What is sucralfate and how does it work. How should sucralfate be taken. What are the potential side effects and interactions of sucralfate. Who should not take sucralfate. How effective is sucralfate for treating ulcers.

Understanding Sucralfate: Mechanism of Action and Uses

Sucralfate is a medication primarily used to treat and prevent duodenal ulcers, as well as other gastrointestinal conditions as determined by a physician. But how exactly does this drug work?

Sucralfate functions by forming a protective barrier or coating over ulcers in the digestive tract. This coating acts as a shield, protecting the ulcerated area from the harsh acidic environment of the stomach. By providing this protection, sucralfate allows the ulcer to heal naturally without further irritation from stomach acid.

It’s important to note that sucralfate contains an aluminum salt. This composition contributes to its effectiveness in treating ulcers and other gastrointestinal issues.

Common Uses of Sucralfate

• Treatment of active duodenal ulcers
• Prevention of duodenal ulcer recurrence
• Management of gastroesophageal reflux disease (GERD)
• Treatment of stress ulcers in critically ill patients
• Other gastrointestinal conditions as prescribed by a doctor

Sucralfate Dosage Forms and Administration

Sucralfate is available in various dosage forms to suit different patient needs and preferences. How should this medication be taken for optimal effectiveness?

Available Dosage Forms

• Oral tablets
• Oral suspension

The oral suspension form, such as Carafate, is particularly useful for patients who have difficulty swallowing tablets or prefer liquid medications.

Proper Administration of Sucralfate

1. Take sucralfate by mouth with a full glass of water.
2. Follow the directions on the prescription label carefully.
3. If using the oral suspension, shake the bottle well before each use.
4. Use a specially marked spoon or container to measure the correct dose. Regular household spoons are not accurate for this purpose.
5. For best results, take sucralfate on an empty stomach, typically 1 hour before meals.
6. Maintain a regular dosing schedule as prescribed by your doctor.
7. Do not stop taking sucralfate without consulting your healthcare provider.

For pediatric patients, it’s crucial to consult with a pediatrician regarding the use of sucralfate, as special care may be needed in determining the appropriate dosage and administration.

Potential Side Effects and Precautions

While sucralfate is generally well-tolerated, it’s essential to be aware of potential side effects and take necessary precautions. What are the most common side effects associated with sucralfate use?

Common Side Effects

• Constipation
• Dry mouth
• Nausea
• Stomach discomfort
• Gas or bloating
• Headache

While these side effects are generally mild, it’s important to report any persistent or severe symptoms to your healthcare provider.

Serious Side Effects Requiring Immediate Medical Attention

• Allergic reactions (skin rash, itching, swelling, severe dizziness, difficulty breathing)
• Signs of kidney problems (changes in urine output, swelling in feet or ankles)
• Severe constipation or abdominal pain
• Unusual bleeding or bruising

If you experience any of these serious side effects, seek medical attention immediately.

Drug Interactions and Contraindications

Sucralfate may interact with various medications, potentially affecting their absorption or effectiveness. What are the key drug interactions to be aware of when taking sucralfate?

Common Drug Interactions

• Antacids
• Cimetidine
• Digoxin
• Ketoconazole
• Phenytoin
• Quinidine
• Ranitidine
• Certain antibiotics (e.g., ciprofloxacin, norfloxacin, ofloxacin)
• Theophylline
• Thyroid hormones
• Warfarin

To minimize potential interactions, it’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you are using.

Contraindications and Special Precautions

Sucralfate may not be suitable for everyone. Inform your healthcare provider if you have any of the following conditions:

• Kidney disease
• History of allergic reactions to sucralfate or its components
• Pregnancy or breastfeeding

Additionally, antacids should not be taken within 30 minutes before or after taking sucralfate, as they may interfere with its effectiveness.

Effectiveness of Sucralfate in Treating Ulcers

Sucralfate has been widely studied and used in clinical practice for decades. But how effective is it in treating duodenal ulcers and other gastrointestinal conditions?

Clinical Efficacy in Duodenal Ulcer Treatment

Numerous clinical studies have demonstrated the efficacy of sucralfate in treating active duodenal ulcers. Research has shown that:

• Sucralfate can promote ulcer healing within 4-8 weeks of treatment in a majority of patients.
• The drug is as effective as H2-receptor antagonists in healing duodenal ulcers.
• Sucralfate has a favorable safety profile compared to some other ulcer medications.

Effectiveness in Ulcer Prevention

Sucralfate has also shown promise in preventing ulcer recurrence:

• Studies have found that maintenance therapy with sucralfate can significantly reduce the risk of ulcer recurrence in patients with a history of duodenal ulcers.
• The drug has been effective in preventing stress ulcers in critically ill patients.

While individual results may vary, sucralfate remains a valuable option in the management of various gastrointestinal conditions.

Sucralfate in Special Populations

The use of sucralfate may require special considerations in certain patient populations. How should sucralfate be used in pediatric patients, pregnant women, and those with kidney disease?

Pediatric Use

While sucralfate is sometimes used in pediatric patients, special care is needed:

• Dosage should be carefully determined by a pediatrician based on the child’s age, weight, and specific condition.
• The safety and efficacy of sucralfate in children under 14 years old have not been fully established.
• Parents should closely monitor their children for any side effects or unusual symptoms.

Use During Pregnancy and Breastfeeding

The safety of sucralfate during pregnancy and breastfeeding is not fully established:

• Pregnant women should only use sucralfate if the potential benefits outweigh the risks.
• It’s unknown if sucralfate passes into breast milk. Breastfeeding mothers should consult their healthcare provider before using this medication.

Use in Patients with Kidney Disease

Patients with kidney disease may require special precautions when using sucralfate:

• The aluminum in sucralfate may accumulate in patients with impaired kidney function.
• Dosage adjustments may be necessary for patients with severe kidney disease.
• Regular monitoring of aluminum levels may be required in long-term use for patients with kidney problems.

Comparing Sucralfate to Other Ulcer Treatments

Sucralfate is one of several options available for treating ulcers and other gastrointestinal conditions. How does it compare to other common treatments?

Sucralfate vs. Proton Pump Inhibitors (PPIs)

• Mechanism: Sucralfate forms a protective barrier, while PPIs reduce stomach acid production.
• Efficacy: Both are effective in treating ulcers, but PPIs may work faster in some cases.
• Side effects: Sucralfate generally has fewer systemic side effects compared to PPIs.

