Sucralfate Dosing for Duodenal Ulcers
The recommended dosage for sucralfate (Carafate) in the treatment of duodenal ulcers is 1 gram four times per day on an empty stomach for 4-8 weeks. 1
Standard Dosing Regimen
The FDA-approved dosing for active duodenal ulcer treatment with sucralfate is:
- 1 gram four times daily
- Taken on an empty stomach
- Typically 30 minutes before meals and at bedtime
- Treatment duration of 4-8 weeks (unless healing is confirmed earlier by endoscopy or x-ray)
Alternative Dosing Option
Research has shown that a twice-daily regimen may be equally effective:
- 2 grams twice daily (on waking and at bedtime)
- Healing rates at 4 weeks: 78-79% (2g twice daily) vs. 72-74% (1g four times daily) 2, 3
- Cumulative healing rates at 8 weeks: 83-85% (2g twice daily) vs. 80-84% (1g four times daily)
This alternative regimen may improve medication adherence due to reduced dosing frequency.
Maintenance Therapy
For prevention of ulcer recurrence after initial healing:
- 1 gram twice daily 1
Special Populations
For elderly patients:
- Start at the lower end of the dosing range
- Consider decreased hepatic, renal, or cardiac function
- Account for concomitant diseases or medications 1
Administration Considerations
- Take on an empty stomach for optimal effect
- Antacids may be prescribed for pain relief but should not be taken within 30 minutes before or after sucralfate 1
- Sucralfate acts locally by binding to the ulcer site, forming a protective barrier against acid, pepsin, and bile salts 4, 5
- Minimal systemic absorption (3-5%) results in few side effects 4, 5
Treatment Duration
- Continue treatment for 4-8 weeks even if symptoms improve earlier
- Endoscopic or radiographic confirmation of healing is recommended before discontinuing therapy 1
Common Side Effects
- Constipation (most common, occurs in 2-4% of patients)
- Xerostomia (dry mouth, 1%)
- Skin eruptions (0.6%) 5
Important Note
While sucralfate is effective for duodenal ulcers, proton pump inhibitors (PPIs) are now generally considered the preferred agents for therapy and prophylaxis of NSAID and ASA-associated GI injury 6. For H. pylori-positive ulcers, eradication therapy should be considered to prevent recurrence 6, 7.