From the FDA Drug Label
Some studies have shown that simultaneous sucralfate administration in healthy volunteers reduced the extent of absorption (bioavailability) of single doses of the following: cimetidine, digoxin, fluoroquinolone antibiotics, ketoconazole, l-thyroxine, phenytoin, quinidine, ranitidine, tetracycline, and theophylline The mechanism of these interactions appears to be nonsystemic in nature, presumably resulting from sucralfate binding to the concomitant agent in the gastrointestinal tract. In all case studies to date (cimetidine, ciprofloxacin, digoxin, norfloxacin, ofloxacin, and ranitidine), dosing the concomitant medication 2 hours before sucralfate eliminated the interaction Because of the potential of sucralfate to alter the absorption of some drugs, sucralfate should be administered separately from other drugs when alterations in bioavailability are felt to be critical.
Sucralfate may interfere with the absorption of prednisone. Although prednisone is not explicitly listed as a drug that interacts with sucralfate, the label warns that sucralfate can alter the absorption of some drugs by binding to them in the gastrointestinal tract. To minimize potential interactions, it is recommended to administer prednisone and sucralfate separately, with prednisone dosed at least 2 hours before sucralfate 1.
From the Research
Interaction between Carafate (Sucralfate) and Prednisone
- The study 2 investigated the effect of sucralfate on the bioavailability of prednisone in 12 healthy male volunteers. The results showed that sucralfate does not have a clinically significant effect on the bioavailability of orally administered prednisone.
- The review 3 discussed the potential for sucralfate to alter the pharmacokinetics of oral drugs by impeding their absorption and reducing their oral bioavailability. However, it did not specifically address the interaction between sucralfate and prednisone.
- Other studies 4, 5, 6 examined the effects of sucralfate on the absorption of other drugs, such as phenytoin, naproxen, and ketoprofen. While these studies found that sucralfate can affect the absorption of certain drugs, they did not investigate the specific interaction between sucralfate and prednisone.
Key Findings
- The study 2 found that the use of sucralfate and prednisone in combination does not result in an interaction requiring dosage regimen alteration.
- The time of peak concentration of prednisolone was slightly delayed when sucralfate was concomitantly administered with prednisone, but this effect was not considered clinically significant 2.
- The review 3 suggested that the impact of co-administering sucralfate with other drugs is manageable in clinical situations, but recommended considering both in vitro and preclinical studies to gauge the level of interaction.