Can Sucralfate be crushed?

Can Sucralfate Be Crushed?

Sucralfate tablets should generally not be crushed because crushing destroys the medication's mechanism of action, which depends on forming a protective barrier at ulcer sites—a property that requires the intact formulation to bind selectively to damaged mucosa. 1, 2, 3

Why Crushing Compromises Efficacy

Mechanism-Based Concerns

• Sucralfate works by forming a viscous, adhesive substance when exposed to gastric acid that binds selectively and durably to ulcerated gastric and duodenal mucosa through electrostatic binding between negatively charged sucralfate polyanions and positively charged proteins exuding from lesions. 3

• The drug creates a protective barrier against acid, pepsin, and bile salts at the ulcer site, remaining there for up to 6 hours—this barrier formation requires the intact formulation. 1, 2

• Crushing the tablet disrupts this selective binding capacity and may alter the drug's ability to adhere preferentially to damaged tissue rather than normal mucosa. 3

General Risks of Tablet Crushing

• Crushing tablets can result in fatal overdose or underdosing that renders treatment ineffective, particularly when it disrupts sustained-release properties or destroys gastro-resistant layers. 4

• Healthcare workers who crush tablets are exposed to drug particles that may be carcinogenic, teratogenic, fetotoxic, or allergenic. 4

Alternative Formulations

Suspension Form

• Sucralfate is available as a suspension, which is the preferred formulation for patients with swallowing difficulties. 5

• The suspension form maintains the drug's ability to coat and protect mucosal lesions without requiring tablet crushing. 1

Special Applications

• For radiation proctitis, sucralfate suspension (2g mixed with 30-50 mL water) can be administered as an enema twice daily, demonstrating that the suspension form is therapeutically effective. 5, 6

Clinical Recommendations

For Patients with Dysphagia

• Request the suspension formulation rather than crushing tablets—this maintains therapeutic efficacy while addressing swallowing difficulties. 7

• A coordinated care team approach involving physicians, pharmacists, nurses, and speech therapists is necessary to develop individualized medication administration plans for patients with dysphagia. 7

Important Caveat

• Before crushing any medication, research the specific impact on the drug's effects, as many drugs should never be crushed or opened. 4

• Consider using a different dosage form or different active ingredient rather than crushing tablets when patients cannot swallow. 4