5 Sucralfate Interactions to know

Key Takeaways

• Remember to take sucralfate on an empty stomach, as food can lessen the effectiveness of this medication. You should take sucralfate at least 1 hour before or 2 hours after food or snacks. 
• If you are suffering from ulcer pain, lifestyle changes are essential in preventing the recurrence of a stress ulcer. While using sucralfate, you should talk to your care team about different stress-reducing programs that you should participate in. 

What is Sucralfate?

Sucralfate is a prescription medication used for the short-term treatment of an active duodenal ulcer. 

Sucralfate is used to treat duodenal ulcers or peptic ulcers. However, this medication does not prevent ulcers from forming in the future.

Sucralfate is also used off-label to treat a stress ulcer, peptic ulcer disease, and gastritis. 

Sucralfate dosage forms

Lower-cost generic of sucralfate can be prescribed by your healthcare professional. 

The following are the sucralfate forms:

• Sucralfate suspension: 1g/10 mL 
• Sucralfate oral tablet: 1 g 

What is sucralfate used for?

• Short-term treatment (up to 8 weeks) of an active duodenal ulcer 
• Maintenance therapy of duodenal ulcers at reduced dosage after healing of active duodenal ulcers 

How does sucralfate work?

Sucralfate works directly on the lining of the stomach and small intestine. Sucralfate helps ulcers heal by providing a protective barrier from stomach acid, digestive enzymes, and bile salts, preventing further injury. 

Regarding sucralfate’s molecular mechanisms of action, sucralfate binds tissue growth factors to facilitate tissue growth and repair. 

The drug information contained herein of sucralfate is for educational purposes only and may not include all possible indications, adverse effects, drug interaction, and potential warnings.  

Common sucralfate drug interactions

Like any medicine, sucralfate can interact with other medications and vice versa. Specific drug interactions can cause other drugs to be less effective. In contrast, others can reduce the ability of sucralfate to heal stomach ulcers. Always tell your doctor or pharmacist about any new medications that you’re about to take to prevent unwanted side effects and adverse effects. 

Below are some possible drug interactions you should watch out for while being on sucralfate. 

Blood thinners and heart medicine

• Warfarin (Coumadin) is a blood thinner used to treat and prevent blood clots. Unlike the newer generations of blood thinners, warfarin requires strict monitoring as other medications or changes in dietary intake can affect how well warfarin works. Sucralfate can interact with warfarin, leading to less warfarin being absorbed into the body. This leads to dangerous side effects like an increased risk of blood clots, stroke, and heart attacks. 
• Digoxin (Lanoxin) is a medication used to treat patients with heart conditions, specifically heart failure and atrial fibrillation (A-Fib). Similar to warfarin, drug interactions between sucralfate and digoxin causes digoxin to be less effective. 

Tell your doctor about all the medications you are taking. Do not try to adjust the warfarin dosing or stop any medication without consulting your doctor first. Blood tests will help healthcare professionals to determine the appropriate dosage of warfarin and digoxin with concurrent sucralfate therapy. 

Your doctor may tell you to take warfarin or digoxin at least 2 hours before taking sucralfate. 

Antibiotics

Sucralfate can also affect fluoroquinolone and tetracyclines, which are two common antibiotic classes. Sucralfate binds to these antibiotics, leading to less of the antibiotics being absorbed into the bloodstream. This interaction can cause a more severe infection. Examples of fluoroquinolones include ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin. Doxycycline and minocycline are some common tetracycline antibiotics. 

These antibiotics should be taken at least 2 hours before or 2 hours after taking sucralfate. You should ask your doctor or pharmacist about how best to time the administration of your antibiotic and sucralfate. 

Thyroid medicine 

Levothyroxine, a medication used for hypothyroidism, is one of the prescription drugs that can be affected by sucralfate. Similarly, sucralfate can reduce the effects of levothyroxine. This drug interaction can have unwanted side effects and worsen the symptoms of hypothyroidism, such as tiredness, puffy face, constipation, cold sensitivity, and voice hoarseness.

