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Name
Sucralfate

Brand Names: International

Acral (IN); Alivoato (CR, DO, GT, HN, NI, PA, SV); Alsucral (EC, MY); Alusac (UY); Alusulin (HU);
Andapsin (SE); Antepsin (AR, BD, DK, FI, GB, IE, IS, IT, MT, NO, TR); Carafate (AU, NZ); Cinebil (PT);
Ciprid (EC); Crasia (IN); Dip (CO, EC); Discral (CR, DO, GT, HN, MX, NI, PA, SV); Episan (ID); Eradict
(EG); Exinol (VE); Gasmezol (VN); Gastril (EC); Gastrofait (BH, EG); Gastronic (BD); Inpepsa (ID);
Iselpin (PH); Keal (FR, LU); Lacrate (IN); Lanpepsa (ID); Metixane (MX); Mucifat (ID); Neciblok (ID);
Netunal (AR); Peptonorm (GR); Serat (VN); Sucrabest (DE, LU); Sucrafil (LK); Sucrafilm (BR); Sucral
(PY); Sucralan (AT); Sucralbene (HU); Sucralfin (IT, PH); Sucralose (AE); Sucramal (IT); Sucrate (CN,
HK, LB); Sucrate Gel (SG); Sude (CN); Sulcran (CL); Sulcrate (JP); Taxilan (ID); Ulcafate (PK); Ulcar
(AE, CY, EG, FR, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE); Ulcera (ID); Ulcerfate (IN); Ulcerlmin (JP, KR);
Ulcermin (PT); Ulcertec (MY); Ulcetab (ZA); Ulcicure (SA); Ulcogant (CZ, LU, PE); Ulcumaag (ID);
Ulgastrin (PL); Ulsaheal (AE, IQ, JO, SA); Ulsanic (ID, IL, JP, TW, ZA); Ulsec (BD); Ulsicral (ID); Unival
(MX); Vanter (LT); Venter (EE, HR, HU, LV, PL, RO, RU, SI, SK, UA)

International Nonproprietary Names (INN)

Sucralfate [English]; Sucralfate [French]; Sucralfato [Spanish]; Sucralfatum [Latin]; Сукральфат
[Russian]; ‫[ ﺳﻮﻛﺮاﻟﻔﺎت‬Arabic]; 硫糖铝 [Chinese]

Brazilian Nonproprietary Names (DCB)

Sucralfato

Japanese Accepted Name (JAN)

スクラルファート水和物

Anatomic Therapeutic Chemical (ATC) Classification

A02BX02
Pharmacologic Category
Gastrointestinal Agent, Miscellaneous

Dosing: Adult
Duodenal ulcer: Oral:
Active duodenal ulcer: Suspension, tablet: Initial: 1 g 4 times daily for 4 to 8 weeks.
Maintenance therapy: Tablet: 1 g twice daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring
dose/frequency adjustment or avoidance. Consult drug interactions database for more
information.

Dosing: Geriatric
Refer to adult dosing. Use with caution; initiate at low end of dosage range.

Dosing: Renal Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling. Aluminum salt is
minimally absorbed; however, may accumulate in renal impairment; use with caution in patients
with chronic renal failure or on dialysis.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric
Peptic ulcer disease, adjunct therapy: Limited data available: Infants, Children, and
Adolescents: Oral: 40 to 80 mg/kg/day divided every 6 hours. Maximum dose: 1,000 mg/dose
(Kliegman 2016; Nelson 1996)
Esophagitis: Limited data available (Arguelles-Martin 1989):
Infants ≥3 months and Children <6 years: Oral: 500 mg/dose four times daily
Children ≥6 years: Oral: 1,000 mg/dose four times daily
Note: Dosing from a prospective trial of 75 patients (age range: 3 months to 13 years) who
received sucralfate tablets (n=25), sucralfate suspension (n=25), or cimetidine (n=25) for
reflux esophagitis. At the end of 8 weeks, 68% of patients receiving sucralfate tablet, 92%
of patients receiving sucralfate suspension, and 79% of patients receiving cimetidine
were asymptomatic. Sucralfate was well tolerated.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring
dose/frequency adjustment or avoidance. Consult drug interactions database for more
information.

