Indications for Sucralfate
Sucralfate is primarily indicated for short-term treatment (up to 8 weeks) of active duodenal ulcer and maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers. 1
Primary Indications
- Sucralfate is FDA-approved for the short-term treatment (up to 8 weeks) of active duodenal ulcers, with treatment typically continued for 4-8 weeks unless healing has been demonstrated by x-ray or endoscopic examination 1
- Maintenance therapy for duodenal ulcer patients at reduced dosage after healing of acute ulcers to prevent recurrence 1, 2
- Treatment of gastric ulcers, with healing rates comparable to cimetidine and antacids, though slightly lower than for duodenal ulcers 3, 2
Secondary Indications
- Second-line agent for stress ulcer prophylaxis in critically ill patients, particularly when H2-blockers or PPIs cannot be used 4, 5
- Treatment of NSAID-induced gastrointestinal symptoms and mucosal damage, helping to relieve symptoms and reduce gastric mucosal lesions 6
- Sucralfate enemas can be used for radiation proctitis with heavy bleeding as a temporary or long-term treatment for patients unsuitable for disease-modifying therapy 4, 7
Mechanism of Action
- Sucralfate acts primarily at the ulcer site by forming a protective barrier against pepsin, acid, and bile salts 3, 8
- It binds with proteinaceous material, neutralizes local acidity without affecting gastric pH, and inhibits the diffusion of hydrogen ions 8
- For radiation proctitis, sucralfate enemas stimulate epithelial healing and form a protective barrier 7
Dosage Recommendations
- Standard dosage for duodenal ulcer treatment: 1g four times daily, one hour before meals and at bedtime 8
- Maintenance therapy for duodenal ulcer: 1g twice daily 2
- For radiation proctitis: 2g sucralfate suspension mixed with 30-50mL water administered rectally as an enema, twice daily initially, then once daily for maintenance 4
Clinical Considerations
- Sucralfate has minimal systemic absorption (only 3-5%), making it well-tolerated with few side effects 3, 8
- Most common side effect is constipation (2-4% of patients) 3, 8
- When used for stress ulcer prophylaxis, sucralfate may be associated with lower risk of nosocomial pneumonia compared to H2-blockers or PPIs that increase gastric pH 4, 7
- Administer at least 2 hours apart from drugs that decrease gastric acidity to avoid interaction 7
- For patients with radiation-induced rectal bleeding, sucralfate enemas should be retained for as long as possible (or 20 minutes) and patients should roll through 360 degrees to coat the entire rectal surface 4
Comparative Efficacy
- For duodenal ulcers, healing rates with sucralfate are comparable to cimetidine and intensive antacid therapy 3, 2
- For stress ulcer prophylaxis, H2-blockers and PPIs are considered first-line agents, with sucralfate as a second-line option 4, 5
- Duodenal ulcer relapse rates after sucralfate healing may be lower than after cimetidine healing 2