadversely
affectingtheabsorptionofotherdrugs,administerotherdrugs2hourspriortosucralfate.

Use Shortterm(8weeks)managementofduodenalulcersmaintenancetherapyforduodenalulcers
MedicationSafetyIssues

Soundalike/lookalikeissues:
Sucralfatemaybeconfusedwithsalsalate
CarafatemaybeconfusedwithCafergot
Administrationissues:
Fororaladministrationonly.Fatalpulmonaryorcerebralembolismhasbeenreportedfollowing
inadvertentIVadministrationofsucralfate.

AdverseReactionsSignificant
1%to10%:Gastrointestinal:Constipation(2%)
<1% (Limited to important or lifethreatening): Anaphylaxis, bezoar formation hypersensitivity (urticaria,
angioedema,facialswelling,laryngospasm,respiratorydifficulty,rhinitis)

Contraindications Hypersensitivitytosucralfateoranycomponentoftheformulation
Warnings/Precautions
Diseaserelatedconcerns:
Duodenal ulceration: Because sucralfate acts locally at the ulcer, successful therapy with sucralfate
shouldnotbeexpectedtoaltertheposthealingfrequencyofrecurrenceortheseverityofduodenal
ulceration.
Renal impairment: Use with caution in patients with chronic renal failure sucralfate is an aluminum
complex, small amounts of aluminum are absorbed following oral administration. Excretion of
aluminummaybedecreasedinpatientswithchronicrenalfailure.
Concurrentdrugtherapyissues:
Drugdrug interactions: Potentially significant interactions may exist, requiring dose or frequency
adjustment,additionalmonitoring,and/orselectionofalternativetherapy.Consultdruginteractions
databaseformoredetailedinformation.
Dosageformspecificissues:
Tablets: Use with caution in patients with conditions that may impair swallowing (eg, tracheostomy,
dysphagiaorotherswallowingdisorders)orinpatientswithalteredgag/coughreflexaspirationhas
beenreported.

Metabolism/TransportEffects Noneknown.
DrugInteractions
(Foradditionalinformation:LaunchLexiInteractDrugInteractionsProgram)
AntifungalAgents(AzoleDerivatives,Systemic):SucralfatemaydecreasetheabsorptionofAntifungal
Agents(AzoleDerivatives,Systemic).Exceptions:FluconazoleIsavuconazoniumSulfate.RiskC:
Monitortherapy
CholicAcid:SucralfatemaydecreasetheabsorptionofCholicAcid.RiskD:Considertherapymodification
Digoxin:SucralfatemaydecreasetheserumconcentrationofDigoxin.Specifically,sucralfatemaydecrease
theabsorptionofdigoxin.Management:Administerdigoxinatleast2hoursbeforeoratleast6hours
aftersucralfate.RiskD:Considertherapymodification
Dolutegravir:SucralfatemaydecreasetheserumconcentrationofDolutegravir.Management:Administer