Dosing: Renal Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling. Aluminum salt is
minimally absorbed (<5%); however, may accumulate in renal failure; use with caution in patients
with chronic renal failure.
Dosing: Hepatic Impairment: Pediatric
There are no dosage adjustments provided in the manufacturer's labeling.

Use: Labeled Indications

Duodenal ulcer: Short-term (≤8 weeks) treatment of active duodenal ulcers; maintenance
therapy for duodenal ulcers (tablets only)

Administration: Oral
Administer on an empty stomach. Shake suspension well before use. Do not administer antacids
within 30 minutes of administration of sucralfate. In general, separate administration of other
oral medications and sucralfate by at least 2 hours; consult drug interactions database for
additional information.

Administration: Pediatric
Oral: Administer on an empty stomach 1 hour before meals and at bedtime; tablet may be
broken or dissolved in water before ingestion; do not administer antacids within 30 minutes of
administration; shake suspension well before use. In general, separate administration of other
oral medications and sucralfate by at least 2 hours; consult drug interactions database for
additional information.

Dietary Considerations
Take with water on an empty stomach.

Storage/Stability
Suspension: Store at 20°C to 25°C (68°F to 77°F); do not freeze.
Tablet: Store at 15°C to 30°C (59°F to 86°F).

Extemporaneously Prepared
Note: Commercial oral suspension is available (100 mg/mL).

A 66.67 mg/mL oral suspension may be made with tablets. Add eight 1 g tablets to a 120 mL
glass bottle. Add 40 mL of SWFI and allow tablets to dissolve (~2 minutes). Add 40 mL of sorbitol
70% solution and shake well. In a separate container, dissolve 2 flavor packets (Vari-Flavors; Ross
Laboratories) with 10 mL of water, and swirl until dissolved then add to drug mixture. Add SWFI
to make 120 mL. Label "shake well" and "refrigerate". Use within 2 weeks.
Ferraro JM. Sucralfate suspension for mouth ulcers. Drug Intell Clin Pharm. 1985;19(6):480.
[PubMed 3839180]

Medication Safety Issues

Sound-alike/look-alike issues:
Sucralfate may be confused with salsalate
Carafate may be confused with Cafergot
Administration issues:
 For oral administration only. Fatal pulmonary or cerebral embolism has been reported
following inadvertent IV administration of sucralfate.

Contraindications
Hypersensitivity to sucralfate or any component of the formulation

Warnings/Precautions
Disease-related concerns:
• Diabetes: Hyperglycemia has been reported with sucralfate suspension in patients with
diabetes; monitor glycemia closely; adjustment of antidiabetic treatment may be
necessary.
• Duodenal ulceration: Because sucralfate acts locally at the ulcer, successful therapy with
sucralfate should not be expected to alter the posthealing frequency of recurrence or
the severity of duodenal ulceration.
• Renal impairment: Use with caution in patients with chronic renal failure; sucralfate is an
aluminum complex, small amounts of aluminum are absorbed following oral
administration. Excretion of aluminum may be decreased in patients with chronic renal
failure or on dialysis, increasing the risk of aluminum accumulation and toxicity (eg,
aluminum osteodystrophy, osteomalacia, and encephalopathy).
Dosage form specific issues:
• Tablets: Use with caution in patients with conditions that may impair swallowing (eg, recent
or prolonged intubation, tracheostomy, dysphagia, history of aspiration) or other
conditions that may alter gag/cough reflexes, or diminish oropharyngeal coordination or
motility; aspiration with accompanying respiratory complications has been reported.
Other warnings/precautions:
• Administration: Administer sucralfate by oral route only; fatal complications, including
cerebral and pulmonary emboli, have been reported with inadvertent IV administration
of sucralfate.

Geriatric Considerations
Caution should be used in the elderly due to reduced renal function. Patients with CrCl <30
mL/minute may be at risk for aluminum intoxication. Due to low side effect profile, this may be
an agent of choice in the elderly with PUD.

Pregnancy Considerations
Sucralfate is only minimally absorbed following oral administration. Based on available data,
sucralfate does not appear to increase the risk of adverse fetal events when used during the first
trimester. Sucralfate is considered acceptable for use in pregnancy (Dağlı 2017; Gomes 2018;
Thélin 2020).

