Carafate (Sucralfate) Administration Timing
Carafate should be taken on an empty stomach, specifically 1 hour before meals and at bedtime, not after meals. 1
Standard Dosing Schedule
The FDA-approved dosing regimen for active duodenal ulcer is:
- 1 gram four times daily on an empty stomach 1
- Timing: 1 hour before each meal (breakfast, lunch, dinner) and at bedtime 1, 2
- This timing is critical because sucralfate must reach the ulcer site before food arrives to form its protective barrier 2
Why Timing Matters
Sucralfate works by binding to proteinaceous material at the ulcer site and forming a protective barrier that remains in place for up to 6 hours 2. Taking it before meals ensures:
- The medication reaches the ulcer site first and can bind effectively 2
- Food doesn't interfere with the drug's ability to adhere to the ulcer crater 2
- Maximum protective coverage during and after the meal when acid secretion increases 3
Alternative Dosing Regimens
For patients who have difficulty with four-times-daily dosing:
- 2 grams twice daily (on waking and at bedtime) has been shown equally effective in clinical trials 4, 5
- This regimen showed healing rates of 78-79% at 4 weeks and 83-85% at 8 weeks, comparable to the standard four-times-daily regimen 4, 5
Critical Timing Considerations
Antacid separation: If antacids are needed for pain relief, they should not be taken within 30 minutes before or after sucralfate 1
Drug interactions: Sucralfate should be administered at least 2 hours apart from medications that decrease gastric acidity (PPIs, H2-blockers) 6
Common Pitfall to Avoid
The most important error to avoid is taking sucralfate with or after meals, as this significantly reduces its effectiveness by preventing proper binding to the ulcer site 2. One early clinical trial showed poorer results specifically because sucralfate was given 2 hours after meals rather than 1 hour before meals 1.