Carafate
Generic Name
sucralfate
Manufacturer
Various (e.g., Sanofi, Abbott, local manufacturers)
Country
Global
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Description
Overview of the medicine
Sucralfate is a medication used to treat and prevent ulcers in the stomach and intestines. It works by forming a protective barrier over the ulcer, allowing it to heal.
Uses & Indications
Dosage
Adults
Active Duodenal Ulcer: 1 gram (1000 mg) orally four times a day (QID) on an empty stomach, 1 hour before meals and at bedtime, for 4-8 weeks. Maintenance: 1 gram twice a day (BID).
Elderly
No specific dosage adjustment is generally required for elderly patients, but use with caution in those with renal impairment.
Renal_impairment
Use with caution in patients with chronic renal failure or those undergoing dialysis due to the risk of aluminum accumulation (sucralfate contains aluminum).
How to Take
Take sucralfate on an empty stomach, usually 1 hour before meals and at bedtime. If taking other medications, take them at least 30 minutes before or 2 hours after sucralfate to avoid interactions.
Mechanism of Action
Sucralfate binds to proteins in the ulcer bed, forming a viscous, adhesive gel that acts as a protective barrier against acid, pepsin, and bile salts, promoting healing.
Pharmacokinetics
Onset
Local action begins within 30 minutes to 1 hour.
Excretion
The small absorbed amount is primarily excreted in the urine. The unabsorbed drug is excreted in the feces.
Half life
Systemic half-life is 6-20 hours (for the small absorbed portion), but local effect is prolonged.
Absorption
Minimally absorbed systemically (less than 5% of oral dose).
Metabolism
Not significantly metabolized.
Side Effects
Contraindications
- Hypersensitivity to sucralfate or any component of the formulation.
Drug Interactions
Tetracyclines
Reduced absorption. Administer at least 2 hours before or 4-6 hours after sucralfate.
Antacids, H2 blockers, PPIs
May reduce sucralfate's effectiveness by altering gastric pH; administer sucralfate 30 minutes before or 2 hours after these agents.
Phenytoin, Digoxin, Warfarin
Reduced absorption of these drugs. Administer at least 2 hours before or after sucralfate.
Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin)
Sucralfate can bind to these antibiotics, reducing their absorption. Administer fluoroquinolones at least 2 hours before or 4-6 hours after sucralfate.
Storage
Store at room temperature (below 30°C), away from moisture and direct light. Keep out of reach of children.
Overdose
Overdose is rare due to minimal systemic absorption. Symptoms are usually mild and may include indigestion, nausea, and vomiting. Treatment is symptomatic and supportive.
Pregnancy & Lactation
Pregnancy Category B. Animal studies have shown no evidence of harm to the fetus. It is generally considered safe but should be used only if clearly needed. It is unknown if sucralfate is excreted in human milk; use with caution during lactation.
Side Effects
Contraindications
- Hypersensitivity to sucralfate or any component of the formulation.
Drug Interactions
Tetracyclines
Reduced absorption. Administer at least 2 hours before or 4-6 hours after sucralfate.
Antacids, H2 blockers, PPIs
May reduce sucralfate's effectiveness by altering gastric pH; administer sucralfate 30 minutes before or 2 hours after these agents.
Phenytoin, Digoxin, Warfarin
Reduced absorption of these drugs. Administer at least 2 hours before or after sucralfate.
Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin)
Sucralfate can bind to these antibiotics, reducing their absorption. Administer fluoroquinolones at least 2 hours before or 4-6 hours after sucralfate.
Storage
Store at room temperature (below 30°C), away from moisture and direct light. Keep out of reach of children.
Overdose
Overdose is rare due to minimal systemic absorption. Symptoms are usually mild and may include indigestion, nausea, and vomiting. Treatment is symptomatic and supportive.
Pregnancy & Lactation
Pregnancy Category B. Animal studies have shown no evidence of harm to the fetus. It is generally considered safe but should be used only if clearly needed. It is unknown if sucralfate is excreted in human milk; use with caution during lactation.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2 to 3 years from manufacturing date, depending on the formulation and manufacturer.
Availability
Available in pharmacies and hospitals
Approval Status
FDA Approved
Patent Status
Off-patent
Clinical Trials
Numerous clinical trials have established sucralfate's efficacy in treating and preventing peptic ulcers, demonstrating significant healing rates comparable to H2 receptor antagonists.
Lab Monitoring
- Not routinely required.
- Monitor serum phosphate levels with prolonged use in patients at risk of hypophosphatemia.
Doctor Notes
- Advise patients to take sucralfate separately from other medications, especially antibiotics, phenytoin, digoxin, and warfarin.
- Remind patients about the importance of taking it on an empty stomach for optimal efficacy.
- Monitor renal function in patients on long-term therapy or with pre-existing renal impairment due to aluminum content.
Patient Guidelines
- Take sucralfate on an empty stomach, 1 hour before meals and at bedtime.
- Do not take antacids within 30 minutes of taking sucralfate.
- Shake the suspension well before use.
- Complete the full course of treatment as prescribed, even if symptoms improve.
Missed Dose Advice
If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not double the dose.
Driving Precautions
Sucralfate is generally not expected to impair the ability to drive or operate machinery. However, if you experience dizziness or drowsiness, avoid these activities.
Lifestyle Advice
- Avoid foods and drinks that irritate your stomach (e.g., spicy foods, caffeine, alcohol).
- Quit smoking, as it can delay ulcer healing.
- Manage stress effectively.
- Elevate the head of your bed if experiencing nighttime reflux symptoms.
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