Breast-Feeding Considerations
It is not known if sucralfate is present in breast milk.
Sucralfate is only minimally absorbed following oral administration. Although the manufacturer
recommends that caution be exercised when administering sucralfate to breastfeeding
women, use is considered acceptable (Dağlı 2017).
Adverse Reactions
The following adverse drug reactions and incidences are derived from product labeling unless
otherwise specified.
1% to 10%: Gastrointestinal: Constipation (2%)
<1%, postmarketing, and/or case reports: Anaphylaxis, back pain, bezoar formation,
bronchospasm, diarrhea, dizziness, drowsiness, dyspepsia, facial edema, flatulence, gastric
distress, headache, hyperglycemia, hypersensitivity reaction, insomnia, laryngeal edema,
mouth edema, nausea, pharyngeal edema, pruritus, pulmonary edema, skin rash, vertigo,
vomiting, xerostomia

Allergy and Idiosyncratic Reactions

Sucralfate Allergy

Metabolism/Transport Effects
None known.

Drug Interactions
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum
concentration of Baloxavir Marboxil. Risk X: Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of
Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours
before or 6 hours after polyvalent cation containing products. Coadministration of
bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk
D: Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum
concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral
medications containing polyvalent cations within: 2 hours before or after
tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after
alendronate/risedronate. Risk D: Consider therapy modification
Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of
Cabotegravir. Management: Administer polyvalent cation containing products at least 2
hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification
Cholic Acid: Sucralfate may decrease the absorption of Cholic Acid. Management: Administer
cholic acid at least 1 hour before or 4 to 6 hours after administration of aluminum-containing
products such as sucralfate to minimize the potential for a significant interaction. Risk D:
Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of
Deferiprone. Management: Separate administration of deferiprone and oral medications or
supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider therapy
modification
Digoxin: Sucralfate may decrease the serum concentration of Digoxin. Specifically, sucralfate may
decrease the absorption of digoxin. Management: Administer digoxin at least 2 hours before
sucralfate. Concomitant administration should be avoided. Monitor for decreased digoxin
levels/effects with initiation of sucralfate therapy. Risk D: Consider therapy modification
Dolutegravir: Sucralfate may decrease the serum concentration of Dolutegravir. Management:
Administer dolutegravir at least 2 hours before or 6 hours after sucralfate. Administer the
dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after
sucralfate. Risk D: Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of
Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after
oral administration of any polyvalent cation containing product. Risk D: Consider therapy
modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of
Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the
administration of polyvalent cation containing products. Risk D: Consider therapy
modification
Furosemide: Sucralfate may decrease the serum concentration of Furosemide. Sucralfate may
impair the absorption of furosemide. Management: Avoid concomitant oral administration of
furosemide and sucralfate. Separate administration by at least 2 hours. Does not apply to
parenterally administered furosemide. Risk D: Consider therapy modification
Ketoconazole (Systemic): Sucralfate may decrease the serum concentration of Ketoconazole
(Systemic). Risk C: Monitor therapy
Levothyroxine: Sucralfate may decrease the serum concentration of Levothyroxine. Risk C:
Monitor therapy
Multivitamins/Fluoride (with ADE): May increase the serum concentration of Sucralfate.
Specifically, the absorption of aluminum may be increased. Sucralfate may decrease the
serum concentration of Multivitamins/Fluoride (with ADE). More specifically, sucralfate may
impair the absorption of fluoride. Management: Avoid administration of aluminum-
containing products, such as sucralfate, within at least 1-2 hours of fluoride administration.
In patients with severe renal dysfunction, consider avoiding this combination altogether. Risk
D: Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of
Sucralfate. Specifically, the absorption of aluminum from sucralfate may be increased,
leading to an increase in the serum aluminum concentration. Risk X: Avoid combination
Naproxen: Sucralfate may decrease the absorption of Naproxen. Risk X: Avoid combination
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of
PenicillAMINE. Management: Separate the administration of penicillamine and oral
polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy
modification
Phosphate Supplements: Sucralfate may decrease the absorption of Phosphate Supplements.
Management: This applies only to oral phosphate administration. Administering oral
phosphate supplements at least 2 hours before sucralfate may reduce the significance of the
interaction. Risk D: Consider therapy modification
QuiNIDine: Sucralfate may decrease the serum concentration of QuiNIDine. Specifically,
sucralfate may decrease the absorption of quinidine. Management: Administer quinidine at
least 2 hours before sucralfate. Risk D: Consider therapy modification
Quinolones: Sucralfate may decrease the serum concentration of Quinolones. Management:
Avoid concurrent administration of quinolones and sucralfate to minimize the impact of this
interaction. Recommendations for optimal dose separation vary by specific quinolone. Risk
 D: Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of
Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after
administration of the polyvalent cations. Dose separation may not adequately minimize the
significance of this interaction. Risk D: Consider therapy modification
Sulpiride: Sucralfate may decrease the serum concentration of Sulpiride. Management: Separate
administration of sucralfate and sulpiride by at least 2 hours in order to minimize the impact
of sucralfate on sulpiride absorption. Risk D: Consider therapy modification
Tetracyclines: Sucralfate may decrease the absorption of Tetracyclines. Management: Administer
most tetracycline derivatives at least 2 hours prior to sucralfate in order to minimize the
impact of this interaction. Administer oral omadacycline 4 hours prior to sucralfate. Risk D:
Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of
Trientine. Management: Avoid concomitant administration of trientine and oral products that
contain polyvalent cations. If oral iron supplements are required, separate the administration
by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour.
Risk D: Consider therapy modification
Vitamin D Analogs: May increase the serum concentration of Sucralfate. Specifically, the
absorption of aluminum from sucralfate may be increased, leading to an increase in the
serum aluminum concentration. Risk X: Avoid combination
Vitamin K Antagonists (eg, warfarin): Sucralfate may diminish the anticoagulant effect of Vitamin
K Antagonists. Sucralfate may decrease the serum concentration of Vitamin K Antagonists.
Specifically, sucralfate may decrease the absorption of Vitamin K Antagonists. Management:
Monitor for decreased vitamin K antagonist effects (eg, decreased INR, thrombosis) when
these agents are combined and consider administering vitamin K antagonists at least 2
hours before sucralfate to minimize this interaction. Risk C: Monitor therapy