Sucralfate vs. H2 Receptor Antagonists

• Mechanism: Sucralfate protects the ulcer site, while H2 blockers reduce acid production.
• Efficacy: Studies have shown similar healing rates for duodenal ulcers.
• Usage: Sucralfate may be preferred in patients who can’t tolerate or don’t respond well to H2 blockers.

Sucralfate vs. Antacids

• Duration of action: Sucralfate provides longer-lasting protection compared to antacids.
• Usage: Sucralfate is typically used for treatment and prevention, while antacids are often used for quick symptom relief.
• Prescription: Sucralfate requires a prescription, unlike many over-the-counter antacids.

The choice between these treatments often depends on the specific condition, severity of symptoms, and individual patient factors. Your healthcare provider can help determine the most appropriate treatment option for your situation.

Long-term Use and Monitoring of Sucralfate Therapy

While sucralfate is generally well-tolerated, long-term use may require certain considerations and monitoring. What should patients and healthcare providers be aware of during extended sucralfate therapy?

Monitoring During Long-term Use

• Regular check-ups: Patients should visit their healthcare provider for periodic evaluations to assess treatment effectiveness and monitor for any side effects.
• Symptom assessment: It’s important to report any persistent or worsening symptoms, as this may indicate a need for treatment adjustment.
• Aluminum levels: In patients with kidney disease, long-term use may require monitoring of blood aluminum levels.
• Nutrient absorption: Sucralfate may affect the absorption of certain nutrients, so long-term users may need to have their nutritional status assessed periodically.

Considerations for Prolonged Therapy

For patients requiring long-term sucralfate treatment:

• Dosage adjustments: The dosage may be reduced for maintenance therapy after initial healing of ulcers.
• Drug holidays: In some cases, intermittent therapy or drug holidays may be considered to minimize potential long-term effects.
• Alternative treatments: For very long-term use, healthcare providers may consider alternating sucralfate with other ulcer treatments to reduce the risk of side effects.

It’s crucial for patients to maintain open communication with their healthcare providers throughout their treatment journey, reporting any changes in symptoms or concerns about long-term use.

Sucralfate (Oral Route) Description and Brand Names

Description and Brand Names

Drug information provided by: IBM Micromedex

US Brand Name

1. Carafate

Canadian Brand Name

1. Sulcrate Suspension Plus

Descriptions

Sucralfate is used to treat and prevent duodenal ulcers and other conditions as determined by your doctor. It works by forming a barrier or coat over the ulcer. This protects the ulcer from the acid of the stomach, allowing it to heal. Sucralfate contains an aluminum salt.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

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.

Sucralfate oral suspension

What is this medicine?

SUCRALFATE (SOO kral fate) helps to treat ulcers of the intestine.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Carafate

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• kidney disease
• an unusual or allergic reaction to sucralfate, other medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should I use this medicine?

Take this medicine by mouth with a glass of water. Follow the directions on the prescription label. Shake well before using. Use a specially marked spoon or container to measure your medicine. Ask your pharmacist if you do not have one. Household spoons are not accurate. This medicine works best if you take it on an empty stomach, 1 hour before meals. Take your doses at regular intervals. Do not take your medicine more often than directed. Do not stop taking except on your doctor’s advice.

Talk to your pediatrician regarding the use of this medicine in children. Special care may be needed.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

• antacid
• cimetidine
• digoxin
• ketoconazole
• phenytoin
• quinidine
• ranitidine
• some antibiotics like ciprofloxacin, norfloxacin, and ofloxacin
• theophylline
• thyroid hormones
• warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular check ups. Let your doctor know if your symptoms do not improve or if you feel worse.

Antacids should not be taken within one half hour before or after this medicine.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
• difficulty breathing

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• back pain
• constipation
• drowsy, dizzy
• dry mouth
• headache
• stomach upset, gas
• trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F). Keep container tightly closed. Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

The Use of Sucralfate Suspension in the Treatment of Oral and Genital Ulceration of Behçet Disease: A Randomized, Placebo-Controlled, Double-blind Study | Ophthalmology | JAMA Dermatology

Objective 
To determine the efficacy of topically applied sucralfate suspension in the treatment of oral and genital ulceration of Behçet disease.

Design and Setting 
A randomized, placebo-controlled, double-blind study at a university referral center.

Patients 
Forty patients with Behçet disease were included in the study.

Intervention 
Patients were given topical sucralfate or placebo 4 times a day for 3 months and examined clinically at biweekly intervals.

Main Outcomes Measures 
For each lesion, the mean frequency, healing time, and pain were evaluated during the pretreatment, treatment, and follow-up periods. No patients were given any concurrent disease-specific or immunosuppressive topical and systemic drugs during the 9-month study period.

Results 
Of the 40 patients included in the study, the results in 30 patients (16 patients treated with sucralfate and 14 patients treated with placebo, ranging in age from 16 to 52 years [mean±SD age, 34.3±8.1 years]) were evaluable for efficacy. Treatment with sucralfate decreased significantly the mean frequency, healing time, and pain of oral ulceration and healing time and pain of genital ulceration compared with the pretreatment period. The effectiveness of sucralfate on the frequency and healing time of oral ulceration continued during the posttreatment period. In the placebo group, no significant difference was found in measured parameters of oral and genital ulceration except the pain of the oral ulceration between the pretreatment and treatment periods.

Conclusion 
Our results showed that topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment for oral and genital ulceration in patients with Behçet disease.

Behçet Disease (BD) was first described in 1937 by Behçet¹ as a trisymptom complex characterized by recurrent oral ulceration (OU), genital ulceration (GU), and uveitis. Later studies² have shown that BD is a multisystemic inflammatory disease with articular, vascular, intestinal, pulmonary, and neurologic involvement. The cause of BD is still unknown. The most likely hypothesis is that an autoimmune reaction is triggered by infectious (viral or bacterial) or other antigens in genetically predisposed individuals, and the basic pathologic process of BD is vasculitis. ^2-4

The most common mucocutaneous lesions in BD are recurrent and painful ulceration of the oral and genital mucosa. The lesions are punched-out ulcers with rolled or overhanging borders and a necrotic base, surrounded with erythematous rim. No standard therapy has been established yet. The agents, such as topical or intralesional corticosteroids and local anesthetics, are used only for palliative therapy.² Clinical trials² have shown controversial results of the use of colchicine, thalidomide, and dapsone to treat OU and GU. The use of immunosuppressive medications, such as azathioprine⁵ and cyclosporine⁶, which are reserved for the most severe cases, and interferon alfa^7,8 was reported to be effective. However, high cost, toxic effects, the need for parenteral administration, and/or the lack of standard regarding doses or duration have led to a search for alternatives.

