Sucralfate is the name of a drug used to treat stomach and duodenal ulcers. The drug builds up a protective layer on the mucous membrane of the upper digestive region.
What is sucralfate?
Sucralfate is an aluminum salt of sucrose sulfate. In medicine, the active ingredient is primarily used to treat gastric ulcer (ulcus ventriculi). It is also suitable for the treatment of duodenal ulcers. Sucralfate was approved for use in Europe in the mid-1980s. In Germany, the drug is administered under the preparation names Sucrabest and Ulcogant. In addition, various generics of the basic aluminum sucrose sulfate are on the market.
Pharmacological action
Sucralfate is classified in the group of acid-binding drugs. It has the property of neutralizing excess gastric acid by binding it. In this way, it is possible to prevent diseases caused by acid. Due to its special mode of action, sucralfate has a special position among acid-binding preparations. It binds with proteins of gastric mucus and gastric mucosa, which in turn creates a protective layer on the surface of the damaged mucosa. This protective layer can be used to counteract further damage to the mucosa due to gastric acid, bile and gastric enzymes. This already points to another property of sucralfate: the binding of gastric enzymes such as pepsin and bile acids. Sucralfate promotes the production of prostaglandins, which are substances produced naturally in the body. They ensure increased production of mucous membrane within the gastrointestinal tract. This protective layer is of great importance for the protection of the mucous membrane against gastric acid. Sucralfate is absorbed to a small extent. This means that most of the active substance is excreted from the organism without any changes. The drug can develop its effect in an acidic environment. This results in a jelly-like coating of the gastric mucosa.
Medical application and use
The most common application of sucralfate is the treatment of gastric and duodenal ulcers. In this context, the drug is also suitable for the prevention of these diseases. It is usually used in the early stages to protect the gastric mucosa. Sucralfate is not used permanently, however, as more effective drugs such as proton pump inhibitors are available for this purpose. Another indication is the treatment of esophagitis caused by refluxing stomach acid. However, sucralfate is not suitable for use in cases of malignant gastric ulcer or infection with the Helicobacter pylori bacterium. Sucralfate can also be administered externally. It is used as an ingredient in various wound healing creams. Sucralfate is administered either in tablet form, as granules or as a suspension. The recommended daily dose is 1 gram. It should be taken one hour before a meal and before going to bed at night. In this way, the effect of the drug unfolds in the acidic environment. The dosage also depends on whether it is a gastric ulcer or duodenal ulcer.
Risks and side effects
Taking sucralfate may be associated with adverse side effects in some patients. These include, first and foremost, constipation. Other possible side effects include dry mouth, bloating, nausea, or dizziness. If there are restrictions on kidney function, it is possible that the aluminum concentration within the body increases. In rare cases, patients also suffer from an itchy rash on the skin. If the side effects described occur, it is advisable to ask a doctor or pharmacist for advice. Sucralfate should not be used at all if the patient suffers from hypersensitivity to drugs containing sucralfate. Careful consideration of the risks and benefits of treatment must be made if there is a severe disturbance of kidney function. There is a risk of precarious accumulation of aluminum contained in the active ingredient. Sucralfate should be taken during pregnancy only if absolutely necessary.Thus, the aluminum can also accumulate in the bones of the unborn child. This accumulation threatens the baby with damage to the nerves. Although the aluminum contained in sucralfate can also penetrate into the mother’s milk, it is considered safe to administer the product for a short time during the breastfeeding period. Thus, only a minor absorption of the aluminum takes place within the fetal body. Possible alternatives should nevertheless be weighed up. The use of sucralfate in children under 14 years of age is not recommended. Thus, not enough studies are available on this age range. Interactions are within the realm of possibility due to the simultaneous use of sucralfate and other medications. For example, antibiotics such as colistin, amphotericin B, or tobramycin, the biliary agents ursodeoxycholic acid and chenodesoxycholic acid, the antifungal agent ketoconazole, the antiepileptic phenytoin, the thyroid hormone levothyroxine, and the acid blockers ranitidine and cimetidine are reduced in their effectiveness. For this reason, there should be an interval of at least two hours between the use of sucralfate and these medications. Sucralfate is also believed to have a negative effect on anticoagulant medications. Therefore, in the event of concomitant use, the treating physician closely monitors the dosage of these agents. When sucralfate is co-administered with drugs containing potassium sodium hydrogen citrate, it often results in increased absorption of aluminum.
