Sucralfate Dosage for Duodenal Ulcers
The recommended dosage of sucralfate for treating duodenal ulcers is 1 gram four times per day on an empty stomach, taken for 4-8 weeks unless healing has been demonstrated by x-ray or endoscopic examination. 1
Standard Dosing Regimen
- For active duodenal ulcer treatment, sucralfate should be administered as 1 g four times daily, taken on an empty stomach (typically 1 hour before meals and at bedtime) 1, 2
- Treatment duration should be 4-8 weeks, continuing until healing has been confirmed through endoscopy or x-ray examination 1
- For maintenance therapy after healing, the recommended dosage is 1 g twice daily 1
Alternative Dosing Options
- Studies have shown that a more convenient regimen of 2 g twice daily (upon waking and at bedtime) is equally effective as the standard 1 g four times daily regimen 3, 4
- Healing rates at 4 weeks were comparable between the two regimens: 78-79% for 2 g twice daily versus 72-74% for 1 g four times daily 3, 4
- Cumulative healing rates at 8 weeks were also similar: 83-85% for 2 g twice daily versus 80-84% for 1 g four times daily 3, 4
Administration Considerations
- Antacids may be prescribed for pain relief but should not be taken within 30 minutes before or after sucralfate 1
- Sucralfate should be administered at least 2 hours apart from drugs that decrease gastric acidity (such as PPIs or H2-blockers) to avoid interaction 5
- For 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
Clinical Efficacy
- Sucralfate is effective for duodenal ulcers with healing rates significantly better than placebo 6
- At 8 weeks, healing rates of 76% have been observed with sucralfate suspension compared to 53% with placebo 6
- Sucralfate works by protecting the ulcer from pepsin, acid, and possibly bile salts, with minimal systemic absorption 7
Special Considerations
- For H. pylori-associated ulcers, eradication therapy should be used in addition to sucralfate 5
- Sucralfate is not effective for NSAID-related gastric ulcers; proton pump inhibitors (PPIs) are preferred for this indication 5, 8
- The most common side effect is constipation, occurring in approximately 2-4% of patients 7, 2