Sucralfate, an aluminium salt of sucrose octasulfate, has been successfully used to treat patients with peptic ulcer. ⁹ Because of the ability of sucralfate to augment healing ulcers of the gastrointestinal tract, it may also be useful for the treatment of OU and GU of BD.

The present randomized, double-blind, placebo-controlled study investigated whether the use of topical sucralfate suspension alone is effective in the treatment of OU and GU of BD.

Forty patients with BD (18 female, 22 male; mean±SD age, 34.3±8.1 years; range, 16-52 years), diagnosed according to the criteria of International Study Group for Behçet’s Disease,¹⁰ were included in the study. Patients were excluded if they had an active eye disease or organ involvement requiring systemic therapy or received recent systemic therapy for at least 12 weeks and topical therapy for at least 4 weeks prior to the study.

The patients were observed for 3 months before the study. The incidence of OU and GU was recorded during this period. The research protocol was approved by the ethics committees, and all patients or their guardians gave their informed consent. The patients in the study were randomly allocated to equal treatment groups. The vehicle of sucralfate that was used as placebo was identical in appearence to the sucralfate suspension. For 3 months, the patient groups received sucralfate or placebo 4 times a day to treat OU and GU. All patients with or without OU were given 5 mL of sucralfate or placebo to use as an oral rinse for 1 to 2 minutes after routine mouth care and before sleep. In patients with GU, either sucralfate or placebo solution was applied to external lesions using a cotton-tipped applicator and to intravaginal lesions using a vaginal douche. The clinical investigator (H.E.) and patients were unaware of the specific drugs that the patients were taking during the course of the study. The patients were examined clinically at biweekly intervals and were followed up for another 3 months after the treatment. The results were obtained by the same investigator and were based on a combination of the data obtained by the physician at clinic visits and the data reported by the patients on the occurrence of OU and GU between the visits. For each lesion, the mean frequency, healing time, and pain were evaluated during the pretreatment, treatment, and follow-up periods. The mean frequency and healing time of lesions were calculated per patient. The level of pain was scored on a scale of 0 to 3 (0, absent; 1, mild; 2, moderate; and 3, severe). The following pain scores were based on a system devised in our department for patients with BD. For OU: 0, no symptoms; 1, mild pain with eating, drinking, and/or speaking; 2, moderate pain and partial difficulty eating, drinking, and/or speaking; and 3, severe pain and marked difficulty eating, drinking, and/or speaking. For GU: 0, no symptoms; 1, mild pain with physical activity; 2, moderate pain and partial difficulty with physical activity; and 3, severe pain and marked difficulty with physical activity. In addition, the overall responses at the end of the treatment period were graded as follows: improvement, decrease in the mean frequency, shortening of healing time, or relief of pain; and no effect or deterioration, ineffectiveness or worsening of clinical signs and symptoms.

Adverse events were also documented during the treatment period. No patients were given any concurrent disease-specific or immunosuppressive topical and systemic drugs during the 9-month study period.

Mean frequency, healing time, and pain of OU and GU in the pretreatment period were compared in the treatment and posttreatment periods in the sucralfate and placebo groups, and the paired Student t test was used to test the changes in the groups. Differences in improvement ratings between groups were tested using the χ²test.

Of the 40 patients in the study, the results in 30 patients were evaluable for efficacy. The demographic data of these patients are shown in Table 1. Treatment groups were similar regarding sex, age, and duration of disease.

Ten patients (4 sucralfate-treated patients and 6 placebo-treated patients) failed to complete the study. The reasons for their withdrawal were noncompliance (3 patients) and using prohibited concomitant medication (2 patients). The therapy in 2 patients in the sucralfate group and 3 patients in the placebo group was discontinued because of disease progression. In all patients, medication use was well tolerated, and no patients were withdrawn from the study because of adverse events.

Mean frequency, healing time, and pain values of OU and GU for both treatment groups and statistical results are summarized in Table 2. The groups were not significantly different in measured disease parameters at the beginning of the study. Treatment with sucralfate decreased significantly the mean frequency, healing time, and pain of OU and the healing time and pain of GU compared with the pretreatment period. In the placebo group, no significant difference was found in measured OU and GU parameters except the pain of OU between the pretreatment and treatment periods.

In the follow-up period, there was a significant difference for only mean frequency and healing time of OU for the patients treated with sucralfate compared with the pretreatment period.

The overall responses of patients with OU and GU associated with BD at the end of the treatment period are summarized in Table 3. In patients with OU, the difference in improvement ratings between therapy with sucralfate and placebo was statistically significant. Although, there was clinical improvement in healing time and pain of GU, the difference was not statistically significant (Table 3).

Sucralfate is widely used in the treatment of ulcers of the gastrointestinal tract. Although the mechanism of action of this drug is still not fully known, we know that it binds to ulcerated tissue and forms a barrier to acid without altering stomach pH or reducing the secretion of gastric acid.¹¹ Sucralfate induces proliferation of dermal fibroblasts and keratinocytes as well as granulation tissue formation.¹² Sucralfate stimulates mucus production and enhances binding of growth factors, including epidermal growth factor, which may play a role in healing.¹³ Sucralfate also activates both the nitric oxide and prostaglandin systems that cooperate in the protective action of this drug.^13,14 The nitric oxide system may contribute to mucosal integrity and preservation of mucosal microcirculation.¹⁴ Because of its antioxidant effects,¹⁵ sucralfate may play a role not only in the healing of damaged mucosa but also in the protection of mucosal surfaces.

Previous studies also reported positive results from the use of sucralfate suspension in patients with stomatitis,¹⁶ chemotherapy-induced oral mucositis,^17,18 and vaginal ulceration.¹⁹ In another study, Rattan et al²⁰ showed the effectiveness of sucralfate suspension in the treatment of recurrent aphthous stomatitis. They demonstrated a reduction of the healing period, duration of pain, response time to first treatment, and duration of remission in patients using sucralfate compared with placebo and antacid.

