Sucralfate

About Sucralfate

Sucralfate forms a coating that sticks to an ulcer and shields it from further attack by acid, pepsin and bile salts while it heals; it is only minimally absorbed from the gut. Both forms are labeled for short-term treatment, up to eight weeks, of an active duodenal ulcer, the kind in the first part of the small intestine. The adult dose is 1 g four times a day on an empty stomach, as one tablet or 10 mL of suspension. Healing may come within the first week or two, but treatment continues for four to eight weeks unless an x-ray or endoscopy shows the ulcer has healed. Only the tablet is also labeled for maintenance after healing, at 1 g twice a day, because duodenal ulcer is a chronic disease that tends to return. Safety and effectiveness in children have not been established.

There is no boxed warning, and the only contraindication is an allergy to sucralfate or another ingredient. Constipation is the most common side effect; diarrhea, nausea, vomiting, dizziness, headache, rash and itching are less common, and allergic reactions with hives, lip swelling or trouble breathing have been reported. People with chronic kidney failure or on dialysis clear absorbed aluminum poorly, and aluminum buildup and toxicity, including bone disease and encephalopathy (a brain disorder), have been described with kidney impairment, so the labels advise caution in chronic kidney failure. Tablets have been inhaled into the airway, so the tablet labels urge care for anyone with trouble swallowing, a past aspiration, a weakened gag or cough reflex, a tracheostomy, or recent or prolonged intubation. Bezoars, masses that form in the stomach, have been reported, mostly in people whose stomach empties slowly or who receive tube feeding.

The suspension has notes of its own. It is for use by mouth only: giving it into a vein by mistake has caused fatal emboli in the lungs and brain. Episodes of high blood sugar have been reported in people with diabetes, so its label recommends close monitoring of blood sugar and says diabetes medicine may need adjusting; the Carafate tablet label does not carry this statement. Equivalence of the suspension to the tablets has not been shown. The label lists lower absorption of cimetidine, digoxin, fluoroquinolone antibiotics such as ciprofloxacin, ketoconazole, levothyroxine, phenytoin, quinidine, ranitidine, tetracycline and theophylline when taken at the same time; in the cases studied, giving the other medicine two hours before sucralfate removed the interaction. Antacids can be used for pain, but not within half an hour before or after a dose.

Taking Sucralfate

How to take it

On an empty stomach, one hour before or two hours after meals, usually four times a day for an active ulcer or twice a day for maintenance, at about the same times each day. Shake the suspension well before each dose. Take it regularly for as long as prescribed; an ulcer can take up to eight weeks to heal.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose and carry on as usual. Do not take a double dose.

Storage

In the original container, tightly closed, at room temperature, away from excess heat and moisture, out of reach of children; do not freeze the suspension. Do not flush unused medicine; use a take-back program.

Interactions to know about

Ask the pharmacist how to space your other medicines; in the cases the label describes, taking the other medicine two hours before sucralfate avoided the interaction. Keep antacids at least half an hour away from a dose. Tell the prescriber if you take warfarin, which reports suggest it may weaken, although two studies found no change.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Sucralfate differs from pharmacy to pharmacy

Generic sucralfate tablets have several makers, so quotes differ mainly by the pharmacy’s fee and markup, but the ulcer dose is four tablets a day, so a month’s supply is a large bottle and the quote depends on how each pharmacy prices volume. The suspension has fewer generic makers and is priced by the bottle, so it is quoted on its own terms. Because the suspension has not been shown to be equivalent to the tablets, a pharmacy fills the form that is prescribed, and a prescription that names Carafate tablets and does not allow substitution is quoted at the brand price.

Ways to pay less for Sucralfate without insurance

• Ask for generic substitution, whether you take the tablets or the suspension.
• If you can swallow tablets safely, ask the prescriber whether tablets would suit you, since they have more generic makers than the suspension.
• For maintenance at 1 g twice a day, ask for a ninety-day supply once the plan is settled.
• Compare more than one pharmacy, and ask whether sucralfate is on its flat-price generic list.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Sucralfate

1. 1.How should I space my other medicines, such as my thyroid pill or an antibiotic, around my sucralfate doses?
2. 2.Can I take my antacid, and how far apart from sucralfate?
3. 3.Is it safe with my kidney disease or dialysis?
4. 4.Should I check my blood sugar more often while I take the liquid?

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