Sucralfate is a cytoprotective agent, an oral gastrointestinal medication primarily indicated for the treatment of active duodenal ulcers.

Brand names include Sucramal in Italy; Carafate in U.S.A.; Pepsigard, Sucral, Sucrafil, Hapifate in India; Sutra or Musin in parts of South-East Asia; Sulcrate in Canada; Ulsanic in South Africa and Israel; and Antepsin in Turkey. Sucralfate is also used for the [2] treatment of gastroesophageal reflux disease (GERD) and stress ulcers. Unlike the other classes of medicationsused for treatment of peptic ulcers, sucralfate is a sucrose sulfate-aluminium complex that binds to the mucosa, thus creating a physical barrier that impairs diffusion ofhydrochloric acid in the gastrointestinal tract and prevents degradation of mucus by acid. It also stimulates bicarbonate output and acts like an acid buffer withcytoprotective properties. Sucralfate was approved by the U.S. Food and Drug Administration (FDA) in 1981.
Contents
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1 Mechanism of action 2 Clinical uses 3 Adverse reactions 4 References 5 External links

[edit]Mechanism

of action

Sucralfate is a locally acting substance that in an acidic environment (pH < 4) reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose. It also attaches to proteins on the surface of ulcers, such as albumin andfibrinogen, to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing further damage from acid, pepsin, and bile. In addition, it prevents back diffusion of hydrogen ions, and adsorbs both pepsin and bile acids. Recently, it has been indicated that sucralfate also stimulates the increase ofprostaglandin E2, epidermal growth factors (EGF), bFGF, and gastric mucus. [edit]Clinical

uses

The only FDA-approved indication for sucralfate is for the treatment of active duodenal ulcers not related to NSAID usage because the mechanism behind these ulcers is secondary to acid oversecretion. It is not technically approved for gastric ulcers because the main mechanism is not due to acid oversecretion but rather from diminished protection. The use for sucralfate in peptic ulcer disease has diminished recently, but it is still the preferred agent for stress ulcer prophylaxis. Active duodenal ulcer not related to NSAID use1 g PO four times a day given 1 h before meals and at bedtime for 48 weeks Maintenance therapy for resolved duodenal ulcers1 g PO bid on empty stomach

Gastric ulcer not related to NSAID use and gastritis due to GERD1 g PO four times a day 1 h before meals and at bedtime. Triple combination therapy withlansoprazole + cisapride + sucralfate can significantly improve symptoms and quality of life and was more cost-effective [3] than ranitidine combination group. Aphthous ulcer and stomatitis due to radiation or chemotherapy5-10 mL PO suspension swish and spit/swallow four times a day. Proctitis from radiation or ulcerative colitis3 g/15 mL rectal suspension once or twice daily. Gastro-esophageal reflux disease during pregnancy -- first-line drug therapy combined [4] with lifestyle and diet modification. Stress ulcer prophylaxisThe use of sucralfate rather than H2 antagonists for stress ulcer prophylaxis, and measures to prevent aspiration, such as semirecumbent positioning or continuous subglottic suctioning, have all been shown to reduce the risk of ventilator-associated [5] pneumonia (VAP). Prevention of stricture formationSucralfate has an inhibitory effect on stricture formation in experimental corrosive burns and can be used in the treatment of corrosiveesophageal burns to [6] enhance mucosal healing and suppress stricture formation Rectal bleeding and its management after irradiation for uterine cervical cancer

Grade 1 bleeding experienced immediate relief with sucrasulfate enema for 1 month. Grade 2 bleeding, sucrasulfate enema and/or coagulation were effective. Grade 3 bleeding lasted for 1 year despite frequent transfusions and coagulation. Grade 2 and 3 rectal bleeding occurred in 8.5% of patients. The most significant risk factor was the ICRU-CRBED. Prompt treatment with a combination of sucrasulfate enema and coagulation is effective in controlling Grade 1 and 2 rectal bleeding without the development [7] of fistula or stricture. [edit]Adverse

reactions

The most common side effects seen are constipation 2-3% and bezoar formation. Less commonly reported include flatulence, cephalalgia (headache), hypophosphatemia, and xerostomia (dry mouth). Avoid using this drug in patients with chronic renal failure, it might cause them aluminum-induced nephropathy. Nursing mothers: Uncertain. [edit]References
a b c

1. 2.

Merck Index, 12th Edition, 9049.

^ Maton PN (2003). "Profile and assessment of GERD pharmacotherapy". Cleve Clin J Med. 70 Suppl 5: S5170. doi:10.3949/ccjm.70.Suppl_5.S51. PMID 14705381.

3.

^ Jian-Min, Si; Liang-Jing, Wang; Shu-Jie, Chen; Lan, Zhao; Ning, Dai (2003). "Quality of life and costeffectiveness of combined therapy for reflux esophagitis". Journal of Zhejiang University SCIENCE A 4 (5): 6026.doi:10.1631/jzus.2003.0602. PMID 12958722.

4. 5. 6.

^ Aliment Pharmacol Ther. 2005 Nov 1;22(9):749-57. ^ Respir Care. 2005 Jun;50(6):725-39; discussion 739-41. ^ Surg Today. 2005;35(8):617-22.

7.

^ International Journal Radiation Oncology Biological Physics , 2004 Jan 1;58(1):98-105

Katzung, Bertram G. Basic and Clinical Pharmacology, 9th ed. (2004).

[edit]External

links