Monitoring Parameters
Blood glucose levels (in diabetic patients receiving oral suspension).

Advanced Practitioners Physical Assessment/Monitoring

Use caution in presence of renal failure. Teach patient proper timing of other medications. May
cause constipation.

Nursing Physical Assessment/Monitoring

Teach patient proper timing of other medications. May cause constipation.

Dosage Forms: US
Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.
Suspension, Oral:
Carafate: 1 g/10 mL (420 mL) [contains fd&c red #40, methylparaben, sorbitol; cherry flavor]
Generic: 1 g/10 mL (10 mL, 420 mL)
Tablet, Oral:
 Carafate: 1 g [scored; contains fd&c blue #1 aluminum lake]
Generic: 1 g

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult
specific product labeling.
Suspension, Oral:
Sulcrate Plus: 200 mg/mL (500 mL) [contains methylparaben sodium, propylparaben sodium]
Tablet, Oral:
Cytogard: 1 g
Sulcrate: 1 g
Generic: 1 g

Generic Available (US)

Yes

Pricing: US
Suspension (Carafate Oral)
1 g/10 mL (per mL): $0.66
Suspension (Sucralfate Oral)
1 g/10 mL (per mL): $1.08 - $1.22
Tablets (Carafate Oral)
1 g (per each): $5.14
Tablets (Sucralfate Oral)
1 g (per each): $0.38 - $0.80
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as
reference price only. A range is provided when more than one manufacturer's AWP price is
available and uses the low and high price reported by the manufacturers to determine the range.
The pricing data should be used for benchmarking purposes only, and as such should not be
used alone to set or adjudicate any prices for reimbursement or purchasing functions or
considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly
disclaims all warranties of any kind or nature, whether express or implied, and assumes no
liability with respect to accuracy of price or price range data published in its solutions. In no event
shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from
use of price or price range data. Pricing data is updated monthly.

Mechanism of Action
Forms a complex by binding with positively charged proteins in exudates, forming a viscous
paste-like, adhesive substance. This selectively forms a protective coating that acts locally to
protect the gastric lining against peptic acid, pepsin, and bile salts.

