From the Guidelines
Yes, sucralfate can block or reduce the absorption of other medications, specifically quinolone antibiotics, by chelation, resulting in a marked decrease in drug levels. This interaction is significant because it can lead to reduced efficacy of the affected medications, potentially compromising treatment outcomes. According to the 1999 USPHS/IDSA guidelines 1, sucralfate can interact with quinolone antibiotics (such as ciprofloxacin, levofloxacin, and ofloxacin) by chelation, which markedly decreases quinolone drug levels. To minimize this interaction, it is recommended to administer the interacting drug at least 2 hours after the quinolone antibiotic. Some key points to consider when prescribing sucralfate with other medications include:
- Separating the administration of sucralfate and other medications by at least 2 hours to minimize interactions
- Monitoring drug levels and adjusting dosages as needed to ensure optimal therapeutic outcomes
- Informing patients about potential drug interactions and the importance of separating medication administration times
- Considering alternative medications that do not interact with sucralfate, if possible. The mechanism of this interaction is thought to be related to the binding properties of sucralfate, which can form complexes with other medications in the gastrointestinal tract, preventing their proper absorption into the bloodstream, as seen with quinolone antibiotics 1.
From the FDA Drug Label
Some studies have shown that simultaneous sucralfate administration in healthy volunteers reduced the extent of absorption (bioavailability) of single doses of the following: cimetidine, digoxin, fluoroquinolone antibiotics, ketoconazole, l-thyroxine, phenytoin, quinidine, ranitidine, tetracycline, and theophylline The mechanism of these interactions appears to be nonsystemic in nature, presumably resulting from sucralfate binding to the concomitant agent in the gastrointestinal tract. Because of the potential of sucralfate to alter the absorption of some drugs, sucralfate should be administered separately from other drugs when alterations in bioavailability are felt to be critical.
Yes, sucralfate can block or reduce the absorption of other medications. The mechanism of this interaction is thought to be due to sucralfate binding to the concomitant agent in the gastrointestinal tract.
- Affected medications include:
- cimetidine
- digoxin
- fluoroquinolone antibiotics
- ketoconazole
- l-thyroxine
- phenytoin
- quinidine
- ranitidine
- tetracycline
- theophylline To minimize interactions, sucralfate should be administered separately from other drugs, and patients should be monitored appropriately 2.
From the Research
Sucralfate and Medication Absorption
- Sucralfate can potentially block or reduce the absorption of other medications due to its ability to form a strong gastrointestinal tract (GIT) mucosal barrier 3.
- The unabsorbed sucralfate may alter the pharmacokinetics of oral drugs by impeding their absorption and reducing oral bioavailability 3.
Affected Medications
- Fluoroquinolones are significantly affected by sucralfate, with a notable loss of oral bioavailability 3, 4.
- Other classes of drugs may also be affected, although the impact is generally variable and manageable in clinical situations 3.
- Sucralfate can impair the oral absorption of fluoroquinolones when coadministered, and concomitant use should be avoided even when dosed several hours apart 4.
Mechanism of Interaction
- Sucralfate forms a physical barrier between the epithelium and damaging agents, including drugs, which can reduce the absorption of other medications 5.
- The interaction between sucralfate and other drugs can be influenced by factors such as study design, objectives, and pharmacokinetic data 3.