What is the use of sucralfate (sucralfate)?

From the Guidelines

Sucralfate is the preferred choice for stress ulcer prophylaxis in critically ill adults due to its association with lower mortality rates and reduced incidence of pneumonia compared to H2-receptor inhibitors and proton pump inhibitors (PPIs) 1.

Key Points

• Sucralfate works by forming a protective coating over ulcers, shielding them from acid, bile, and enzymes in the stomach and intestines, allowing natural healing to occur.
• The typical adult dose is 1 gram taken four times daily, usually on an empty stomach, one hour before meals and at bedtime.
• For ulcer treatment, the course usually lasts 4-8 weeks, while preventive use may continue longer under medical supervision.
• Sucralfate comes as a tablet or oral suspension and is generally well-tolerated because it works locally in the digestive tract and very little is absorbed into the bloodstream.
• Common side effects include constipation, dry mouth, and nausea.
• According to a recent guideline, sucralfate is associated with less pneumonia compared to PPIs (RR, 0.49; 95% CI, 0.3–0.79) and H2RAs (RR, 0.83; 95% CI, 0.71–0.96) 1.
• Network meta-analyses suggest that sucralfate may be a better option than PPIs and H2RAs for stress ulcer prophylaxis in critically ill adults, despite the certainty of evidence varying across analyses 1.

Considerations

• The use of sucralfate may be influenced by the patient's individual risk factors for stress-related gastrointestinal bleeding and the presence of other comorbidities.
• The guideline recommends using either PPIs or H2RAs as first-line agents for stress ulcer prophylaxis in critically ill adults with risk factors for clinically important stress-related UGIB, but sucralfate may be a viable alternative 1.
• It is essential to weigh the benefits and risks of each medication and consider the latest evidence when making treatment decisions.
• As sucralfate can interfere with the absorption of other medications, they should be taken at least 2 hours before or after sucralfate 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. Clinical Pharmacology Sucralfate is only minimally absorbed from the gastrointestinal tract. The main use of sucralfate is for the short-term treatment of active duodenal ulcer.

• It can be used for maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers.
• The mechanism of action is through a local, rather than systemic, action 2 2.

From the Research

Sucralfate Overview

• Sucralfate is a basic aluminium salt of sulphated sucrose used in the treatment of peptic ulcer disease 3
• It acts by protecting the ulcer from the effects of pepsin, acid, and bile salts, and is minimally absorbed after oral administration 3

Dosage and Efficacy

• The conventional dosage schedule for sucralfate is 1 g 4 times a day, but a dose of 2 g twice a day may be equally effective in duodenal ulcer healing 4
• Sucralfate has been shown to be effective in increasing the rate of healing of duodenal and gastric ulcers over a period of 4 to 8 weeks 3
• Trials comparing sucralfate and cimetidine have not found any significant difference in efficacy between the drugs in small numbers of patients 3

Side Effects and Interactions

• Sucralfate is well tolerated, with constipation being the most common side effect, occurring in 2% of patients 3
• Other side effects include xerostomia and skin eruptions, but no drug-drug interactions have been reported 5

Use in Stress Ulcer Prophylaxis

• Sucralfate may be used as an alternative to proton pump inhibitors (PPI) and histamine 2 receptor antagonists (H2RA) for stress ulcer prophylaxis in mechanically ventilated patients 6, 7
• A meta-analysis of 10 randomized controlled trials found that sucralfate decreased the incidence of gastric colonization and ventilator-associated pneumonia compared to H2RA 7