Sucralfate Syrup Dosing
For active duodenal ulcers, administer sucralfate suspension 1 gram four times daily on an empty stomach, or alternatively 2 grams twice daily (upon waking and at bedtime) for equivalent efficacy. 1
Standard Dosing Regimens
Active Duodenal Ulcer Treatment
- Primary regimen: 1 gram four times daily, taken on an empty stomach (30 minutes before meals and at bedtime) for 4-8 weeks 1
- Alternative regimen: 2 grams twice daily (upon waking and at bedtime) demonstrates equivalent healing rates of 78-85% at 4-8 weeks 2, 3
- Continue treatment for 4-8 weeks unless endoscopic or radiographic healing is documented earlier 1
- Antacids may be used for pain relief but must be separated by at least 30 minutes before or after sucralfate administration 1
Maintenance Therapy
- Duodenal ulcer prevention: 1 gram twice daily reduces recurrence significantly compared to placebo (42% vs 63% recurrence at 4 months) 1, 4
- This maintenance dosing is FDA-approved for preventing duodenal ulcer recurrence 1
Stress Ulcer Prophylaxis (Critical Care)
- Low-dose regimen: 1 gram every 6 hours via oral or nasogastric route (total daily dose ≤4 grams) 5
- Sucralfate demonstrates superior safety compared to PPIs and H2-blockers, with significantly lower pneumonia risk (RR 0.49 vs PPIs, RR 0.83 vs H2RAs) 5
Special Formulations
Radiation Proctitis (Enema Preparation)
- Mix 2 grams sucralfate suspension with 30-50 mL tap water 6, 7
- Administer twice daily initially, with potential reduction to once daily for maintenance 6
- Patient should roll through 360 degrees to coat entire rectal surface and retain for at least 20 minutes 6
Critical Administration Considerations
Timing and Drug Interactions
- Acid-suppressing medications: Separate sucralfate from PPIs and H2-blockers by at least 2 hours, as sucralfate requires acidic environment for optimal activity 6
- Ketoconazole: Administer ketoconazole at least 2 hours before sucralfate 6
Age-Specific Precautions
- Elderly patients: Start at the low end of dosing range due to potential decreased hepatic, renal, or cardiac function 1
- Neonates: Avoid commercially available liquid preparations containing sorbitol (hyperosmolar preservative); use hospital pharmacy-prepared sorbitol-free formulations instead 6
Formulation Preferences
- Sucralfate suspension is preferred over tablets for patients with swallowing difficulties, as it maintains mucosal coating ability without requiring tablet crushing 7
Important Limitations
- Not recommended for: NSAID-induced gastric ulcers (PPIs are preferred), radiation-induced oral mucositis, or acute radiation-induced diarrhea 6
- Safety profile: Constipation occurs in 2-4% of patients; minimal systemic absorption (3-5%) results in excellent tolerability 8, 9
- Sucralfate remains at gastric ulcer sites for up to 6 hours, providing prolonged local protection 9