Sucralfate is a complex salt of sucrose sulfate and aluminum hydroxide. It is a locally acting, non-systemic cytoprotective agent used primarily for the treatment and prevention of gastroduodenal ulcers. It acts by forming a viscous, adhesive, gel-like protective barrier over ulcerated or eroded mucosa, shielding it from gastric acid, pepsin, and bile salts. It is particularly valued in the Indian context for its efficacy, safety profile, and minimal systemic absorption.
Adult: For active ulcers: 2 gm (one 2gm sachet or tablet) orally twice daily on an empty stomach, 1 hour before meals and at bedtime. For maintenance: 1 gm twice daily.
Note: Take on an empty stomach, at least 1 hour before or 2 hours after meals and other medications. For the 2gm sachet: mix the granules thoroughly in 15-30 mL of water to form a slurry and drink immediately. Do not swallow the granules dry. Tablets should be swallowed whole with a full glass of water. Do not take antacids within 30 minutes before or after sucralfate.
Sucralfate's mechanism is multifaceted and primarily local. In the acidic environment of the stomach, it undergoes polymerization and cross-linking to form a viscous, paste-like substance. This substance selectively adheres to and precipitates on the surface of ulcers and erosions, forming a physical barrier that lasts for several hours. This barrier protects the underlying mucosa from the damaging effects of gastric acid, pepsin, and bile salts.
Pregnancy: Category B: Animal studies show no risk, but no adequate human studies. Use only if clearly needed. Minimal systemic absorption reduces fetal risk.
Driving: Unlikely to affect driving ability. However, if dizziness is experienced as a side effect, caution is advised.
| Ciprofloxacin / Levofloxacin / Tetracycline | Markedly reduced absorption of the antibiotic due to chelation and physical barrier. | Major |
| Phenytoin / Digoxin / Warfarin | Reduced absorption, leading to decreased therapeutic effect. Monitor levels/INR. | Moderate |
| Thyroxine | Decreased thyroxine absorption. Separate administration by at least 4 hours. | Moderate |
| Ketoconazole / Itraconazole | Reduced absorption of the antifungal due to increased gastric pH from barrier. | Moderate |
| Antacids (Aluminum/Magnesium based) | May interfere with sucralfate's activation in acidic medium. Separate by at least 30 minutes. | Moderate |
| Proton Pump Inhibitors (Omeprazole, Pantoprazole) | Theoretical reduction in sucralfate efficacy due to increased gastric pH. Clinical significance debated. | Minor |