From the Guidelines
Definition and Use of Sucralfate
Sucralfate is a prescription medication that belongs to the class of cytoprotective agents. It is typically administered orally in a dose of 1 gram, one to four times daily, for the treatment and prevention of gastrointestinal disorders such as duodenal ulcers and gastroesophageal reflux disease 1.
Key Characteristics
- The usual duration of treatment with sucralfate ranges from 4 to 8 weeks, although it may be extended for up to 12 weeks in some cases.
- Sucralfate has been used for stress bleeding prophylaxis, as it does not decrease intragastric acidity or significantly increase gastric volume 1.
- It is a non-systemically absorbed aluminum hydroxide complex, which has been investigated for preventing diarrhea in patients receiving pelvic RT 1.
Clinical Guidelines and Evidence
- Several clinical trials have focused on the prevention of diarrhea in patients receiving pelvic RT, with sucralfate being the most widely investigated agent 1.
- However, some studies have yielded mixed results, and sucralfate is not recommended to reduce related side effects of radiotherapy due to its association with more gastrointestinal side effects, including rectal bleeding 1.
- The evidence suggests that sucralfate may not be effective in preventing acute diarrhea in patients with pelvic malignancies undergoing external beam radiotherapy 1.
Important Considerations
- The use of sucralfate should be weighed against its potential benefits and risks, particularly in patients with certain gastrointestinal conditions or those undergoing radiotherapy.
- Alternative treatments, such as sulfasalazine or amifostine, may be considered for preventing radiation-induced enteropathy or proctitis 1.
From the FDA Drug Label
Sucralfate, USP is an α-D-glucopyranoside, β-D-fructofuranosyl-, octakis(hydrogen sulfate), aluminum complex. Sucralfate is only minimally absorbed from the gastrointestinal tract. Sucralfate is an antiulcer medication that works through a local action, forming an ulcer-adherent complex that protects the ulcer site against further attack by acid, pepsin, and bile salts 2.
- It is an aluminum complex of a sulfated disaccharide
- Key words: antiulcer, sucralfate, aluminum complex, sulfated disaccharide 2
From the Research
Definition and Mechanism of Action
- Sucralfate is a unique drug for peptic-ulcer disease that exerts its antiulcer effect by binding with proteinacious material, neutralizing local acidity without affecting gastric pH, and forming a protective barrier at the ulcer site 3.
- It also inhibits the diffusion of hydrogen ion, inhibits the action of pepsin, and adsorbs bile salts 3.
Pharmacokinetics and Dosage
- Approximately 3-5% of an orally administered dose of sucralfate is absorbed; more than 90% of the dose is excreted unchanged in the feces 3.
- The recommended dose of sucralfate is 1 g four times a day one hour before meals and at bedtime 3.
- Alternative dosing regimens, such as 2 g twice daily, have been shown to be as effective as the standard dosing regimen in healing gastric ulcers 4 and duodenal ulcers 5.
Efficacy and Safety
- Sucralfate is more effective than placebo and comparable with cimetidine and intensive antacid therapy in the treatment of duodenal ulcers 3.
- Healing rates for gastric ulcers are less impressive but are comparable with those produced by cimetidine and antacids 3.
- Sucralfate has few side effects because it is not absorbed; most frequently reported are constipation, xerostomia, and skin eruptions 3.
- Sucralfate does not alter the extent of ibuprofen absorption and would not be expected to change the response to that anti-inflammatory agent 6.
- Sucralfate treatment has been shown to relieve gastrointestinal symptoms and mucosal damage associated with nonsteroidal anti-inflammatory drugs (NSAIDs) 7.