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Cytoprotective Agent — GI Mucosal Protection Pregnancy: Use with caution — minimal absorption; considered safe

Sucralfate (Burns — GI Mucosal Protection)

Brand names: Antepsin

Adult dose

Dose: 1 g four times daily (30 min before meals and at bedtime)
Route: Oral (suspension or tablet)
Frequency: Four times daily
Max: 8 g/day
Sucralfate forms protective barrier over ulcer craters — used as alternative to PPIs for stress ulcer prophylaxis in burns patients who can tolerate oral route. Some studies suggest lower VAP (ventilator-associated pneumonia) risk than PPIs in ICU — maintains gastric acidity, reducing bacterial overgrowth.

Paediatric dose

Dose: 40–80 mg/day/kg
Route: Oral
Frequency: Divided four times daily
Max: 2 g/day (children)
40–80 mg/kg/day in 4 divided doses. Seek specialist opinion.

Dose adjustments

Renal

Avoid in renal impairment — aluminium absorption risk (aluminium toxicity).

Hepatic

No specific adjustment.

Paediatric weight-based calculator

40–80 mg/kg/day in 4 divided doses. Seek specialist opinion.

Clinical pearls

  • STRESS trial (Cook et al.): sucralfate vs. ranitidine — ranitidine superior for ulcer prevention but similar GI bleed rates. PPIs now preferred over both in UK practice.
  • Key clinical advantage: maintains gastric acidity — some studies show reduced VAP in ventilated patients vs. acid suppressants (controversial)
  • Always administer other medications at least 2 hours before or after sucralfate — reduces absorption of most drugs significantly

Contraindications

  • Severe renal impairment (aluminium accumulation)
  • Dysphagia (tablet form — risk of bezoar)

Side effects

  • Constipation (most common)
  • Aluminium toxicity (renal impairment — encephalopathy, osteomalacia)
  • Bezoar formation (rare)
  • Hypophosphataemia (aluminium binds phosphate)

Interactions

  • Reduces absorption of many drugs — administer other medications 2 hours apart: fluoroquinolones, digoxin, phenytoin, warfarin, levothyroxine, ketoconazole

Monitoring

  • GI bleeding signs (malaena, haematemesis)
  • Serum phosphate (aluminium binding)
  • Serum aluminium (long-term use in renal patients)

Reference: BNFc; BNF 90; STRESS Trial (Cook et al.); BBA Burns GI Complication Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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