sucralfate
Brand: Carafate
Prototype Drug
Drug Class: cytoprotective agent
Drug Family: GI agent
Subclass: aluminum sucrose octasulfate (mucosal barrier)
Organ Systems: gastrointestinal
Mechanism of Action
Forms viscous gel at pH <4; binds positively charged proteins in ulcer base creating protective barrier against pepsin and bile; stimulates prostaglandins and bicarbonate secretion.
ulcer base — forms protective barrier
Indications
- duodenal ulcer treatment and prevention
- NSAID-induced ulcer
- stress ulcer prophylaxis (ICU)
- esophagitis
Contraindications
- severe renal impairment (aluminum accumulation)
Adverse Effects
Common
- constipation
- dry mouth
- nausea
Serious
- aluminum toxicity (dialysis patients)
- bezoar formation (rare)
Pharmacokinetics (ADME)
| Absorption | 3-5% absorbed systemically |
| Distribution | minimal |
| Metabolism | minimal |
| Excretion | renal (aluminum) |
| Half-life | 6-20 hours |
| Onset | 30-60 min |
| Peak | 30-60 min |
| Duration | 6 hours |
| Protein Binding | minimal |
| Vd | minimal |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| fluoroquinolones/tetracyclines | binds and chelates — take 2 hours apart | major |
| warfarin | may reduce warfarin absorption | moderate |
| digoxin | reduces digoxin absorption — separate by 2h | moderate |
Nursing Considerations
- Give 1 hour before meals and at bedtime on EMPTY STOMACH (acid pH needed for gel formation)
- Separate from other medications by 1-2 hours (chelates many drugs)
- Avoid in dialysis patients (aluminum accumulation — encephalopathy risk)
- Not absorbed systemically — safe in pregnancy
Clinical Pearls
- Mechanism requires acid: must take on empty stomach before meals
- Physical barrier rather than acid suppression — preferred when acid suppression contraindicated
Safety Profile
Pregnancy generally-safe
Lactation generally-safe
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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