What are the instructions for creating a liquid formulation of Carafate (sucralfate) for a patient with difficulty swallowing or underlying medical conditions?

Carafate Tablet to Liquid Conversion Instructions

For patients unable to swallow tablets, Carafate (sucralfate) 1-gram tablets can be crushed and suspended in water for administration, though commercially available liquid preparations should be avoided in neonates due to hyperosmolar preservative content. 1

Preparation Method

Standard Liquid Formulation

• Crush the 1-gram tablet and suspend it in a small amount of water (approximately 15-30 mL) immediately before administration 2, 3
• Administer the suspension 1 hour before meals and at bedtime to allow adequate binding time at the ulcer site 2
• The standard dosing remains 1 gram four times daily regardless of formulation 2, 3

Critical Neonatal Consideration

• Avoid commercially available liquid sucralfate preparations in neonates due to hyperosmolar preservative (sorbitol) content 1
• Hospital pharmacies can prepare sorbitol-free preparations specifically for neonatal use 1

Administration Timing and Drug Interactions

Separation from Other Medications

• Separate sucralfate administration from acid-suppressing medications (PPIs, H2-blockers) by at least 2 hours to avoid reduced efficacy 1
• Sucralfate requires an acidic environment for optimal activity, so concurrent acid suppression diminishes its protective barrier formation 1
• Administer ketoconazole ≥2 hours before sucralfate to ensure adequate absorption of the antifungal 1

Feeding Tube Administration

While the evidence doesn't specifically address nasogastric tube administration of crushed sucralfate tablets, the drug's mechanism of action—forming a viscous, adhesive substance when exposed to gastric acid—suggests it can be administered via gastric feeding tubes 4. However, avoid administration distal to the stomach as sucralfate requires gastric acid exposure to activate its protective properties 4.

Mechanism Supporting Liquid Use

• Sucralfate turns into a viscous and adhesive substance when exposed to gastric acid, binding selectively to ulcerated mucosa 4
• The drug remains at the ulcer site for up to 6 hours after administration 2
• Minimal systemic absorption (3-5%) means the formulation change doesn't significantly affect safety profile 2, 3
• Over 90% is excreted unchanged in feces, making it particularly well-tolerated regardless of formulation 2

Common Pitfalls to Avoid

• Do not prepare suspensions in advance—the crushed tablet should be mixed with water immediately before administration to ensure proper dispersion 2
• Do not administer with antacids or acid suppressants simultaneously, as this negates sucralfate's acid-dependent activation 1
• Constipation occurs in 2-4% of patients and is the most common side effect regardless of formulation 2, 3