Carafate

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GENERIC NAME: sucralfate

BRAND NAME: Carafate

DRUG CLASS AND MECHANISM: Sucralfate is a unique oral drug. Chemically, it is

a complex of the disaccharide sugar, sucrose, combined with sulfate and

aluminum. It is minimally absorbed into the body, and its actions are entirely

on

the lining of the stomach and duodenum. Although its mechanism is not entirely

understood, the following actions are thought to be important for its

beneficial effects:

sucralfate binds to the surface of ulcers (attaching to exposed proteins) and

coats the ulcer, thus protecting the ulcer surface to some extent from

further injury by acid and pepsin;

sucralfate directly inhibits pepsin (an enzyme that breaks apart proteins) in

the presence of stomach acid;

sucralfate binds bile salts coming from the liver via the bile thus

protecting the stomach lining from injury caused by the bile acids;

sucralfate may increase prostaglandin production, and prostaglandins are

known to protect the lining of the stomach. Sucralfate was approved by the FDA

in

1981.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Oblong tablets (pink): 1 gram; pink- colored suspension (1 gram

per 2 teaspoonsful).

STORAGE: Tablets and suspension should be kept at room temperature, between

15° and 30°C (59-86°F). The suspension should not be frozen and should be

shaken prior to each use.

PRESCRIBED FOR: Sucralfate is used for the treatment of peptic ulcer disease

and to prevent recurrent ulcers after healing of the ulcer has been achieved.

It also has been used to relieve or prevent the ulcers caused by nonsteroidal

anti-inflammatory drugs (NSAIDs) but is less effective than misoprostol

(Cytotec). Sucralfate also is used in the treatment of patients with

gastroesophageal reflux disease (GERD) who are prone to get ulcers in the

esophagus, and to

prevent ulcers associated with high degrees of physical stress (e.g. extensive

burns, surgery, and overwhelming infection.) among hospitalized patients.

DOSING: Sucralfate generally is given four times daily for treating

ulcerations and twice daily for preventing ulcers. It is recommended that it be

taken

on an empty stomach, at least one hour prior to meals, for best coating of the

ulcers.

DRUG INTERACTIONS: Sucralfate reduces the absorption of many drugs when taken

at the same time as the other drugs. These drugs include: cimetidine

(Tagamet), digoxin (Lanoxin), ketoconazole (Nizoral), levothyroxine (Synthroid),

phenytoin (Dilantin), quinidine (Quinidex, Quinaglute), ranitidine (Zantac),

tetracycline, theophylline (Theo-Dur, Uniphyl, others), and all of the

fluoroquinolone antibiotics, including ciprofloxacin (Cipro), norfloxacin

(Noroxin),

ofloxacin (Floxin), and lomefloxacin (Maxaquin). All of these medications should

be

taken at least two hours prior to the sucralfate. It is possible, if not

likely, that many other drugs will interact similarly with sucralfate.

Therefore,

it probably is prudent to take all medications at least 2 hours prior to

sucralfate.

PREGNANCY: Sucralfate itself is not teratogenic in animals, even in doses

considerably higher than those used in humans. Although some animal data

demonstrate concern for the effects of aluminum during pregnancy, all human data

show

no ill-effect on the fetus. Sucralfate is considered safe during pregnancy.

NURSING MOTHERS: Minimal if any sucralfate penetrates into breast milk

because so little is absorbed from the gastrointestinal tract. Although there is

no

data, sucralfate is considered safe in nursing mothers.

SIDE EFFECTS: Sucralfate is well tolerated. Constipation is the most frequent

side effect and occurs in 1 of every 50 patients who take sucralfate.