What is the recommended dose of sucralfate for adults?

Recommended Dosage of Sucralfate for Adults

The recommended adult oral dosage of sucralfate for duodenal ulcer treatment is 1 g four times per day on an empty stomach, typically administered one-half hour before meals and at bedtime for 4-8 weeks. 1

Standard Dosing Regimens

For Duodenal Ulcer Treatment:

• 1 g four times daily on an empty stomach for 4-8 weeks 1, 2
• Alternative regimen: 2 g twice daily (morning and bedtime) has shown equivalent healing rates to the four-times-daily regimen 3, 4

For Maintenance Therapy:

• 1 g twice daily for prevention of duodenal ulcer recurrence 1, 5

For Stress Ulcer Prophylaxis in Critical Care:

• Low-dose sucralfate is defined as a daily dose of less than or equal to 4 g 6
• Typically administered as 1 g every 6 hours via oral or nasogastric route 6

Clinical Considerations

Efficacy:

• Sucralfate acts locally by binding to the ulcer site, creating a protective barrier against acid, pepsin, and bile salts 5, 2
• Healing rates of 72-79% at 4 weeks and 80-85% at 8 weeks have been demonstrated with both standard (1 g QID) and alternative (2 g BID) dosing regimens 3, 4

Administration Guidelines:

• Should be taken on an empty stomach 1
• Antacids may be prescribed for pain relief but should not be taken within 30 minutes before or after sucralfate 1
• For stress ulcer prophylaxis, either enteral or IV routes can be used for administration 6

Special Populations:

• Elderly patients: Dose selection should be cautious, usually starting at the lower end of the dosing range due to potential decreased hepatic, renal, or cardiac function 1
• Patients with renal impairment: No specific dose adjustment is required as sucralfate is minimally absorbed (3-5%) 5, 2

Comparative Efficacy and Safety

• Sucralfate has shown comparable efficacy to cimetidine and intensive antacid therapy in treating duodenal ulcers 5, 2
• In critically ill patients, sucralfate is associated with less pneumonia compared to PPIs (RR, 0.49; 95% CI, 0.3-0.79) and H2RAs (RR, 0.83; 95% CI, 0.71-0.96) when used for stress ulcer prophylaxis 6
• The most common side effect is constipation, occurring in approximately 2-4% of patients 5, 7
• Other reported side effects include dry mouth (1%) and skin eruptions (0.6%) 2

Alternative Uses

• Sucralfate enemas (2 g mixed with 30-50 mL water) can be used to treat chronic radiation-induced proctitis in patients with rectal bleeding 6
• Not recommended for prevention of radiation-induced enteropathy or acute diarrhea in patients with pelvic malignancies 6