Keep in mind that levothyroxine should be taken on an empty stomach, similar to sucralfate. For best results, you should take thyroid medicines 30 minutes before breakfast and wait at least 4 hours before sucralfate administration. 

Antacid 

Sucralfate can reduce the absorption of certain antacids. Tums, Mylanta, and Pepto-Bismol are some common over-the-counter medications used to treat heartburn and acid reflux. The rule of thumb is to avoid taking antacids within 30 minutes of sucralfate administration. 

Tell your doctor if you are taking antacids, and be sure to ask them which type of over-the-counter medications for acid reflux are best to use while taking sucralfate. 

Food

While sucralfate reduces the effectiveness of many prescription drugs and over-the-counter medicines, the presence of food causes sucralfate to be less effective. Specifically, since sucralfate acts locally to heal ulcers, food makes it harder for sucralfate to work. 

It is important to always take sucralfate on an empty stomach. Ideally, you should take sucralfate 1 hour before or 2 hours after any meal or snack. 

Not all drug interactions are listed here. Ask your doctor or pharmacist, or consult drug interaction database about the potential drug interactions between your current medications and sucralfate.

Instructions for taking sucralfate

Dosage of sucralfate

Treatment of active duodenal ulcer 

The typical adult dose for sucralfate tablet or sucralfate oral suspension is 1 gram orally 4 times daily. The duration of this therapy is 4 to 8 weeks. 

Maintenance therapy

The recommended adult dose for sucralfate tablet or sucralfate oral suspension is 1 gram twice daily. 

Older adults

Dosing for older adults usually starts at the low end of the dosing range due to their decreased liver and kidney function. 

How should I be taking sucralfate?

Take sucralfate suspension and regular oral tablets on an empty stomach. 

You should follow all instructions on the prescription labels and medication guides. Use sucralfate exactly as prescribed every time. Ask your doctor any questions you may have on how to take this medication to prevent unwanted side effects and maximize the positive effects of sucralfate. 

Sucralfate is available as regular oral tablets or oral suspension. Both dosage forms are to be given by mouth only. Sucralfate oral suspension should never be injected into a vein. 

Shake the oral suspension well before each dose and use the dosing syringe or a medicine dose-measuring device to measure the dose accurately. Tell your pharmacist if you need a dosing syringe. You should never use household tools such as a tablespoon or teaspoon to measure oral liquid medications. 

You should finish the whole course of treatment even if you no longer feel ulcer pain after only a week of taking sucralfate. 

The dosage and duration of therapy for sucralfate is based on your medical condition. Always take this medication exactly as directed by your doctor. 

Diabetic patients should check their blood sugar regularly as directed by their health care professional. For patients with diabetes, sucralfate may affect the absorption of certain diabetes medications. You should not attempt to adjust the dose of your diabetes medications. Your doctor may adjust the dosage based on your blood sugar levels. 

You should store this medication at room temperature, away from heat and moisture, and out of reach of pets and children. If you are using sucralfate oral suspension, make sure the liquid medication is not stored at a temperature where it can potentially freeze.

Missed dose instructions

If you take this medication on a regular dosing schedule and you miss a dose of sucralfate, you should take the missed dose as soon as you remember. However, if it is almost time for your next dose, take only that dose and skip the missed dose. Do not take twice the amount to make up for the missed dose. 

What should I tell my doctor before starting sucralfate? 

You should not take this medication if you’ve had an allergic reaction to it or if you have had any hypersensitivity reactions to any component of this medication.  

Tell your doctor immediately if you develop symptoms of an anaphylactic allergic reaction, including difficulty breathing, hives, rash, swelling of the face, tongue, lips, or throat.