Our results showed that sucralfate therapy decreased significantly the frequency, healing time, and pain of OU and the healing time and pain of GU in patients with BD. The effectiveness of the sucralfate on the frequency and healing time of OU continued during the posttreatment period. These results indicated that the continuous use of sucralfate suspension had a protective effect against the development of OU, and it can be given as a prophylactic for OU associated with BD.

One of the most striking results of the present study was the marked decrease in pain scores in both groups. Although the percentage decrease was higher in the sucralfate group, this finding indicates that coating agents are helpful in the palliation of pain, a finding that was also noted by Barker et al.²¹

Since studies have demonstrated the noteworthy effects of sucralfate in the healing and prevention of oral mucositis, stomatitis, and vaginal ulceration, it is possible that sucralfate will have a similar effect in the oral and genital environment and in stratified squamous mucosa. In our study, the use of sucralfate suspension increased patient compliance and represented a major therapeutic advance and practical use, especially in the treatment of OU.

In conclusion, topical sucralfate suspension is an easy, safe, inexpensive, and effective treatment for OU and GU associated with BD. To our knowledge, the use of sucralfate in patients with BD has not been reported in the literature.

Accepted for publication January 14, 1999.

The study was presented at the Congress of the Seventh European Academy of Dermatology and Venereology, Nice, France, October 10, 1998.

We thank Bilim Ilaç Sanayii ve Ticaret AŞ, Antalya, Turkey, for supplying both placebo and sucralfate suspensions for the study.

Corresponding author: Erkan Alpsoy, MD, Akdeniz University School of Medicine, Department of Dermatology, 07070 Antalya, Turkey (e-mail: [email protected]).

1.Behçet
 H Über rezidivierende, aphthöse, durch ein Virus verursachte Geschwüre, am Mund, am Auge, und an den Genitalien.  Dermatol Wochenschr. 1937;1051152- 1157Google Scholar2.Jorizzo
 JL Behcet’s disease. Fitzpatrick
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 TSuzuki
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 H Etiopathology of Behçet disease: immunological aspects.  Yonsei Med J. 1997;38350- 358Google Scholar5.Yazici
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 E Interferon therapy for Behcet’s disease.  J Am Acad Dermatol. 1994;31617- 619Google ScholarCrossref 8.Zouboulis
 CCOrfanos
 CE Treatment of Adamantiades-Behçet disease with systemic interferon alfa.  Arch Dermatol. 1998;1341010- 1016Google ScholarCrossref 9.McHardy
 GG A multicenter, double-blind trial of sucralfate and placebo in duodenal ulcer.  J Clin Gastroenterol. 1981;3147- 152Google ScholarCrossref 10.International Study Group for Behçet’s Disease, Criteria for diagnosis of Behçet’s disease.  Lancet. 1990;3351078- 1080Google Scholar11.Garnett
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Carafate (sucralfate) dosing, indications, interactions, adverse effects, and more

SUCRALFATE SUSPENSION – ORAL

(sue-KRAL-fate)

COMMON BRAND NAME(S): Carafate

USES: This medication is used to treat ulcers in the intestines. Sucralfate forms a coating over ulcers, protecting the area from further injury. This helps ulcers heal more quickly.

HOW TO USE: Shake the bottle well before each dose. Take this medicine by mouth, usually 2 teaspoonfuls 4 times daily, on an empty stomach at least 1 hour before a meal, or as directed by your doctor.The dosage is based on your medical condition and response to therapy.Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. It is important to continue taking this medication even if you do not feel ulcer pain. Do not stop taking this medication without consulting your doctor. It may take 4 to 8 weeks for your ulcer to heal completely.Some medications may not work as well if you take them at the same time as sucralfate. They may need to be taken at a different time of the day than the time you take sucralfate. Ask your doctor or pharmacist for help making a dosing schedule that will work with all your medications.Antacids can be used with this medicine, but they should be taken at least 30 minutes before or after sucralfate.Inform your doctor if your condition persists or worsens after you have been taking sucralfate for 4 weeks.

SIDE EFFECTS: Constipation, dry mouth, upset stomach, gas, and nausea may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if these unlikely but serious side effects occur: an unusual/persistent feeling of fullness in the stomach, nausea/vomiting/stomach pain especially after meals.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking sucralfate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, stomach/intestine problems (e.g., delayed gastric emptying), tube feeding.Kidney function declines as you grow older. This medication contains aluminum, which is normally removed by your kidneys. Elderly people may be at greater risk for developing high aluminum levels while using this drug with other products that contain aluminum (e.g., antacids).If you are pregnant, tell your doctor before using sucralfate.It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.Some products that may interact with this drug include: antacids that contain aluminum, certain antibiotics (including quinolones such as ciprofloxacin/levofloxacin/ofloxacin, tetracyclines), digoxin, ketoconazole, penicillamine, phenytoin, quinidine, thyroid medications (such as levothyroxine, liothyronine).

OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Your doctor may recommend some lifestyle changes such as stress-reducing programs, diet changes and exercise to assist in treatment and prevention of ulcers. This medicine should not be injected into your veins. Do not share this medication with others.

MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Sucralfate – StatPearls – NCBI Bookshelf

Continuing Education Activity

Sucralfate is a medication used to treat duodenal ulcers, epithelial wounds, chemotherapy-induced mucositis, radiation proctitis, ulcers in Behcet disease, and burn wounds. Sucralfate exhibits its action by forming a protective layer, increasing bicarbonate production, exhibiting anti-peptic effects, promoting tissue growth, regeneration, and repair. The most common side effect seen with this drug is constipation. Some of the more severe side effects are hypophosphatemia, aluminum intoxication seen in end-stage disease patients. The medication has a relatively safe profile as there is negligible absorption from the enteral system. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, toxicity, and monitoring, of sucralfate, so providers can direct patient therapy in conditions where it has therapeutic benefit as part of the interprofessional team.

Objectives:

• Identify the mechanism of action of sucralfate.

• Describe the adverse effects of sucralfate.

• Review the toxicity of sucralfate.

• Summarize interprofessional team strategies for improving care coordination and communication to advance sucralfate use and improve outcomes.

