SUCRALFATE

SUCRALFATE
(soo-kral'fate)
Carafate, Sulcrate

Classifications: antiulcer;
Therapeutic: antiulcer
Pregnancy Category: B

Availability

1 g tablets; 1 g/10 mL suspension

Action

A complex of aluminum hydroxide and sulfated sucrose. Following oral administration, sucralfate and gastric acid react to form a viscous, adhesive, paste-like substance that resists further reaction with gastric acid. This "paste" adheres to the GI mucosa with a major portion binding electrostatically to the positively charged protein molecules in the damaged mucosa of an ulcer crater or an acute gastric erosion caused by alcohol or other drugs.

Therapeutic Effect

Absorbs bile, inhibits the enzyme pepsin, and blocks back diffusion of H⁺ ions. These actions plus adherence of the paste-like complex protect damaged mucosa against further destruction from ulcerogenic secretions and drugs.

Uses

Short-term (up to 8 wk) treatment of duodenal ulcer.

Unlabeled Uses

Short-term treatment of gastric ulcer, aspirin-induced erosions, suspension for chemotherapy-induced mucositis.

Contraindications

Pregnancy (category B). Safety and efficacy in children are not established.

Cautious Use

Chronic kidney failure or dialysis due to aluminum accumulation; renal impairment.

Route & Dosage

Duodenal Ulcer
Adult: PO 1 g q.i.d. 1 h a.c. and h.s. PO Maintenance 1 g b.i.d.

Administration

Oral

Use drug solubilized in an appropriate diluent by a pharmacist when given through nasogastric tube.
Administer antacids prescribed for pain relief 30 min before or after sucralfate.
Separate administration of QUINOLONES, digoxin, phenytoin, tetracycline from that of sucralfate by 2 h to prevent sucralfate from binding to these compounds in the intestinal tract and reducing their bioavailability.
Store in tight container at room temperature, 15°–30° C (59°–86° F). Stable for 2 y after manufacture.

Adverse Effects (≥1%)

GI: Nausea, gastric discomfort, constipation, diarrhea.

Interactions

Drug: May decrease absorption of quinolones (e.g., ciprofloxacin, norfloxacin), digoxin, phenytoin, tetracycline.

Pharmacokinetics

Absorption: Minimally absorbed from GI tract (<5%). Duration: Up to 6 h (depends on contact time with ulcer crater). Elimination: 90% in feces.

Nursing Implications

Assessment & Drug Effects

Be aware of drug interactions and schedule other medications accordingly.

Patient & Family Education

Although healing has occurred within the first 2 wk of therapy, treatment is usually continued 4–8 wk.
Be aware that constipation is a drug-related problem. Follow these measures unless contraindicated: Increase water intake to 8–10 glasses per day; increase physical exercise, increase dietary bulk. Consult physician: a suppository or bulk laxative (e.g., Metamucil) may be prescribed.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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