dolutegraviratleast2hoursbeforeor6hoursaftersucralfate.RiskD:Considertherapymodification
Eltrombopag:SucralfatemaydecreasetheserumconcentrationofEltrombopag.Management:Administer
eltrombopagatleast2hoursbeforeor4hoursafteroraladministrationofsucralfate.RiskD:Consider
therapymodification
Furosemide:SucralfatemaydecreasetheserumconcentrationofFurosemide.Sucralfatemayimpairthe
absorptionoffurosemide.Management:Avoidconcomitantoraladministrationoffurosemideand
sucralfate.Separateadministrationbyatleast2hours.Doesnotapplytoparenterallyadministered
furosemide.RiskD:Considertherapymodification
Levothyroxine:SucralfatemaydecreasetheserumconcentrationofLevothyroxine.RiskC:Monitortherapy
Multivitamins/Fluoride(withADE):MayincreasetheserumconcentrationofSucralfate.Specifically,the
absorptionofaluminummaybeincreased.Sucralfatemaydecreasetheserumconcentrationof
Multivitamins/Fluoride(withADE).Morespecifically,sucralfatemayimpairtheabsorptionoffluoride.
Management:Avoidadministrationofaluminumcontainingproducts,suchassucralfate,withinatleast
12hoursoffluorideadministration.Inpatientswithsevererenaldysfunction,consideravoidingthis
combinationaltogether.RiskD:Considertherapymodification
Multivitamins/Minerals(withADEK,Folate,Iron):MayincreasetheserumconcentrationofSucralfate.
Specifically,theabsorptionofaluminumfromsucralfatemaybeincreased,leadingtoanincreaseinthe
serumaluminumconcentration.RiskX:Avoidcombination
PhosphateSupplements:SucralfatemaydecreasetheabsorptionofPhosphateSupplements.
Management:Thisappliesonlytooralphosphateadministration.Administeringoralphosphate
supplementsatleast1hourbeforeor2hoursafteradministrationofsucralfatemayreducethe
significanceoftheinteraction.Exceptions:SodiumGlycerophosphatePentahydrate.RiskD:Consider
therapymodification
QuiNIDine:SucralfatemaydecreasetheserumconcentrationofQuiNIDine.Specifically,sucralfatemay
decreasetheabsorptionofquinidine.Management:Administerquinidineatleast2hoursbeforeorat
least6hoursaftersucralfate.RiskD:Considertherapymodification
QuinoloneAntibiotics:SucralfatemaydecreasetheserumconcentrationofQuinoloneAntibiotics.
Management:Administeroralquinolonesatleast2hoursbeforeor6hoursafterthesucralfatedose.
Greaterseparationofdosesmayfurtherlessentheriskforasignificantinteraction.RiskD:Consider
therapymodification
Sulpiride:SucralfatemaydecreasetheserumconcentrationofSulpiride.Management:Separate
administrationofsucralfateandsulpiridebyatleast2hoursinordertominimizetheimpactofsucralfate
onsulpirideabsorption.RiskD:Considertherapymodification
TetracyclineDerivatives:SucralfatemaydecreasetheabsorptionofTetracyclineDerivatives.Management:
Administerthetetracyclinederivativeatleast2hourspriortosucralfateinordertominimizetheimpact
ofthisinteraction.RiskD:Considertherapymodification
VitaminDAnalogs:MayincreasetheserumconcentrationofSucralfate.Specifically,theabsorptionof
aluminumfromsucralfatemaybeincreased,leadingtoanincreaseintheserumaluminum
concentration.RiskX:Avoidcombination
VitaminKAntagonists(eg,warfarin):SucralfatemaydiminishtheanticoagulanteffectofVitaminK
Antagonists.SucralfatemaydecreasetheserumconcentrationofVitaminKAntagonists.Specifically,
sucralfatemaydecreasetheabsorptionofVitaminKAntagonists.Management:AdministervitaminK
antagonistsatleast2hoursbeforeoratleast6hoursaftersucralfate.RiskD:Considertherapy
modification

PregnancyRiskFactor B(showtable)

PregnancyImplications Adverseeventswerenotobservedinanimalreproductionstudies.
Sucralfateisonlyminimallyabsorbedfollowingoraladministration.Basedonavailabledata,useof
sucralfatedoesnotappeartoincreasetheriskofadversefetaleventswhenusedduringthefirsttrimester
(Mahadevan,2006).

BreastFeedingConsiderations Itisnotknownifsucralfateisexcretedinbreastmilk.Sucralfate
isonlyminimallyabsorbedfollowingoraladministration.Themanufacturerrecommendsthatcautionbe
exercisedwhenadministeringsucralfatetonursingwomen.

