From the Guidelines
Sucralfate is not recommended as an acid coating due to its limited effectiveness and the availability of superior alternatives, such as proton pump inhibitors (PPIs), which have been proven to be more effective in preventing NSAID ulcer recurrence and overall symptom control 1. The role of sucralfate as an acid coating is limited, and its use is not recommended due to the availability of far superior alternatives. Sucralfate has been shown to be effective in the treatment of NSAID-associated duodenal ulcers, particularly when the NSAID is stopped, but it is not effective in the treatment or prevention of NSAID-related gastric ulcers 1.
Key Points
- Sucralfate forms an ulcer-adherent complex at duodenal ulcer sites, protecting the ulcer and promoting healing, but its use is not recommended due to limited effectiveness 1.
- PPIs, such as lansoprazole and omeprazole, have been proven to be more effective in preventing NSAID ulcer recurrence and overall symptom control, and are considered a better alternative to sucralfate 1.
- The level of acid suppression provided by traditional doses of H2-receptor antagonists (H2RAs) does not prevent most NSAID-related gastric ulcers, and PPI therapy is the rational alternative to H2RAs in this clinical setting 1.
Clinical Considerations
- When considering the use of sucralfate or other acid coating medications, it is essential to weigh the benefits and risks, including the potential for side effects, such as constipation and nausea, and the limited effectiveness of sucralfate in preventing NSAID-related gastric ulcers 1.
- PPIs, such as lansoprazole and omeprazole, are generally well-tolerated and have been proven to be effective in preventing NSAID ulcer recurrence and overall symptom control, making them a better alternative to sucralfate 1.
From the FDA Drug Label
Although the mechanism of sucralfate’s ability to accelerate healing of duodenal ulcers remains to be fully defined, it is known that it exerts its effect through a local, rather than systemic, action In vitro, a sucralfate-albumin film provides a barrier to diffusion of hydrogen ions These observations suggest that sucralfate’s antiulcer activity is the result of formation of an ulcer-adherent complex that covers the ulcer site and protects it against further attack by acid, pepsin, and bile salts.
The role of sucralfate as an acid coating is to form a barrier that prevents acid diffusion and protects the ulcer site from further attack by acid, pepsin, and bile salts.
- Key points:
- Sucralfate exerts its effect through a local action.
- It has an acid-neutralizing capacity of approximately 14 to 16 mEq per 1 g dose.
- The ulcer-adherent complex formed by sucralfate covers the ulcer site and protects it against further attack. 2
From the Research
Role of Sucralfate as an Acid Coating
- Sucralfate acts as a protective barrier at the ulcer site, shielding it from acid, pepsin, and bile salts 3, 4, 5, 6.
- It binds to proteinaceous material and forms a protective barrier, neutralizing local acidity without affecting gastric pH 4, 6.
- Sucralfate inhibits the diffusion of hydrogen ions, inhibits the action of pepsin, and adsorbs bile salts, creating a comprehensive protective barrier effect 4, 6.
- The drug's viscous adhesiveness and formation of polyvalent bridges with positively charged proteins in mucosal lesions enable it to bind to defective mucosa 6.
- Sucralfate's protective activity depends on the presence of an acid milieu in the stomach, with its potency and duration of protection increasing at lower pH levels 7.
- The ulcer-healing effects of sucralfate occur even after a marked inhibition of gastric acid secretion, suggesting that its therapeutic action is not solely dependent on acid neutralization 7.