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# Sucralfate (sucrafil O Gel)
## Overview
Sucralfate is a basic aluminum salt of sulfated disaccharide that acts as a cytoprotective agent. In the acidic environment of the stomach, it forms a viscous, paste-like complex that binds to proteins at ulcer sites, creating a protective barrier against acid, pepsin, and bile salts.
## Primary Indications
* Duodenal ulcer (short-term treatment).
* Oral mucositis/stomatitis (often used off-label as an oral suspension/gel).
* Stress ulcer prophylaxis (off-label).
* GERD (off-label).
## Adult Dosing
* **Duodenal Ulcer:** 1 g orally four times daily (on an empty stomach) for up to 8 weeks. Alternatively, 2 g twice daily.
* **Maintenance:** 1 g twice daily.
* **Oral Mucositis:** 1 g (usually 10 mL of 100 mg/mL suspension) swished and swallowed or spit, four times daily as needed.
* **Maximum Dose:** 8 g/day.
## Pediatric Dosing
* **General Dosing:** 40–80 mg/kg/day divided into 4 doses.
* **Stress Ulcer Prophylaxis:** 0.5–1 g every 6 hours.
* *Note: Dosing is often institution-specific; verify with local pediatric protocols.*
## Dose Adjustments
* **Renal Impairment:** Use with caution. Accumulation of aluminum may occur in patients with chronic kidney disease (CKD) or dialysis-dependent patients. Avoid long-term use in patients with severe renal impairment.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Hypersensitivity to sucralfate or any component of the product.
* Risk of bezoar formation (avoid in patients with delayed gastric emptying/gastroparesis).
## Adverse Effects
* **Common:** Constipation (most frequent).
* **Rare:** Dry mouth, nausea, gastric discomfort, diarrhea, dizziness, sleepiness.
* **Serious:** Aluminum toxicity (in patients with renal failure), bezoar formation.
## Key Drug Interactions
Sucralfate acts as a physical barrier and interferes with the absorption of many medications.
* **Spacing:** Administer other oral medications **at least 2 hours before or after** sucralfate.
* **Specific Agents:** Fluoroquinolones, tetracyclines, levothyroxine, digoxin, phenytoin, and warfarin.
* **Antacids:** Do not administer within 30 minutes of sucralfate, as an acidic environment is required for sucralfate to form its protective gel.
## Monitoring
* Monitor for symptom relief and healing of ulcers.
* Monitor for constipation.
* In patients with renal impairment, monitor serum aluminum, phosphate, and calcium levels if used for prolonged periods.
## Clinical Pearls
* **Timing is critical:** Must be taken on an empty stomach (1 hour before or 2 hours after meals) to maximize binding to ulcerated tissue.
* **Oral Gel Formulation:** "Sucrafil O" (oral gel) is specifically marketed for coating oral/esophageal surfaces; ensure patients understand whether it should be swallowed or expectorated based on the intended site of action.
* **Bezoars:** Reported primarily in critically ill patients, especially those receiving enteral tube feedings.
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**Disclaimer:** This information is for educational purposes only. Drug dosing, contraindications, and interaction profiles may change. Always verify current prescribing information through official clinical resources (e.g., Lexicomp, Micromedex, or the package insert) and follow your institution’s clinical guidelines before prescribing or administering medication.
