When would sucralfate (Sucralfate) be fine to give?

From the Guidelines

Sucralfate can be given to patients with radiation proctitis, specifically those with vascular telangiectasia and nonhealing mucosal ulceration, as it may help stimulate epithelial healing and form a protective barrier 1. When considering the use of sucralfate, it's essential to understand its mechanism of action and potential benefits in specific clinical contexts. In the case of radiation proctitis, sucralfate enemas have been shown to be effective in managing bleeding, with the strongest evidence coming from a prospective randomized, double-blind, controlled trial 1. Key points to consider when administering sucralfate include:

• Its use in radiation proctitis is based on its ability to stimulate epithelial healing and form a protective barrier 1
• The strongest evidence for its use comes from a prospective randomized, double-blind, controlled trial of 37 patients 1
• Sucralfate enemas may be used as an alternative to formalin enemas, which can sclerose and seal fragile neovasculature in radiation-damaged tissues 1
• The success of bleeding control with sucralfate or formalin is related to the accurate localization of and application to all the bleeding sites 1

From the FDA Drug Label

Indications and Usage Section INDICATIONS AND USAGE Sucralfate tablets, USP are indicated in: Short-term treatment (up to 8 weeks) of active duodenal ulcer. Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers. The physician should read the PRECAUTIONS section when considering the use of this drug in pregnant or pediatric patients, or patients of childbearing potential. Sucralfate tablets should be used with caution by patients who have known conditions that may impair swallowing, such as recent or prolonged intubation, tracheostomy, prior history of aspiration, dysphagia, or any other conditions that may alter gag and cough reflexes, or diminish oropharyngeal coordination or motility Sucralfate should be used with caution in patients with chronic renal failure

Sucralfate would be fine to give in the following situations:

• Short-term treatment of active duodenal ulcer for up to 8 weeks 2
• Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers 2 However, sucralfate should be used with caution in certain patients, including:
• Those with conditions that may impair swallowing 2
• Patients with chronic renal failure 2
• Pregnant or pediatric patients, or patients of childbearing potential 2 It is also recommended to administer sucralfate separately from other drugs when alterations in bioavailability are felt to be critical 2

From the Research

Indications for Sucralfate

• Sucralfate can be given for the treatment of peptic ulcer disease, including duodenal and gastric ulcers 3, 4, 5, 6.
• It is also used to prevent the recurrence of duodenal ulcers 3, 6.
• Additionally, sucralfate can be used to treat other gastrointestinal diseases such as gastro-esophageal reflux, gastritis, stress ulcer, and dyspepsia 7.
• It may also be used in non-acid related gastrointestinal diseases, including radiation-induced mucosal procto-sigmoiditis or ulcerative colitis 7.

Dosage and Administration

• The recommended dose of sucralfate is 1g four times a day, one hour before meals and at bedtime 4.
• A dosage of 2g daily can be given prophylactically to decrease the rate of recurrence of duodenal ulcers 3.

Safety and Efficacy

• Sucralfate is well tolerated, with constipation being the most common side effect, occurring in 2-4% of patients 3, 4.
• It has been shown to be effective in increasing the rate of healing of duodenal and gastric ulcers, with healing rates ranging from 60 to 90% at 4-6 weeks 5, 6.
• Sucralfate is also safe to use during pregnancy, due to its low absorption and lack of side effects 7.