Sucralfate Treatment for Stomach and Duodenal Ulcers
For treatment of duodenal ulcers, sucralfate should be administered at a dosage of 1 g four times per day on an empty stomach for 4-8 weeks. 1
Dosage Recommendations
Active Duodenal Ulcer
- The recommended adult oral dosage is 1 g four times per day on an empty stomach 1
- Treatment should continue for 4-8 weeks unless healing has been demonstrated by x-ray or endoscopic examination 1
- Antacids may be prescribed for pain relief but should not be taken within 30 minutes before or after sucralfate 1
Gastric Ulcer
- Although the FDA label doesn't specifically mention gastric ulcer dosing, clinical studies have shown that the same dosage of 1 g four times daily is effective for gastric ulcers 2
- Healing rates for gastric ulcers are typically lower than for duodenal ulcers but comparable to those produced by other treatments 3
Maintenance Therapy
- For preventing ulcer recurrence, the recommended adult oral dosage is 1 g twice a day 1
- This maintenance dosage has been shown to reduce duodenal ulcer relapse rates from approximately 60% to 20% after 6 months 4
Special Populations
Elderly Patients
- Dose selection for elderly patients should be cautious, usually starting at the lower end of the dosing range 1
- This reflects the greater frequency of decreased hepatic, renal, or cardiac function, and potential drug interactions in elderly patients 1
Treatment Considerations
Efficacy
- Sucralfate works by binding to proteinaceous material at the ulcer site, forming a protective barrier, neutralizing local acidity, inhibiting pepsin action, and adsorbing bile salts 3
- Healing rates for duodenal ulcers with sucralfate are 75-85% after 4 weeks and 95-97% after 8 weeks of treatment 5
Place in Therapy
- Proton pump inhibitors (PPIs) are generally considered first-line agents for treating and preventing gastrointestinal ulcers 6
- Sucralfate is recommended as a second-line agent by the American College of Gastroenterology 6
- For H. pylori-associated ulcers, eradication therapy should be used in addition to sucralfate 6
NSAID-Induced Ulcers
- For NSAID-induced ulcers, discontinuation of NSAIDs is recommended when possible 6
- If NSAIDs must be continued, adding a PPI for gastroprotection is preferred over sucralfate 7
Common Pitfalls and Caveats
- Sucralfate should be taken on an empty stomach for maximum effectiveness 1
- Absorption of other medications may be affected by sucralfate; therefore, other oral medications should be taken at least 30 minutes before or after sucralfate 3
- Constipation is the most common side effect, occurring in approximately 2-4% of patients 3, 2
- Testing for H. pylori infection should be performed in all patients with duodenal ulcer, as eradication therapy is necessary for H. pylori-positive patients 7
- For stress ulcer prophylaxis in critically ill patients, PPIs or H2-receptor antagonists are typically preferred over sucralfate 6