Pharmacodynamics/Kinetics
Onset of action: Paste formation and ulcer adhesion: 1 to 2 hours; acid neutralizing capacity: ~14
to 16 mEq/1 g dose of sucralfate
Absorption: Minimal from GI tract
Distribution: Acts locally at ulcer sites; unbound in GI tract to aluminum and sucrose octasulfate
Metabolism: None
Excretion: Primarily urine (small amounts of sulfated disaccharide)

Dental: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions

Dental: Effects on Dental Treatment

No significant effects or complications reported

Dental: Effects on Bleeding

No information available to require special precautions

Index Terms
Aluminum Sucrose Sulfate, Basic

References
Algozzine GJ, Hill G, Scoggins WG, et al, “Sucralfate Bezoar,” N Engl J Med, 1983, 309(22):1387.
Apo-Sucralfate (sucralfate) [product monograph]. Toronto, Ontario, Canada: Apotex Inc; October
2018.
Argüelles-Martin F, Gonzalez-Fernandez F, Gentles MG. Sucralfate versus cimetidine in the
treatment of reflux esophagitis in children. Am J Med. 1989;86(6A):73-76.[PubMed 2735338]
Carafate (sucralfate) suspension [prescribing information]. Madison, NJ: Allergan USA Inc; June
2018.
Carafate (sucralfate) tablets [prescribing information]. Madison, NJ: Allergan USA, Inc; June 2018.
Collard HR, Saint S, and Matthay MA, “Prevention of Ventilator-Associated Pneumonia: An
Evidence-Based Systematic Review,” Ann Intern Med, 2003, 138(6):494-501.[PubMed 12639084]
Cook D, Guyatt G, Marshall J, et al, “A Comparison of Sucralfate and Ranitidine for the Prevention
of Upper Gastrointestinal Bleeding in Patients Requiring Mechanical Ventilation. Canadian Critical
Care Trials Group,” N Engl J Med, 1998, 338(12):791-7.[PubMed 9504939]
Dağlı Ü, Kalkan İH. Treatment of reflux disease during pregnancy and lactation. Turk J
Gastroenterol. 2017;28(Suppl 1):S53-S56.[PubMed 29199169]
Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy:
what does the gastroenterologist need to know?. Ann Gastroenterol. 2018;31(4):385‐394.
doi:10.20524/aog.2018.0264[PubMed 29991883]
Kliegman RM, Stanton BMD, St. Geme J, et al, eds. Nelson' s Textbook of Pediatrics. 20th ed.
Philadelphia, PA: Saunders Elsevier; 2016.
Loprinzi CL, Ghosh C, Camoriano J, et al, “Phase III Controlled Evaluation of Sucralfate to Alleviate
Stomatitis in Patients Receiving Fluorouracil-Based Chemotherapy,” J Clin Oncol, 1997, 15(3):1235-
8.[PubMed 9060567]
Nelson WE, Behrman RE, Kliegman RM, et al, eds. Nelson Textbook of Pediatrics. 15th ed.
Philadelphia, PA: WB Saunders Company; 1996.
Overdahl MC and Wewers MD, “Acute Occlusion of a Mainstem Bronchus by a Rapidly Expanding
Foreign Body,” Chest, 1994, 105(5):1600-2.[PubMed 8181371]
Robertson JA, Salusky IB, Goodman WG, et al, “Sucralfate, Intestinal Aluminum Absorption, and
Aluminum Toxicity in a Patient on Dialysis,” Ann Intern Med, 1989, 111(2):179-81.[PubMed
2742249]
Sulcrate and Sulcrate Suspension Plus (sucralfate) [product monograph]. Mont-St-Hilaire, Quebec,
Canada: Aptalis Pharma Canada Inc; September 2013.
Thélin CS, Richter JE. Review article: the management of heartburn during pregnancy and
lactation. Aliment Pharmacol Ther. 2020;51(4):421‐434. doi:10.1111/apt.15611[PubMed
31950535]

Brand Names: US
Carafate

Brand Names: Canada

APO-Sucralfate; Cytogard; PMS-Sucralfate; Sulcrate; Sulcrate Plus; TEVA-Sucralfate