Can Kremil S (Sucralfate) Cause Low Blood Pressure?
No, sucralfate does not cause hypotension—it is one of the safest antiulcer medications with minimal systemic effects because less than 5% is absorbed from the gastrointestinal tract. 1, 2
Safety Profile of Sucralfate
Sucralfate has an excellent safety record with virtually no cardiovascular effects:
Minimal systemic absorption: Only 3-5% of an oral dose is absorbed, with over 90% excreted unchanged in feces, which explains the absence of systemic side effects including hypotension 2
No reported hypotensive effects: In clinical trials involving over 2,000 patients, hypotension was not identified as an adverse effect 1
Most common side effects are local: The primary adverse effects are constipation (3-4% of patients), dry mouth (1%), and skin eruptions (0.6%)—none of which are cardiovascular in nature 1, 2
Mechanism Explains Safety
The drug works locally at the ulcer site rather than systemically:
Sucralfate binds to proteinaceous material at ulcer sites, forming a protective barrier without affecting gastric pH or causing systemic effects 2
It remains at gastric ulcer sites for up to 6 hours, exerting purely local effects 2
Clinical Context
Important caveat: If a patient taking sucralfate experiences hypotension, look for other causes:
Concurrent medications that actually do cause hypotension (beta-blockers, calcium channel blockers, diuretics, ACE inhibitors) 3
Underlying conditions such as gastrointestinal bleeding (which sucralfate is used to prevent), sepsis, or hypovolemia 4
Polypharmacy effects, particularly in elderly patients taking multiple cardiovascular medications 3
Special Population Consideration
The only significant concern with sucralfate is aluminum accumulation in renal failure patients with prolonged use, but this does not manifest as hypotension 5