Access free multiple choice questions on this topic.

Indications

Sucralfate is a unique anti-ulcer drug. It is a basic aluminum salt of sucrose octasulfate. The labeled use of sucralfate is as below:

Treatment of duodenal ulcer: Sucralfate is FDA approved for the treatment of duodenal ulcers up to 8 weeks (short term). Duodenal ulcers are treated with 1g four times daily for eight weeks, followed by 1 g twice daily for maintenance therapy. The efficacy of sucralfate in the treatment of duodenal ulcers is shown to be comparable to that of cimetidine and intensive antacid therapy.[1] Sucralfate forms a protective coat and protects the gastric mucosa from pepsin, pectic acid, and bile salts. It binds to positively charged proteins in exudates, forming a thick viscous substance locally. 

Sucralfate has also been used to treat various other conditions that are non-FDA approved, as outlined below.

1. Dyspepsia: It is shown to reduce the frequency and intensity of dyspeptic symptoms during NSAID therapy, and the efficacy is similar to that of an H-2 receptor blocker.[2] 
2. Treatment of epithelial wounds: Sucralfate has also seen use as a topical drug in treating various epithelial wounds such as ulcers, inflammatory dermatitis, mucositis, and burns wounds. Several studies have been conducted to study the efficacy of sucralfate in the treatment of epithelial wounds. A study done by Tsakayannis et al. showed that the venous ulcer that failed conventional therapy responded to treatment with topical sucralfate.[3] Sucralfate increases the bio-availability of growth factors, especially fibroblast growth factor (FGF), which has a pivotal role in angiogenesis and, in turn, promotes epithelial wound healing.  

3. Treatment of chemotherapy-induced mucositis: A study done by McCullough showed that high potency sucralfate accelerates the activation of growth factor and is useful in treating chemotherapy-induced mucositis of the oropharynx and alimentary tract. This resulted from administering 1.5 g of sucralfate three times daily at the onset of mucositis for two days, followed by 1.5 g two times daily throughout the course of cancer therapy and two weeks after the completion of treatment. 

4. Treatment of radiation proctitis: Sucralfate paste enema has shown clinical improvement in hemorrhagic radiation proctitis treatment. This therapy uses a low volume paste in an enema applicator, and pre and post-treatment improvements were assessed using clinical proctitis scores with a positive outcome.[4] A study done by Kocchar et al. has shown that sucralfate enema is better than oral sulfasalazine in the short-term treatment of radiation proctitis.[5]
5. Prevention of ulceration of diversion colitis: The use of enemas containing sucralfate is shown to preserve the mucus layer covering the epithelium, thereby reducing inflammation in diversion colitis. The concentration of sucralfate used in the enema is 2 g/kg/day.[6] 
6. Stress ulcer prophylaxis in ventilated patients: Research has shown that sucralfate is better for stress ulcer prophylaxis when compared to H-2 blockers or antacids in patients receiving ventilation therapy as the latter increases the pH of gastric contents causing stagnation of gram-negative bacilli and subsequently increasing the risk of nosocomial pneumonia.[7]

7. Behcet Disease: Topical sucralfate 1 g/5mL four times daily alone or in combination with topical corticosteroids reduced pain and promotes healing of oral ulcers in Behcet disease. Sucralfate in the form of suspension is the dosage form for the treatment of oral ulcers in Behcet disease.

Mechanism of Action

The principal action of sucralfate is unknown. The following actions of sucralfate have been the object of study in vitro, but the in vivo actions remain unknown[2]: 

1. Antipeptic effects – It prevents hydrolysis by preventing the formation of the enzyme-substrate complex. It adsorbs to pepsin and decreases its concentration.

2. Site-protective effects – By forming a polyanion gel, it acts as a physical barrier between luminal contents and mucosa.

3. Effects on mucus – Increases mucous hydrophobicity, viscosity, sulfation, and aluminum and carbohydrate content, which leads to improved mucosal protection from acid. It also increases the production of mucus by increasing prostaglandin production. Sucralfate prevents the breakdown of mucus by pepsin A, reducing ulcerogenesis.

4. Effect on bicarbonate output – It increases prostaglandin-dependent and independent production of bicarbonate by stomach and duodenum. 

5. Effects on tissue growth, regeneration, and repair – It binds epidermal growth factor and tissue growth factor to tissues and facilitates repair. 

Administration

Sucralfate administration can be via oral, rectal, and topical routes:

1. Oral forms:

   • Tablet – Sucralfate is a basic aluminum salt of sucrose octasulfate. When given orally, it disintegrates in the stomach in the presence of acid and binds to normal and damaged mucosa forming a protective layer. It releases aluminum and binds to positively charged compounds like proteins, peptides, glycoproteins, and glycolipoproteins, forming an adhesive layer, thereby protecting the mucosa. The onset of action is within 1 to 2 hours, and 1 g of sucralfate can neutralize 14 to 16 mEq of acid. The tablets are available as 1 g tablets.

   • Suspension: Suspension is available as 1 g/10 mL or 500 mg/5mL. 

2. Rectal: Sucralfate tablets have been mixed with water to form a sucralfate paste enema: 2 tablets (that is 2g of sucralfate) mixed with 4.5 ml of water and is an option in the treatment of hemorrhagic radiation proctitis. Sucralfate enema is also useful in solitary rectal ulcer syndrome and diversion colitis.

3. Topical: Sucralfate is used topically in the treatment of skin conditions and also for mucosal ulcers. 

Adverse Effects

Sucralfate acts locally with negligible absorption making it relatively safe. The most common side effect is constipation seen in 1-10% of patients. Hyperglycemia is also reported in diabetic patients using sucralfate. Some of the other negligible side effects are nausea, vomiting, flatulence, headache, dry mouth, pruritis, skin rash, gastric bezoar formation, aluminum intoxication, hypophosphatemia. Inadvertent IV use of sucralfate has caused fatal complications such as pulmonary emboli and cerebral edema.