Tell your doctor if you have any of the following medical conditions:

• Diabetes. Your doctor may have to adjust the dosage of your diabetes medications.
• Kidney disease or if you are on dialysis. Impaired kidney function puts you at higher risk for aluminum toxicity. 
• Any medical condition that can cause delayed gastric emptying.

Also, inform your healthcare professional if you have difficulty swallowing, as there are some reports of sucralfate tablet aspiration leading to respiratory problems.

Tell your doctor of any other medications that you are taking besides sucralfate.

Pregnancy/Lactation

Talk to your doctor if you get pregnant while taking sucralfate or are planning to get pregnant. Even though animal studies showed minor risks, there is no data from human studies on the effects of sucralfate in pregnant women. Therefore, sucralfate should only be prescribed to pregnant women when the potential benefits justify the potential risk.

Sucralfate is designed to act locally, so it is minimally absorbed into the bloodstream. However, it is not known if this medication passes into breast milk. There is currently no human data available. Talk to your doctor if you are breastfeeding or plan to breastfeed. 

Other warnings

If you have one or more of the risk factors listed above, you should talk to your doctor to learn more about the risk and benefits of this medication and discuss alternative therapy if necessary. 

Sucralfate is a basic aluminum salt of sucrose octasulfate. Sucralfate increases the risk of high aluminum levels and should be used with caution in people with kidney disease, chronic renal failure, and those who are on dialysis. This is because people with renal failure cannot secrete aluminum in the urine, unlike healthy individuals. 

This risk is higher when a person is also taking other aluminum-containing products, such as aluminum-containing antacids. 

Kidney function also naturally declines with age. Therefore, elderly adults are also at higher risk for developing high aluminum levels, especially if they are also using other aluminum-containing products such as antacids. 

Signs and side effects of aluminum toxicity include muscle weakness, bone pain, confusion, altered mental status, and seizures. 

What are the side effects of sucralfate?

Serious side effects 

An anaphylactic allergic reaction can happen in some cases. You must seek emergency medical attention if you experience the following side effects: difficulty breathing, hives, rash, and swelling of the face, tongue, lips, or throat. 

Common side effects

Below are the common side effects associated with sucralfate. These side effects typically improve over time as your body gets used to the medication. Let your health care professional know if these side effects do not go away or if they become worse with time. 

• Nausea, vomiting
• Gastrointestinal discomfort 
• Unusual feeling of fullness or bloating
• Constipation 
• Diarrhea 
• Drowsiness
• Dizziness 
• Back pain
• Headache 
• Itching skin rash
• Sleep problems 

Overdosage

If you think you’ve taken more than the prescribed dose, tell your doctor or call the poison control center at 800-222-1222. Get emergency medical help at the nearest emergency department if the symptoms are severe or if the person is not breathing, collapsed, or having a seizure after taking sucralfate. 

Reference

1. American Society of Health-System Pharmacists: ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998. Am J Health Syst Pharm 1999; 56(4):347-379.
2. Product Information: CARAFATE(R) oral suspension, sucralfate oral suspension. Allergan USA, Inc. (per FDA), Irvine, CA, 2017.
3. Product Information: CARAFATE(R) oral tablets, sucralfate oral tablets. Allergan USA, Inc. (per DailyMed), Irvine, CA, 2016.
4. Pugh M, Small R, & Garnett W: Effect of sucralfate on ibuprofen absorption in normal volunteers. Clin Pharm 1984; 3:630-6.
5.  McHardy GG: Role of sucralfate in duodenal ulcer disease: account of a double-blind, randomized, multicenter, endoscopically controlled evaluation of ulcer response in peptic ulcer disease: an update. Third Int Symposium Gastroenterol, BMI Inc, New York, NY:321-331, March 1979.
6. Giesing DH, Bighley LD, & Iles HL: Effect of food and antacid on binding of sucralfate to normal and ulcerated gastric and duodenal mucosa in rats. J Clin Gastroenterol 1981; 3(suppl 2):111-116.