Sucralfate

Sucralfate is a prescription medication used to treat peptic ulcers. It is marketed under the brand name Carafate. It can be taken orally, in tablet or suspension form. Sucralfate was approved by the FDA in 1981. more...

Chemical makeup

Chemically, it is a complex of the disaccharide sugar, sucrose, combined with sulfate and aluminum. Its chemical formula is C₁₂H₁₄O₁₁(SO₃Al(OH)₂)₈·(Al(OH)₃)_x·(H₂O)_y, where x is 8 to 10 and y is 22 to 31. In acidic solutions (e.g. gastric acid) it forms a thick paste that has a strong negative charge.

Usage mechanism

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:

1. sucralfate, with its strong negative charge, binds to exposed positively-charged proteins at the base of ulcers. In this way, it coats the ulcer and forms a physical barrier that protects the ulcer surface from further injury by acid and pepsin;
2. sucralfate directly inhibits pepsin (an enzyme that breaks apart proteins) in the presence of stomach acid;
3. sucralfate binds bile salts coming from the liver via the bile thus protecting the stomach lining from injury caused by the bile acids;
4. sucralfate may increase prostaglandin production, and prostaglandins are known to protect the lining of the stomach.
5. sucralfate may also bind epithelial growth factor and fibroblast growth factor, both of which enhance the growth and repair mechanism of the stomach lining

Clinical Uses

The current clinical uses of sucralfate are limited. It is effective for the healing of duodenal ulcers, but it is not frequently used for this since more effective drugs (e.g. proton pump inhibitors) have been developed. It is effective at preventing stress-related gastritis in critically ill patients and is sometimes used to treat patients who are experiencing NSAID-related dyspepsia.

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