Long-term users of sucralfate are shown to retain aluminum that is negligible, except when a patient has renal insufficiency. Uremia causes increased absorption of aluminum from the gut, and the quantity of aluminum absorbed is similar to that of aluminum hydroxide. Sucralfate should be used with caution in patients with end-stage renal disease or avoided altogether to prevent aluminum intoxication.[2][8]

Sucralfate has several drug interactions and can decrease the serum concentrations of digoxin, levothyroxine, furosemide, quinolones, oral phosphate supplements, warfarin, antiretrovirals like raltegravir, bisphosphonates, among others. Sucralfate administration should have at least a 2-hour gap from the administration of these medications. Multivitamins can increase the serum concentration of sucralfate and aluminum. A few medications like antacids administered within 15 minutes of sucralfate can reduce its efficacy by decreasing the binding ability of sucralfate to gastric ulcers.

Contraindications

Documented hypersensitivity to sucralfate is an absolute contraindication as it can cause an anaphylactic reaction. Some of the relative contraindications include end-stage renal disease, uncontrolled diabetes mellitus with hyperglycemia, impaired swallowing/gag reflex. Sucralfate was an FDA category B medication under the prior pregnancy classification system, and its safety in pregnancy, during breastfeeding, and in infants is not established.

Monitoring

No therapeutic monitoring has been recommended for this medication as it undergoes minimal absorption from the enteral system.

Toxicity

Risks associated with sucralfate overdosing are minimal as sucralfate has minimal absorption from the gastrointestinal system; many patients that overdosed on sucralfate remained asymptomatic. Due to the small amount of aluminum absorbed with oral intake of sucralfate, it can cause aluminum accumulation and toxicity in patients with chronic kidney disease or those receiving dialysis.

Enhancing Healthcare Team Outcomes

Patient satisfaction and relief of symptoms are very valuable to caregivers in the age of medicine. Managing the side effects of chemotherapy and radiation has become a challenge and encountered more often by physicians with new treatment regimens and prolonged survival of oncology patients. The incidence of peptic ulcer disease is also on the rise, with population migration from regions endemic to Helicobacter pylori, lifestyle changes, and overuse of pain medications like NSAIDs. Understanding and using medications like sucralfate requires the effort of an interprofessional healthcare team, including clinicians, mid-level practitioners, nurses, and pharmacists can provide the best patient outcomes. [Level 5]

References

1.

Garnett WR. Sucralfate–alternative therapy for peptic-ulcer disease. Clin Pharm. 1982 Jul-Aug;1(4):307-14. [PubMed: 6764389]

2.

McCarthy DM. Sucralfate. N Engl J Med. 1991 Oct 03;325(14):1017-25. [PubMed: 1886624]

3.

Masuelli L, Tumino G, Turriziani M, Modesti A, Bei R. Topical use of sucralfate in epithelial wound healing: clinical evidences and molecular mechanisms of action. Recent Pat Inflamm Allergy Drug Discov. 2010 Jan;4(1):25-36. [PubMed: 19832693]

4.

McElvanna K, Wilson A, Irwin T. Sucralfate paste enema: a new method of topical treatment for haemorrhagic radiation proctitis. Colorectal Dis. 2014 Apr;16(4):281-4. [PubMed: 24299100]

5.

Kochhar R, Patel F, Dhar A, Sharma SC, Ayyagari S, Aggarwal R, Goenka MK, Gupta BD, Mehta SK. Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate. Dig Dis Sci. 1991 Jan;36(1):103-7. [PubMed: 1670631]

6.

Fernandez OOA, Pereira JA, Campos FG, Araya CM, Marinho GE, Novo RS, Oliveira TS, Franceschi YT, Martinez CAR. EVALUATION OF ENEMAS CONTAINING SUCRALFATE IN TISSUE CONTENT OF MUC-2 PROTEIN IN EXPERIMENTAL MODEL OF DIVERSION COLITIS. Arq Bras Cir Dig. 2017 Apr-Jun;30(2):132-138. [PMC free article: PMC5543793] [PubMed: 29257850]

7.

Driks MR, Craven DE, Celli BR, Manning M, Burke RA, Garvin GM, Kunches LM, Farber HW, Wedel SA, McCabe WR. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. The role of gastric colonization. N Engl J Med. 1987 Nov 26;317(22):1376-82. [PubMed: 2891032]

8.

Burgess E. Aluminum toxicity from oral sucralfate therapy. Nephron. 1991;59(3):523-4. [PubMed: 1758558]

Sucralfate – Oral | HealthLink BC

Pronunciation: soo-KRAL-fate

Common Brand Name(s): Cytogard, Sulcrate

Important: How To Use This Information

This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Uses

This medication is used to treat and prevent ulcers in the intestines. Sucralfate forms a coating over ulcers, protecting the area from further injury. This helps ulcers heal more quickly.

Other Uses

This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used for ulcers in the stomach. It may also be used to lessen the risk of ulcers caused by aspirin or other anti-inflammatory drugs (such as ibuprofen, naproxen).

How To Use

Take this medicine by mouth, usually 2 to 4 times daily, on an empty stomach at least 1 hour before a meal, or as directed by your doctor.

The dosage is based on your medical condition and response to therapy.

Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. Keep taking this medication even if you do not feel ulcer pain. Do not stop taking this medication without consulting your doctor. It may take 4 to 8 weeks for your ulcer to heal completely.

Some medications may not work as well if you take them at the same time as sucralfate. They may need to be taken at a different time of the day than the time you take sucralfate. Ask your doctor or pharmacist for help making a dosing schedule that will work with all your medications.

Antacids can be used with this medicine, but they should be taken at least 30 minutes before or after sucralfate.

Inform your doctor if your condition persists or worsens after you have been taking sucralfate for 4 weeks.

Side Effects

Constipation, dry mouth, upset stomach, gas, and nausea may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including:

• an unusual/persistent feeling of fullness in the stomach
• nausea/vomiting/stomach pain especially after meals
• difficulty swallowing

A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US –

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking sucralfate, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• kidney problems
• swallowing problems (such as difficulty swallowing, history of aspiration)
• stomach/intestine problems (e.g., delayed gastric emptying)
• tube feeding
• use of a breathing tube (tracheotomy)

Kidney function declines as you grow older. This medication contains aluminum, which is normally removed by your kidneys. Therefore, elderly people may be at greater risk for developing high aluminum levels while using this drug with other products that contain aluminum (e.g., antacids).

If you are pregnant, tell your doctor before using sucralfate.

It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.

