What is the best way to take lansoprazole (PPI) and sucralfate?

Optimal Administration of Lansoprazole and Sucralfate

Lansoprazole should be taken at least 30 minutes before sucralfate to prevent decreased absorption and delayed bioavailability of the PPI. 1

Rationale for Timing Separation

• When lansoprazole is administered concomitantly with sucralfate, the absorption of lansoprazole is delayed and its bioavailability is reduced by approximately 17% 1
• The FDA drug label specifically states that lansoprazole should be taken at least 30 minutes prior to sucralfate to ensure optimal absorption 1
• This timing recommendation is based on pharmacokinetic studies showing significant drug-drug interaction when these medications are taken simultaneously 1

Optimal Administration Schedule

For Lansoprazole:

• Take lansoprazole in the morning before breakfast for optimal acid suppression 2
• Morning dosing of lansoprazole 30 mg has been shown to be more effective for controlling daytime acidity compared to evening dosing 2
• Lansoprazole should be swallowed whole; do not crush or chew the delayed-release capsules 1

For Sucralfate:

• Standard dosing of sucralfate is typically 1 g four times daily (before meals and at bedtime) 3, 4
• Sucralfate forms a protective barrier at ulcer sites and requires direct contact with the gastric mucosa to be effective 4, 5
• Sucralfate works by binding to proteinaceous material at ulcer sites, forming a protective barrier against acid, pepsin, and bile salts 5

Clinical Implications

• PPIs like lansoprazole are the preferred agents for therapy and prophylaxis of NSAID and ASA-associated GI injury 6
• Sucralfate has been shown to be effective in treating NSAID-associated duodenal ulcers but is not effective for gastric ulcers 6
• The American College of Cardiology Foundation notes that sucralfate's use is not recommended for NSAID-related gastric ulcers because of the availability of superior alternatives like PPIs 6

Common Pitfalls to Avoid

• Administering sucralfate simultaneously with lansoprazole will significantly reduce the PPI's effectiveness 1
• Failing to maintain adequate time separation between these medications may result in treatment failure due to reduced bioavailability of lansoprazole 1
• Crushing or chewing lansoprazole capsules will destroy the enteric coating and reduce effectiveness 1
• Taking lansoprazole after meals rather than before can reduce its acid-suppressive effects 2

Special Considerations

• For patients with hepatic impairment, lansoprazole dosage adjustment may be necessary as its metabolism is primarily hepatic 1
• If a dose of either medication is missed, it should be taken as soon as possible, but if it's close to the next scheduled dose, skip the missed dose and take the next one as scheduled 1
• For patients taking both medications for stress ulcer prophylaxis, PPIs have been proven superior to both ranitidine and misoprostol in preventing NSAID ulcer recurrence 6

By following these specific timing recommendations, the therapeutic benefits of both medications can be maximized while minimizing potential drug interactions.