Sucralfate

Sucralfate - a complex of aluminium hydroxide and sulphated sucrose. It acts by protecting the mucosa from acid-pepsin attack.

Uses
Prophylaxis of stress ulceration

Contraindications
Severe renal impairment (CC <10 ml/min)

Administration
• Orally: 1 g suspension 4 hourly
Stop sucralfate when enteral feed commences

How not to use sucralfate
Do not give with enteral feed (risk of bezoar formation)
Do not give ranitidine concurrently (may need acid environment to work)

Adverse effects
Constipation
Diarrhoea
Hypophosphataemia

Cautions
Renal impairment (neurological adverse effects due to aluminium toxicity)

Risk of bezoar formation and potential intestinal obstruction
Interferes with absorption of quinolone antibiotics, phenytoin and digoxin when given orally

Organ failure
Renal: aluminium may accumulate

Renal replacement therapy
CVVH not dialysable, dose as in CC 10–20 ml/min, i.e. half normal dose 2–4 g daily. HD/PD not dialysable CC < 10 ml/min, i.e. 2–4 g daily.