Sucralfate

trade name: Carafate; drug class: protectant, aluminum salt of sulfated sucrose; action: forms an ulcer-adherent complex that covers and protects the ulcer site; use: treatment of duodenal ulcer.

Brand names: Carafate®

Chemical formula:

Drug Forms:
• Sucralfate Oral tablet (below)
• Sucralfate Oral suspension
• Sucralfate tablets
• Sucralfate oral suspension

Español:
• Sucralfato, Tableta oral
• Sucralfato, Suspensión oral
• Tabletas de sucralfato
• Suspensión oral de sucralfato

Sucralfate Oral tablet

What is this medicine?

SUCRALFATE (SOO kral fate) helps to treat ulcers of the intestine.
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•kidney disease
•an unusual or allergic reaction to sucralfate, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. This medicine works best if you take it on an empty stomach, 1 hour before meals. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor's advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

•antacid
•cimetidine
•digoxin
•ketoconazole
•phenytoin
•quinidine
•ranitidine
•some antibiotics like ciprofloxacin, norfloxacin, and ofloxacin
•theophylline
•thyroid hormones
•warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular check ups. Let your doctor know if your symptoms do not improve or if you feel worse.

Antacids should not be taken within one half hour before or after this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•difficulty breathing

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•back pain
•constipation
•drowsy, dizzy
•dry mouth
•headache
•stomach upset, gas
•trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Keep container tightly closed. Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

A complex of aluminum hydroxide and sulfated sucrose used for short-term treatment of peptic ulcer; it forms a complex with proteins that resists digestion by acid and pepsin thereby making a protective coating for the ulcer.

Sucralfate
Systematic (IUPAC) name
Hexadeca-μ-hydroxytetracosahydroxy[μ8-[1,3,4,6-tetra-O-sulfo-β-Dfructofuranosyl-α-D-glucopyranoside tetrakis(hydrogen sulfato)8-)]]hexadecaaluminum[1]
Identifiers
CAS number	54182-58-0
ATC code	A02BX02
PubChem	6398525
DrugBank	APRD01238
Chemical data
Formula	C12H54Al16O75S8[1]
Mol. mass	2086.75 g/mol[1]
Pharmacokinetic data
Bioavailability	3-5% (local acting)
Metabolism	GI; liver: unknown
Half life	unknown
Excretion	feces, urine
Therapeutic considerations
Pregnancy cat.	B
Legal status	℞-only
Routes	oral, suspension, rectal suspension

Sucralfate is an oral gastrointestinal medication primarily indicated for the treatment of active duodenal ulcers. Brand names include Ulsanic in Pakistan, Sucramal in Italy; Carafate in U.S.A.,Pepsigard,Sucral,sucrafil in India; Sutra in parts of South-East Asia, Sulcrate in Canada; and Antepsin in Turkey. Sucralfate is also used for the treatment of gastroesophageal reflux disease (GERD)^[2] and stress ulcers. Unlike the other classes of medications used for treatment of peptic ulcers, sucralfate is a sucrose sulfate-aluminium complex that binds to the hydrochloric acid in the stomach and acts like an acid buffer with cytoprotective properties. Sucralfate was approved by the U.S. Food and Drug Administration (FDA) in 1981.

Contents 1 Mechanism of action 2 Clinical uses 3 Adverse reactions 4 Notes 5 References 6 External links

Mechanism of action

Sucralfate is a locally acting substance that in an acidic environment (pH < 4), reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose. It also attaches to proteins on the surface of ulcers, such as albumin and fibrinogen, to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing further damage from acid, pepsin, and bile. In addition, it prevents back diffusion of hydrogen ions, and adsorbs both pepsin and bile acids. Recently, it has been indicated that sucralfate also stimulates the increase of prostaglandin E₂, epidermal growth factors (EGF), bFGF, and gastric mucus.

Clinical uses

The only FDA-approved indication for sucralfate is for the treatment of active duodenal ulcers not related to NSAID usage because the mechanism behind these ulcers is secondary to acid oversecretion. It is not technically approved for gastric ulcers because the main mechanism is not due to acid oversecretion but rather from diminished protection. The use for sucralfate in peptic ulcer disease has diminished recently, but it is still the preferred agent for stress ulcer prophylaxis.

• Active duodenal ulcer not related to NSAID use -- 1 g PO four times a day given 1 hr before meals and at bedtime for 4–8 weeks 'Tablet Available as well'
• Maintenance therapy for resolved duodenal ulcers -- 1 g PO bid on empty stomach
• Gastric ulcer not related to NSAID use and gastritis due to GERD -- 1 g PO four times a day 1 hr before meals and at bedtime. Triple combination therapy with lansoprazole + cisapride + sucralfate can significantly improve symptoms and quality of life and was more cost-effective than ranitidine combination group. [Journal of Zhejiang University 2003 Sep-Oct; 4(5): 602-6]
• Aphthous ulcer and stomatitis due to radiation or chemotherapy -- 5-10 mL PO suspension swish and spit/swallow four times a day.
• Proctitis from radiation or ulcerative colitis -- 3 g/15 mL rectal suspension once or twice daily.
• Gastro-esophageal reflux disease during pregnancy -- first-line drug therapy combined with lifestyle and diet modification.^[3]
• Stress ulcer prophylaxis -- The use of sucralfate rather than H₂ antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of ventilator-associated pneumonia (VAP).^[4]
• 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^[5]
• Rectal bleeding and its management after irradiation for uterine cervical cancer

Grade 1 bleeding experienced immediate relief with sucrasulfate enema for 1 month. Grade 2 bleeding, sucrasulfate 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 patients. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucrasulfate enema and coagulation is effective in controlling Grade 1 and 2 rectal bleeding without the development of fistula or stricture.^[6]

Adverse reactions

The most common side effects seen are constipation and bezoar formation. Less commonly reported include flatulence, cephalalgia (headache), hypophosphatemia, and xerostomia (dry mouth). Nursing mothers: Uncertain.

Notes

1. ^ ^{a b c} Merck Index, 12th Edition, 9049.
2. ^ Maton PN (2003). "Profile and assessment of GERD pharmacotherapy". Cleve Clin J Med 70 Suppl 5: S51–70. doi:10.3949/ccjm.70.Suppl_5.S51. PMID 14705381. 
3. ^ Aliment Pharmacol Ther. 2005 Nov 1;22(9):749-57.
4. ^ Respir Care. 2005 Jun;50(6):725-39; discussion 739-41.
5. ^ Surg Today. 2005;35(8):617-22.
6. ^ International Journal Radiation Oncology Biological Physics, 2004 Jan 1;58(1):98-105

References

• Journal of Zhejiang University 2003 Sep-Oct; 4(5): 602-6
• Katzung, Bertram G. Basic and Clinical Pharmacology, 9th ed. (2004).

External links

• Medline Plus
• Mar Vista Animal Medical Center
• Medicine Net
• Rx List
• Drugs.com
• Whole Health MD
• Kyoto Encyclopedia of Genes and Genomes
• Carafate prescribing information

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