Sucralfate for Alcohol-Induced Vomiting
No, sucralfate is not an appropriate treatment for vomiting induced by alcohol consumption. Sucralfate has no established role in managing acute alcohol intoxication or its associated symptoms, including nausea and vomiting.
Why Sucralfate Is Not Indicated
Mechanism mismatch: Sucralfate works by forming a protective barrier over ulcerated gastric tissue and binding to damaged mucosa, protecting it from acid and pepsin 1. This mechanism does not address the pathophysiology of alcohol-induced vomiting, which results from direct gastric irritation, central nervous system effects, and metabolic disturbances 2.
No guideline support: Current guidelines recommend sucralfate only for peptic ulcer disease, stress ulcer prophylaxis (as a second-line agent), and radiation proctitis 3, 4, 5. There are no guideline recommendations supporting its use for acute alcohol-related gastrointestinal symptoms.
Wrong clinical context: While animal studies show sucralfate can prevent ethanol-induced gastric mucosal damage when given prophylactically 6, 7, this does not translate to treating active vomiting in patients who have already consumed alcohol. The protective effect requires pretreatment, not post-exposure intervention 7.
Appropriate Management of Alcohol-Induced Vomiting
Supportive care remains the cornerstone: Management focuses on stabilizing the patient's clinical condition, addressing dehydration, electrolyte abnormalities, and monitoring for complications of acute alcohol intoxication 2.
Specific pharmacotherapy: Metadoxine is the only drug with evidence for accelerating ethanol excretion in acute alcohol intoxication 2, though it does not specifically target vomiting.
Antiemetics when needed: Standard antiemetic therapy (ondansetron, metoclopramide) would be more appropriate for symptomatic relief of vomiting than sucralfate, based on general medical practice.
Critical Pitfall to Avoid
Do not confuse sucralfate's protective effects against alcohol-induced gastric mucosal injury in experimental settings 6, 7 with clinical utility for treating active symptoms of alcohol intoxication. The evidence shows prophylactic protection in controlled animal studies, not therapeutic benefit for established vomiting in humans 1, 8.