Drug Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include:

• antacids that contain aluminum
• certain antibiotics (for example, quinolones such as ciprofloxacin/levofloxacin/ofloxacin, tetracyclines)
• digoxin
• ketoconazole
• penicillamine
• phenytoin
• quinidine
• thyroid medications (such as levothyroxine, liothyronine)

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Your doctor may recommend some lifestyle changes such as stress-reducing programs, diet changes and exercise to assist in treatment and prevention of ulcers.

Do not share this medication with others.

Missed Dose

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Sucralfate 300 Mg/Ml Oral Suspension – Equine Gastrointestinal For Veterinarian Use

Sucralfate For Equine GI Ulcers 

Equine gastric ulcer syndrome (EGUS) is often said to be one of the most misdiagnosed and mistreated conditions in equine medicine. This is interesting, given the advancements in diagnostic technology and veterinary medicine overall in recent years. Still, however, a definitive diagnosis of EGUS in any given horse often remains elusive until the animal’s overall health has been significantly compromised.

The word “gastritis” is the general term used to describe inflammation and/or irritation of the stomach lining, but this is actually a condition caused by an underlying disease process. Gastric ulcers are highly prevalent in horses, and result in decreased performance and loss of revenue. The prevalence of EGUS in domesticated horses is high, with its prevalence in performance horses (such as Thoroughbreds in race training) running as high as 70 to 94%.¹

How Do Horses Wind Up With GI Ulcers?

A horse’s stomach lining consists of two different tissue types:

• The Squamous mucosa (which includes the top half of the horse’s stomach)
• The Glandular mucosa (which includes the bottom half of the stomach)

Ulcers can occur in either of these locations, but they are much more common in the squamous mucosa, which is similar to the lining of the esophagus. While the glandular mucosa contains acid-producing cells, most equine gastric ulcers affect the squamous mucosa.² Exposure to excess acid is the principal mechanism responsible for squamous mucosal ulceration.

Gastric ulcers are sometimes accompanied by hindgut or colonic ulcers. While gastric ulcers are found in the stomach, colonic ulcers are lesions that occur in the hindgut. Horses are known as “hindgut fermenters.” This means that the horse ferments forage in its colon to create Volatile Fatty Acids which produce the majority of a horse’s energy. The risk for colonic ulcers is even greater in performance horses and those that are already suffering from gastric ulcers.² As with gastric ulcers, colonic ulcers occur when the mucosal lining of the affected area is compromised.

Clinical Signs of Gastric Ulcers in the Horse

The clinical signs of EGUS in horses vary, and typically include anorexia and chronic or intermittent colic.¹ “Many horses with endoscopic evidence of disease may appear to be clinically normal or have vague signs that include decreased consumption of concentrates, postprandial episodes of colic, poor performance or failure to train up to expectations, poor quality hair coat, and decreased condition or failure to thrive.”³ Diarrhea is not typically associated with gastric ulceration in horses, but can occur in cases of colonic ulcers.²

Although a diagnosis of EGUS can be suspected based upon clinical signs and response to treatment, the only current method of confirmation is via gastroscopy, which can easily be performed in the standing horse with mild sedation after a 12-18 hour fast.

Treatment of EGUS

Many treatments have been used for EGUS in horses. Since acid is the essential culprit in the case of squamous ulcer disease, most anti-ulcer therapy centers on decreasing gastric acid.¹ The principal therapeutic options for ulcer treatment include H² antagonists such as cimetidine, ranitidine and famotidine), proton pump inhibitors (or PPIs) such as omeprazole, pantoprazole and esomeprazole), and the mucosal adherent sucralfate.

Sucralfate has been widely used in treating ulcers affecting the glandular part of the stomach in horses. Its effects are local rather than systemic and it does not affect production of gastric acid. Sucralfate has often been used to treat oral, esophageal, gastric, and duodenal ulcers and to prevent drug (eg, aspirin)-induced gastric erosions.

After oral administration, sucralfate may react with hydrochloric acid in the stomach to form a paste-like complex that preferentially binds to the proteinaceous exudates that are generally found at ulcer sites. Sucralfate may have some cytoprotective effects, possibly by stimulation of prostaglandin E₂ and I₂. It also has some antacid activity, although this may not be of clinical importance. Sucralfate may also bind to intact GI mucosa to form a protective layer.⁴

Sucralfate is contraindicated in patients with known hypersensitivity to it, and has several drug interaction warnings. Because it may cause constipation, it should be used with caution in animals in which decreased GI transit times might be deleterious.³ Otherwise, no contraindications nor serious adverse effects have been reported.

Sucralfate Dosages for Horses

As a GI-mucosal protectant, Plumb’s Veterinary Drugs recommends 10 – 20 mg/kg PO of sucralfate every 6 to 8 hours. This is said to be advisable particularly in the case of preventing stress-induced ulcers in foals. For the treatment of right dorsal colitis (colonic ulcers), 22 mg/kg PO of sucralfate every 6 to 8 hours is recommended. For the treatment of gastric glandular disease, 12 mg/kg PO of sucralfate twice daily is recommended. As an adjunct, 4 mg/kg PO of omeprazole once daily resulted in gastroscopic healing in 20% of horses as compared with 72% of misoprostol-treated horses in a study.

Where to buy Sucralfate

Sucralfate is available in the U.S. through several pharmaceutical manufacturers and through veterinary custom compounding companies. SUCRALFATE 300 MG/ML ORAL SUSPENSION is a superior medication for the treatment of ulcers and esophagitis in the horse, and aids in protecting against GI ulceration.

Please consult your veterinarian prior to beginning any treatment regimen.

FOR RX ONLY: A valid prescription from a licensed veterinarian is required for dispensing this medication.

¹McClure SR, Glickman LT, Glickman NW. Prevalence of gastric ulcers in show horses. Journal of the American Veterinary Medical Association. 1999 Oct;215(8):1130-1133.

²Nadeau, J., et. al. Evaluation of diet as a cause of gastric ulcers in horses. AJVR, Vol 61, No. 7, July 2000.

³Murray MJ. Gastric ulceration in horses: 91 cases (1987-1990). Journal of the American Veterinary Medical Association. 1992 Jul;201(1):117-120.

⁴Plumb’s Veterinary Drugs.

⁵Videla R, Andrews FM. New perspectives in equine gastric ulcer syndrome. Vet Clin North Am Equine Pract. 2009;25(2):283-301.

