Sucralfate is a complex salt of sucrose sulfate and aluminum hydroxide. It is a locally acting, non-systemic gastroprotective agent used primarily for the treatment and prevention of duodenal and gastric ulcers. In the Indian context, it is a widely prescribed, cost-effective cytoprotective agent, particularly useful in NSAID-induced gastropathy and stress ulcer prophylaxis in hospitalized patients. Its action is purely topical within the gastrointestinal tract.
Adult: Active Ulcers: 1 g (10 ml of 500mg/5ml suspension) four times daily, 1 hour before meals and at bedtime, for 4-8 weeks. Maintenance/Prophylaxis: 1 g twice daily.
Note: SHAKE WELL BEFORE USE. Take on an empty stomach, at least 1 hour before meals and at bedtime. If using antacids, H2 blockers (e.g., Ranitidine), or Proton Pump Inhibitors (e.g., Omeprazole), administer at least 30 minutes to 2 hours apart from sucralfate to avoid interference with its activation and binding.
Sucralfate exerts its therapeutic effect through multiple local, non-systemic mechanisms. In the acidic environment of the stomach, it undergoes polymerization and cross-linking to form a viscous, adhesive paste. This paste selectively binds to proteins at the base of ulcers and erosions (e.g., albumin, fibrinogen), creating a durable, protective barrier that lasts for several hours. This barrier shields the damaged mucosa from further injury by pepsin, bile acids, and other aggressive factors. It also directly inhibits pepsin activity and adsorbs bile salts.
Pregnancy: Pregnancy Category B (US FDA). Animal studies show no risk, but human data is limited. Use only if clearly needed. It is not systemically absorbed, making it a preferred option for ulcer treatment in pregnancy over systemic agents.
Driving: Unlikely to affect driving ability. Dizziness has been reported rarely.
| Ciprofloxacin / Levofloxacin / Tetracycline | Markedly reduced absorption of the antibiotic due to chelation. Therapeutic failure can occur. | Major |
| Phenytoin / Digoxin / Warfarin | Reduced absorption of these drugs, potentially decreasing their efficacy. | Moderate |
| Thyroxine (Levothyroxine) | Decreased thyroxine absorption. Separate administration by at least 4 hours. | Moderate |
| Ketoconazole / Itraconazole | Reduced absorption of the antifungal agent. | Moderate |
| Antacids (Aluminum/Magnesium based) | May interfere with the acid-mediated activation and binding of sucralfate. | Moderate |
Same composition (Sucralfate (500mg/5ml)), different brands: