What is the recommended dose of sucralfate (sucralfate) syrup?

Recommended Dosage of Sucralfate Syrup

The recommended dose of sucralfate syrup for stress ulcer prophylaxis is 1 g four times daily, not exceeding a total daily dose of 4 g. 1

Dosing Recommendations by Indication

For Oral Administration (Peptic Ulcer Disease)

• Active Duodenal Ulcer: 1 g four times per day on an empty stomach 2
• Maintenance Therapy: 1 g twice a day 2
• Alternative Regimen: 2 g twice daily (morning and bedtime) has shown equivalent efficacy to the standard 1 g four times daily regimen 3, 4

For Rectal Administration (Radiation Proctitis)

• Sucralfate Enemas: 2 g sucralfate suspension mixed with 30-50 mL water, administered rectally 1
• Initial Treatment: Twice daily administration
• Maintenance: Once daily when symptoms stabilize 1

Administration Guidelines

Oral Administration

• Take on an empty stomach
• Antacids may be prescribed for pain relief but should not be taken within 30 minutes before or after sucralfate 2
• For elderly patients, start at the lower end of the dosing range due to potential decreased hepatic, renal, or cardiac function 2

Rectal Administration (for radiation proctitis)

1. Mix 2 g sucralfate suspension with 30-50 mL tap water
2. Draw up in a bladder syringe
3. Fit a soft Foley catheter to the syringe
4. Lubricate the catheter and pass into the rectum
5. Inject the mixture into the rectum
6. Have patient roll through 360 degrees to coat the entire rectal surface
7. Lying prone helps cover anterior wall rectal telangiectasia (usual area of greatest bleeding)
8. Retain the enema for as long as possible or at least 20 minutes 1

Clinical Considerations

Efficacy

• Oral sucralfate is effective for duodenal and gastric ulcer healing over 4-8 weeks 5
• Rectal sucralfate enemas are useful for radiation-induced proctitis with bleeding 1
• When used for stress ulcer prophylaxis, sucralfate is associated with less pneumonia compared to PPIs and H2RAs 1

Important Cautions

• No concurrent administration: No evidence supports the concurrent administration of sucralfate and acid suppressants for stress ulcer prophylaxis 1
• Oral sucralfate for radiation effects: Not recommended to reduce radiation-related side effects; does not prevent acute diarrhea in patients with pelvic malignancies undergoing external beam radiotherapy and is associated with more gastrointestinal side effects, including rectal bleeding 1
• Drug interactions: Drugs that decrease gastric acidity or sucralfate should be administered ≥2 hours after ketoconazole 1

Common Side Effects

• Constipation (most common, occurs in approximately 2% of patients) 5, 6
• Xerostomia (dry mouth) 7
• Skin eruptions (rare) 7

Special Populations

• Elderly: Dose selection should be cautious, usually starting at the lower end of the dosing range 2
• Critically ill: For stress ulcer prophylaxis in critically ill adults, low-dose sucralfate (≤4 g daily) is recommended 1

Remember that when using sucralfate for radiation proctitis, bleeding is likely to recur when treatment is stopped 1. For stress ulcer prophylaxis, discontinue when critical illness is no longer evident or risk factors are no longer present 1.