When is chronic use of sucralfate (carafate) indicated?

From the Guidelines

Chronic use of sucralfate is indicated for stress ulcer prophylaxis in critically ill adults, particularly when the risk of pneumonia is high, as it is associated with a lower incidence of pneumonia compared to H2-receptor antagonists and proton pump inhibitors (PPIs) 1.

Key Points

• The use of sucralfate for stress ulcer prophylaxis is supported by recent guidelines, which suggest that it may be a suitable alternative to PPIs and H2RAs in certain situations 1.
• Sucralfate has been shown to reduce the incidence of pneumonia in critically ill adults, which is a significant advantage over other acid-suppressing agents 1.
• The typical dosage for chronic therapy is 1 gram taken orally four times daily, usually administered on an empty stomach one hour before meals and at bedtime.
• Sucralfate works by forming a protective barrier over ulcerated areas, binding to the ulcer site and creating a physical shield against acid, pepsin, and bile salts.

Considerations

• The choice of stress ulcer prophylaxis should be individualized based on the patient's risk factors and clinical condition.
• Sucralfate may not be suitable for patients with severe renal impairment or those taking other medications that may interact with sucralfate.
• Patients should be aware that sucralfate may decrease the absorption of other medications, so they should be taken at least 2 hours apart from sucralfate.

Evidence

• A recent network meta-analysis compared PPIs, H2RAs, and sucralfate for the outcomes of clinically important UGIB, overt UGIB, pneumonia, and mortality, and found that sucralfate was associated with less pneumonia compared to PPIs and H2RAs 1.
• Another study found that sucralfate was associated with a lower incidence of ventilator-associated pneumonia (VAP) compared to H2-receptor inhibitors 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. While healing with sucralfate may occur during the first week or two, treatment should be continued for 4 to 8 weeks unless healing has been demonstrated by x-ray or endoscopic examination. Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers. The chronic use of sucralfate (carafate) is indicated for maintenance therapy of duodenal ulcer patients at a reduced dosage after healing of acute ulcers 2.

• Key points:
  • Indicated for maintenance therapy
  • Reduced dosage after healing of acute ulcers
  • For duodenal ulcer patients

From the Research

Indications for Chronic Use of Sucralfate

• Chronic use of sucralfate is indicated for the prevention of duodenal ulcer recurrence, as it has been shown to decrease the rate of recurrence when given prophylactically at a dosage of 2g daily 3.
• Maintenance treatment with sucralfate can also delay symptoms of gastric ulcer recurrence, with significant differences between sucralfate and placebo after six months and 12 months 4.
• Sucralfate is effective in preventing duodenal ulcer recurrence when used as maintenance therapy, and it is a safe and effective medication for this purpose 5.
• The use of sucralfate as a maintenance therapy may be particularly beneficial for patients who are at high risk of ulcer recurrence, such as those with a history of peptic ulcer disease, smokers, and those with concomitant disease or concomitant steroid use 6.

Dosage and Administration

• The recommended dose of sucralfate for maintenance therapy is 1g twice a day or 2g taken at night, although some studies suggest that continuing maintenance therapy at the healing dose may be more effective 5.
• The dosage of sucralfate for the prevention of gastric ulcer recurrence is 2g per day 4.

Patient Populations

• Chronic use of sucralfate may be indicated for patients with a history of peptic ulcer disease, particularly those who are at high risk of recurrence 6, 5.
• Patients who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) may also benefit from chronic use of sucralfate, as it can reduce the frequency of gastrointestinal symptoms and complications associated with NSAID use 6.