Management of Sucralfate Overdose
Sucralfate overdose requires minimal intervention as the drug is only minimally absorbed from the gastrointestinal tract, and acute toxicity is extremely low with no specific treatment needed beyond supportive care. 1
Immediate Assessment and Risk Stratification
- No lethal dose has been identified in animal studies even at doses up to 12 g/kg body weight, indicating extremely low acute toxicity. 1
- Most patients who overdose on sucralfate remain completely asymptomatic. 1
- When symptoms do occur, they are limited to mild gastrointestinal complaints including dyspepsia, abdominal pain, nausea, and vomiting. 1
Management Approach
Supportive Care Only
- No specific treatment recommendations exist due to the minimal systemic absorption of sucralfate (only 3-5% of an oral dose is absorbed). 1, 2, 3
- More than 90% of the drug is excreted unchanged in the feces, further limiting systemic toxicity risk. 3
- Risks associated with acute overdosage are minimal given the pharmacokinetic profile. 1
Symptomatic Management
- If gastrointestinal symptoms develop (dyspepsia, abdominal pain, nausea, vomiting), provide symptomatic relief as needed. 1
- Monitor for constipation, which is the most common side effect even at therapeutic doses (occurring in 2-4% of patients). 2, 3, 4
Key Clinical Pitfalls to Avoid
- Do not attempt gastric decontamination (activated charcoal, gastric lavage) as the drug is poorly absorbed and poses minimal systemic risk. 1
- Do not confuse sucralfate overdose management with aluminum toxicity concerns—the aluminum content is bound to the sucrose sulfate complex and minimally absorbed. 2, 3
- Avoid unnecessary laboratory testing or prolonged observation for asymptomatic patients, as clinical experience demonstrates benign outcomes. 1