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(sue-KRAL-fate)
Carafate
Suspension: 1 g/10 mL
Tablets: 1 g
Sulcrate
Tablets: 1 g
Class: Gastrointestinal

 Actions Adheres to ulcer in acidic gastric juice, forming protective layer that serves as barrier against acid, bile salts, and enzymes present in stomach and duodenum.

 Indications Short-term treatment of duodenal ulcer; maintenance therapy of duodenal ulcer.

Treatment of gastric ulcers; reflux and peptic esophagitis; treatment of NSAID- or aspirin-induced GI symptoms and mucosal damage; prevention of stress ulcers and GI bleeding in critically ill patients; treatment of oral and esophageal ulcers caused by radiation, chemotherapy, and sclerotherapy; treatment of oral ulcerations and dysphagia in patients with epidermolysis bullosa.

 Contraindications Standard considerations.

 Route/Dosage

Active Duodenal Ulcer: ADULTS: PO 1 g qid on empty stomach (1 hr before meals and at bedtime) for 4 to 8 wk. Maintenance (tablets only): 1 g bid.

 Interactions

Aluminum-containing antacids: May increase total body burden of aluminum. Cimetidine, ciprofloxacin (and other quinolone antibiotics), diclofenac, digoxin, hydantoins (eg, phenytoin), ketoconazole, pencillamine, ranitidine, tetracycline, theophylline: Oral absorption and pharmacologic action of these agents may be reduced if given with sucralfate. Administer 2 hr apart from sucralfate.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Dizziness; insomnia; vertigo; headache. DERMATOLOGIC: Rash; pruritus. GI: Constipation; diarrhea; nausea; vomiting; dry mouth; indigestion; flatulence. OTHER: Back pain.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established. Chronic renal failure/dialysis: Small amounts of aluminum may be absorbed from sucralfate, and concomitant use of other aluminum-containing products may increase total body burden of aluminum. Aluminum is not removed by dialysis and excretion through kidneys is impaired in patients with chronic renal failure. Aluminum accumulation and toxicity (eg, aluminum osteodystrophy, osteomalacia, encephalopathy) have occurred.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Administer with glass of water, on empty stomach, at least 1 hr before meals and at bedtime (maintenance therapy may be bid).
  • Administer other medications 2 hr before or after giving sucralfate to minimize effect on absorption.
  • Do not administer antacids within ½ hr of giving this drug.
  • Use with caution in patients with chronic renal failure; avoid concomitant use of other products containing aluminum (eg, some antacids).
  • Store at room temperature.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Report constipation, diarrhea, nausea, rash, pruritus, or other side effects to health care provider.
  • Observe for signs of GI bleeding or GI distress and report to health care provider.
  • Be alert to possibility of aluminum accumulation and toxicity in patients with chronic renal failure (evidenced by drowsiness and seizures); excretion of aluminum through kidneys will be impaired and aluminum is not removed by dialysis.

 Patient/Family Education

  • Caution patient not to crush or chew tablets.
  • Tell patient to take with glass of water, on empty stomach at least 1 hr before meals.
  • If patient is taking other medications, instruct patient to take these drugs 2 hr before or after taking sucralfate, if possible.
  • Instruct patient to use antacids only with health care provider permission and not to use within ½ hr of taking this drug.
  • Advise patient to consult health care provider or pharmacist before taking any other medication (including OTC).
  • Explain that increase in fluid and fiber intake, and exercise may prevent drug-induced constipation.
  • Instruct patient to report the following symptoms to health care provider: drowsiness, constipation, diarrhea, nausea, rash, pruritus, or other side effects (including signs of GI bleeding).

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