Drug reference

Sucralfate

Prokinetic · Antiulcer

Also known as Sucrose Octasulfate Aluminum Complex, Carafate, Ulcerban

START

Confirm duodenal/gastric ulcer (endoscopy or clinical diagnosis). Rule out H. pylori (test-and-treat if positive). Ensure patient can take medication on empty stomach. Assess renal function.

TYPICAL MAX

1 g QID (4 g/day). No additional benefit from higher doses.

STOP IF

Severe constipation unresponsive to laxatives, signs of aluminum toxicity (confusion, bone pain in renal impairment), severe hypersensitivity

WATCH

Constipation, renal function (aluminum accumulation risk), timing of other medications (sucralfate interferes with absorption of many drugs)

CDSCO approvedJan AushadhiATC A02BX02

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 1h · 1 h (mucosal adherence)
PEAK: 1.5h · 1-2 h (ulcer site adherence)
t½: 0s · N/A (local action, no systemic absorption)
DURATION: 6h · 6 h (gastric residence)

EXCRETION

Fecal (unchanged); <5% absorption; aluminum renally excreted

route + CYP

INTERACTIONS

6 major

SEVERE in our sources

PREGNANCY

FDA PLLR: Minimal systemic absorption makes fetal exposure negligible. Generally considered safe in pregnancy. Animal studies showed no teratogenicity.

FDA category + note

Top interactionssee all 12 →

BictegravirSevereDatabaseDDInter
DolutegravirSevereDatabaseDDInter
DoxercalciferolSevereDatabaseDDInter
FluoroquinolonesSevereDatabaseKimi deep-research + Cla · p656

Available in India

217 branded formulations and 548 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Jan Aushadhi — generic available at GoI pharmacies

Mechanism

Sucralfate is a locally-acting gastrointestinal agent with no systemic absorption. In acidic environments (pH <4), it undergoes extensive cross-linking to form a sticky, viscous paste that adheres selectively to ulcerated mucosa (not normal mucosa) via electrostatic binding to positively charged proteins at the ulcer site. This adherent barrier protects the ulcer base from acid, pepsin, and bile salts, creating a favorable environment for healing. Additionally, sucralfate stimulates local production of prostaglandins (PGE2), enhances mucosal blood flow, promotes epithelial cell migration, and binds epidermal growth factor (EGF) at the ulcer site, concentrating this healing-promoting substance.

Indications

Active duodenal ulcer (short-term treatment)Active benign gastric ulcerMaintenance therapy for duodenal ulcer preventionGastroesophageal reflux disease (GERD) — refractory cases (off-label)Prevention of stress-related mucosal damage in critically ill patients (off-label)Oral mucositis (suspension swish-and-swallow) — off-labelRadiation proctitis/proctopathy (enema formulation) — off-labelChemotherapy-induced mucositis — off-label

Dosing

Adult: Active duodenal ulcer: 1 g PO QID (1 hour before meals and at bedtime) x 4-8 weeks. Maintenance: 1 g PO BID. Gastric ulcer: 1 g PO QID. GERD: 1 g PO QID (1 hour before meals and at bedtime).
Pediatric: Limited data. 0.5-1 g PO QID (dosing based on adult regimen scaled by weight).
Renal adjustment: CrCl <30: avoid or use with extreme caution (aluminum accumulation risk). Not dialyzable.
Hepatic adjustment: No adjustment required (minimal systemic absorption).
Geriatric: No specific adjustment. Monitor for constipation and aluminum toxicity if renal impairment present.
Max dose: 4 g/day (1 g QID)

Pharmacokinetics

Onset

Mucosal protective effect within 1 hour of administration.

Peak effect

Peak adherence to ulcer crater within 1-2 hours. Healing occurs over 4-8 weeks.

Duration

Up to 6 hours in the stomach (adherent to ulcer site).

Half-life

N/A (minimal systemic absorption; acts locally in GI tract).

Bioavailability

<5% (essentially no systemic absorption; acts entirely locally).

Protein binding

N/A (local action; minimal protein binding of absorbed fraction).

Metabolism

Not systemically metabolized. In the acidic stomach, it forms aluminum hydroxide and a sulfated sucrose polymer complex.

Excretion

Primarily fecal (unchanged and as aluminum hydroxide). Trace amounts of aluminum absorbed are renally excreted.

Contraindications

Hypersensitivity to sucralfate or any component
Relative: chronic renal failure (risk of aluminum accumulation and toxicity)

Side effects

Common

Constipation (most common — ~2% of patients)Dry mouthNauseaFlatulenceHeadache

Serious

Aluminum toxicity in renal impairment (encephalopathy, osteomalacia, anemia — rare, with prolonged use in patients with CrCl <30)
Bezoar formation (with impaired gastric emptying or in ICU patients receiving enteral nutrition)
Severe hypersensitivity reactions (rare)

Pregnancy & lactation

Pregnancy

FDA PLLR: Minimal systemic absorption makes fetal exposure negligible. Generally considered safe in pregnancy. Animal studies showed no teratogenicity.

Lactation

Minimal absorption means negligible excretion in breast milk. Considered safe during breastfeeding.

Drug interactions

Bictegravir

Severe

Database

Reduced bioavailability of bictegravir.

Should be taken 2 h before or 6 h after cation-containing antacids or laxatives, sucralfate, or oral supplements containing Fe2+ or Ca2+, unless given with food.

Source: DDInter

Dolutegravir

Severe

Database

Reduced bioavailability of dolutegravir.

Should be taken 2 h before or 6 h after cation-containing antacids or laxatives, sucralfate, or oral supplements containing Fe2+ or Ca2+, unless combined with food.

Source: DDInter

Doxercalciferol

Severe

Database

Clinical effect not specified

Source: DDInter

Fluoroquinolones

Severe

Database

Sucralfate contains aluminum which chelates fluoroquinolones in the GI tract, reducing absorption by 85-90% and rendering the antibiotic ineffective.

Separate administration by at least 6 hours. Give fluoroquinolone 2 hours BEFORE or 6 hours AFTER sucralfate. Monitor clinical response to antibiotic.

Source: Kimi deep-research + Cla · p656

Paricalcitol

Severe

Database

Clinical effect not specified

Source: DDInter

Tetracyclines

Severe

Database

Aluminum in sucralfate chelates tetracyclines, reducing absorption by 50-80% and causing treatment failure.

Separate administration by at least 2 hours. Give tetracycline 1 hour before or 2 hours after sucralfate.

Source: Kimi deep-research + Cla · p656