ENROFLON 10% ORAL SOLUTION instructions for use, composition, indications, contraindications, side effects – oral solution

Enroflon 10% solution for oral administration – a drug for the treatment of bacterial and mycoplasma diseases of calves, lambs, pigs and poultry.

Enrofloxacin, the active ingredient of Enroflon, belongs to the group of fluoroquinolones. Suppresses bacterial DNA gyrase, disrupts DNA synthesis, growth and division of bacteria; causes pronounced morphological changes (incl.including in the cell wall and membranes), which causes the rapid death of the bacterial cell.

Acts bactericidal on gram-negative microorganisms during dormancy and division, on gram-positive microorganisms – only during division.

While using enrofloxacin, there is no parallel development of resistance to other antibiotics that do not belong to the group of gyrase inhibitors. Resistance of microorganisms to enrofloxacin develops relatively slowly, becausethe mechanism of its antimicrobial action is associated with inhibition of replication of the DNA helix in the nucleus of a bacterial cell.

Enrofloxacin has a broad spectrum of antibacterial and antimycoplasmic activity against the majority of gram-positive and gram-negative microorganisms , incl. Escherichia coli, Salmonella spp., Enterobacter spp., Proteus mirabilis, Proteus vulgaris, Haemophilus spp., Klebsiella spp., Pasteurella multocida, Pseudomonas aeruginosa, Bordetella spp., Campylobacter spp., Erysipelothrix spp., Corynebacterium spp., Staphylococcus spp., Streptococcus spp., Actinobacillus spp., Clostridium spp., Fusobacterium spp., Bacteroides spp., And also Mycoplasma spp .. 9000

Enrofloxacin is well and quickly absorbed from the gastrointestinal tract and penetrates into all organs and tissues of the body, with the exception of the nervous tissue. The maximum concentration of enrofloxacin in the blood is reached 1-2 hours after the administration of Enroflon and lasts for 6 hours, and the therapeutic concentration for 24 hours.The concentration of enrofloxacin in blood neutrophils and body tissues is 2-12 times higher than in plasma.

Enrofloxacin is partially metabolized in the liver to form ciprofloxacin, which has antibacterial activity. Fluoroquinolones are excreted from the body mainly in urine and bile.

The low toxicity of enrofloxacin for the cells of the macroorganism is explained by the absence of DNA gyrase in them. Enroflon 10% solution for oral administration according to the degree of exposure to the body belongs to the 4th hazard class (low-hazard substances) according to GOST 12.1.007-76.

instructions, reviews, price in the Pharmacy NTs

Active (active) components of the product

Sodium hyaluronate 2 mg / g and Sucralfate 5 mg / g

Features

Hyaluronic acid is a substance that is naturally synthesized into the human body and is the most important component of connective tissue, in addition to its structure, it helps to restore the soft tissues of the oral cavity by forming a barrier.

Due to the strong astringent action of aluminum, which contains Sucralfate, the gel has the ability to strengthen the soft tissues of the oral cavity and increase their mechanical stability.

A unique combination of components – hyaluronic acid and sucralfate, acts on the affected parts of the oral cavity with gingivitis, periodontitis, stomatitis, orthodontic procedures, radiation therapy, etc.

Product advantages

– Has good adhesion to the affected area

– Gentle in relation to mucous membranes

– Does not bake or change taste

– Pleasant mint taste

– Does not stain tooth enamel

– Permitted pregnant and lactating

– No age restrictions.Allowed for children from birth

– Suitable for professional use

– Manufactured according to GMP standards, ISO

Intended use

CI + AL Gel® Oromucose gel is used for irritations of the soft tissue of the oral cavity at:

– gingivitis;

– periodontitis;

– stomatitis;

– orthodontic procedures;

– radiation therapy;

– ulcers, wounds, injuries of any etiology (periodontal abrasions, tooth extraction, wounds from braces and prostheses, dry mouth, etc.)

Contraindications

Do not use on open wounds (in such cases, apply the gel on the second day)

How to use

After oral hygiene, apply the required amount of gel to the affected area using your finger using light massage movements until a film forms. Keep the gel on the affected area for 5 minutes, then spit out the rest of the gel without rinsing with water.

Use 4 times a day for 3 to 4 weeks.

COMPOSITION: purified water, xylitol, Sodium CMC, polyvinyl alcohol, polycarbophil, sucralfate, hydroxymethyl glycinate Sodium, PEG-40 hydrogenized ricin olea, aroma of m’yati, blue sodium hydroxyl sodium.

Noroflox 10% (oral) 10 ml bottle (O.L.KAR.), Enroflox, price 11 UAH.

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Manufacturer …………………………………………… OLKAR
Release form: 10 ml glass vials

Noroflox 10% – Medicinal product for veterinary use, transparent solution.
The color of the preparation is yellow or light yellow, there is a strong specific odor.

Composition
Content of active ingredients in 1 ml of medicinal product:
enrofloxacin – 100.0 mg;

Presence of excipients – up to 1 ml.

Application
The drug is used to treat a number of diseases in poultry (chickens, ducks, turkeys, chickens).
Noroflox 10% is effective against bacteria sensitive to enrofloxacin, as well as diseases of mycoplasmosis, pseudomonosis, campylobacteriosis, hemophilia, colibacillosis, salmonellosis, pasteurellosis, necrotic enteritis, staphylococcosis, streptococcal poultry.

Dosage
The drug is taken orally at: per 1 kg of weight – 0.10 ml; for 1 liter of water – from 0.5-1 ml.
For poultry, enrofloxacin is added to the water during treatment. Drinking water is prepared fresh every day.
Duration of admission – 3 days. In case of salmonellosis, treatment is 5 days.

Contraindications
While taking the drug, the following rules should be observed:
It is forbidden to treat hens with drugs that lay eggs for individual or mass consumption;
It is forbidden to give the drug together with antacids, theophylline, nitrofurantoin, sucralfate;
It is prohibited to treat poultry with a drug that is sensitive to the substance enrofloxacin;
It is forbidden to take the drug to poultry with a nervous breakdown or any disorders of the growth of cartilage tissue;
The appearance of antagonistic phenomena is possible when mixed with substances
tetracycline, macrolides, chloramphenicol.
Do not take with Marek’s disease vaccine.

Precautions
The consumption of poultry meat is possible only 5 days after the last dose of the drug.