Sucralfate
CLASS
- aluminium salt of sulphated sucrose
MECHANISM OF ACTION
- forms viscous paste -> adheres to ulcers via ionic binding -> acts as a barrier to the diffusion of acid, pepsin and bile salts
- weak antacid effect
- increases gastric blood flow & enhances gastric epithelial proliferation via stimulation of gastric mucosal epidermal growth factor & fibroblast growth factor
- stimulates gastric mucus and HCO3 secretion
PHARMACEUTICS
- tablets: 1g
- suspension: 200mg/mL
DOSE
- 1g Q6hrly
INDICATIONS
- peptic ulcer disease
- prevention of stress ulceration -> PPIs and H2 antagonists are more commonly used (less effective than H2R antagonists in one MCRCT)
ADVERSE EFFECTS
- constipation
- hypophosphataemia
- aluminium toxicity in renal failure and CVVHF
- may decrease the absorption of other concomitantly administrated oral medications such as ciprofloxacin, theophylline, phenytoin, ranitidine, levothyroxine, ketoconazole, and digoxin (these drugs must be given 2h before sucralfate)
PHARMACOKINETICS
- Absorption – 5% absorbed
- Distribution –
- Metabolism – none!
- Elimination – faeces
EVIDENCE
Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A. 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 Mar 19;338(12):791-7. PMID: 9504939.
- MRCT
- oral placebo + ranitidine vs sucralfate + IV
-> GIH: ranitidine (1.7%), sucralfate (3.8%) – P < 0.05 i.e. ihose receiving ranitidine had a significantly lower rate of clinically important gastrointestinal bleeding than those treated with sucralfate.
-> pneumonia incidence: ranitidine (19.2%), sucralfate (16.2%) – P > 0.05
-> no change in LOS or mortality
References and Links
- Cook D, Guyatt G, Marshall J, Leasa D, Fuller H, Hall R, Peters S, Rutledge F, Griffith L, McLellan A, Wood G, Kirby A. 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 Mar 19;338(12):791-7. PMID: 9504939.
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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