DietaryConsiderations Takewithwateronanemptystomach.
Pricing:US
Suspension(CarafateOral)
1g/10mL(420mL):$174.05
Tablets(CarafateOral)
1g(100):$323.10
Tablets(SucralfateOral)
1g(100):$70.92
Disclaimer:ThepricingdataprovidearepresentativeAWPand/orAAWPpricefromasinglemanufacturer
ofthebrandand/orgenericproduct,respectively.Thepricingdatashouldbeusedforbenchmarking
purposesonly,andassuchshouldnotbeusedtosetoradjudicateanypricesforreimbursementor
purchasingfunctions.Pricingdataisupdatedmonthly.

InternationalBrandNames Alsucral(EC,FI,MY)Alusac(UY)Alusulin(HU)Andapsin(SE)
Antepsin(AR,DK,FI,GB,IE,IS,IT,MT,NO,TR)Calfate(PT)Carafate(AU,NZ)Ciprid(EC)Dip(CO,
EC)Discral(MX)Dolisec(GR)Episan(ID)Exinol(VE)Gasmezol(VN)Gastril(EC)Gastrofait(QA)
Inpepsa(ID)Iselpin(PH)Keal(FR,LU)Metixane(MX)Neciblok(ID)Peptonorm(GR)Profat(ID)Serat
(VN)Sucrabest(LU)Sucrafilm(BR)Sucral(PY)Sucralfin(IT)Sucralose(AE)Sucramal(CR,DO,GT,
HN,IT,NI,PA,SV)Sucrassyl(CR,DO,GT,HN,NI,PA,SV)Sucrate(CN,HK,LB)SucrateGel(SG)
Sude(CN)Sulcran(CL)Sulcrate(JP)Taxilan(ID)Ulcafate(PK)Ulcar(AE,BH,CY,EG,FR,IQ,IR,JO,
KW,LB,LY,OM,QA,SA,SY,YE)Ulcerfate(IN)Ulcerlmin(JP,KR)Ulcermin(PT)Ulcertec(MY)Ulcetab
(ZA)Ulcicure(QA,SA)Ulcogant(AT,BE,CH,CZ,DE,HU,LU,NL,PE)Ulcumaag(ID)Ulcyte(AU)
Ulsaheal(AE,BH,IQ,JO,SA)Ulsanic(ID,IL,JP,TH,TW,ZA)Ulsicral(ID)Unival(MX)Urbal(ES)
Vanter(LT)Venter(EE,HR,HU,PL,RO,RU,SK)

MechanismofAction Formsacomplexbybindingwithpositivelychargedproteinsinexudates,
formingaviscouspastelike,adhesivesubstance.Thisselectivelyformsaprotectivecoatingthatactslocally
toprotectthegastricliningagainstpepticacid,pepsin,andbilesalts.

PharmacodynamicsandPharmacokinetics
Onsetofaction:Pasteformationandulceradhesion:12hours
Duration:Upto6hours
Absorption:Oral:Minimal
Distribution:ActslocallyatulcersitesunboundinGItracttoaluminumandsucroseoctasulfate
Metabolism:None
Excretion:Urine(smallamountsasunchangedcompounds)
UseofUpToDateissubjecttotheSubscriptionandLicenseAgreement.

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Review,AnnInternMed,2003,138(6):494501.[PubMed12639084]

3. CookD,GuyattG,MarshallJ,etal,AComparisonofSucralfateandRanitidineforthePreventionofUpper

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4. LoprinziCL,GhoshC,CamorianoJ,etal,PhaseIIIControlledEvaluationofSucralfatetoAlleviateStomatitisinPatients
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5. MahadevanU,KaneS.AmericanGastroenterologicalAssociationInstitutetechnicalreviewontheuseofgastrointestinal
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6. OverdahlMCandWewersMD,AcuteOcclusionofaMainstemBronchusbyaRapidlyExpandingForeignBody,Chest,
1994,105(5):16002.[PubMed8181371]

7. RobertsonJA,SaluskyIB,GoodmanWG,etal,Sucralfate,IntestinalAluminumAbsorption,andAluminumToxicityina
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