Recommended Dosage and Treatment Duration for Carafate (Sucralfate) in Treating Stomach and Duodenal Ulcers
For active duodenal ulcers, the recommended dosage of Carafate (sucralfate) is 1 g four times per day on an empty stomach for 4-8 weeks. For maintenance therapy after healing, the recommended dosage is 1 g twice daily. 1
Dosage Recommendations
Active Duodenal Ulcer Treatment
- 1 g four times per day on an empty stomach (one-half hour before meals and at bedtime) for 4-8 weeks 1
- Treatment should continue for 4-8 weeks unless healing has been demonstrated by x-ray or endoscopic examination 1
- While healing may occur during the first 1-2 weeks, full treatment course is recommended to ensure complete healing 1, 2
Maintenance Therapy After Healing
- 1 g twice daily (typically in the morning and at bedtime) 1
- This reduced dosage is effective for preventing ulcer recurrence 1, 3
Alternative Dosing Schedule
- Some studies suggest 2 g twice daily (on waking and at bedtime) may be equally effective as 1 g four times daily for duodenal ulcer healing 4
- This more convenient dosing schedule showed comparable healing rates (85% vs 80% after 8 weeks) 4
Treatment Duration
Initial Treatment
- Short-term treatment up to 8 weeks is indicated for active duodenal ulcers 1
- Endoscopic studies show healing rates of 76% after 8 weeks of treatment with sucralfate suspension compared to 53% with placebo 5
- Healing rates at 4 weeks are approximately 51% with sucralfate versus 34% with placebo 5
Maintenance Therapy
- Long-term maintenance therapy at reduced dosage (1 g twice daily) is indicated after healing of acute ulcers 1, 3
- Maintenance therapy has shown relapse rates of approximately 9.4% at 6 months and 31.3% at 12 months 3
Administration Guidelines
- Take on an empty stomach, one-half hour before meals and at bedtime 1, 2
- Antacids may be prescribed as needed for pain relief but should not be taken within 30 minutes before or after sucralfate 1
- Sucralfate works locally at the ulcer site by:
Special Considerations
- For elderly patients, dose selection should be cautious, usually starting at the lower end of the dosing range 1
- Minimal systemic absorption (3-5%) makes it well-tolerated with few side effects 2, 6
- Most common side effect is constipation (2-4% of patients) 2, 6
- Sucralfate is not the first-line therapy for peptic ulcer disease when compared to proton pump inhibitors (PPIs) 7
- For H. pylori-associated ulcers, eradication therapy should be added to the treatment regimen 7
Comparative Efficacy
- Sucralfate has been shown to be more effective than placebo for duodenal ulcer healing 5
- Healing rates are comparable to ranitidine (H2-receptor antagonist) with 97.6% vs 95.2% healing after 8 weeks 3
- Modern guidelines generally recommend PPIs over sucralfate as first-line therapy for peptic ulcer disease 7