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INTRODUCTION

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sucralfate (soo-kral-fate)

Carafate, Image not available.Sulcrate

Classification

Therapeutic: antiulcer agents

Pharmacologic: GI protectants

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Indications
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Short-term management of duodenal ulcers. Maintenance (preventive) therapy of duodenal ulcers. Unlabeled Use: Management of gastric ulcer or gastroesophageal reflux. Prevention of gastric mucosal injury caused by high-dose aspirin or other NSAIDs in patients with rheumatoid arthritis or in high-stress situations (e.g., intensive care unit). Suspension: Mucositis/stomatitis/rectal or oral ulcerations from various etiologies.

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Action
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Aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste, which selectively adheres to the ulcer surface. Therapeutic Effects: Protection of ulcers, with subsequent healing.

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Adverse Reactions/Side Effects
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CNS: dizziness, drowsiness. GI: constipation, diarrhea, dry mouth, gastric discomfort, indigestion, nausea. Derm: pruritus, rashes.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Patient/Client-Related Instruction
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  • Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

  • Instruct patient to report troublesome side effects such as severe or prolonged skin reactions (rash, itching) or GI problems (nausea, diarrhea, constipation, gastric pain, indigestion, dry mouth).

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Pharmacokinetics
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Absorption: Systemic absorption is minimal (<5%).

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Distribution: Unknown.

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Metabolism and Excretion: >90% is eliminated in the feces.

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Half-life: 6–20 hr.

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TIME/ACTION PROFILE (mucosal protectant effect)

ROUTE ONSET PEAK DURATION

PO

1–2 hr

unknown

6 hr

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity.

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Use Cautiously in: Renal failure (accumulation of aluminum can occur).

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Interactions
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Drug-Drug: May ↓ the absorption of phenytoin, fat-soluble vitamins, or tetracycline. Concurrent antacids, cimetidine, or ranitidine ↓ the effectiveness of sucralfate. ↓ absorption of fluoroquinolones (separate administration by 2 hr).

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Route/Dosage
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Treatment of Ulcers
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PO (Adults): 1 g qid, 1 hr before meals and hs; or 2 g bid, on waking and hs.

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Prevention of Ulcers
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PO (Adults): 1 g bid, 1 hr before a meal.

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Gastroesophageal Reflux
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PO (Adults): 1 g qid, 1 hr before meals and hs (unlabeled).

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PO (Children): 40–80 mg/kg/day divided q 6 hr, 1 hr before meals and hs (unlabeled).

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Stomatitis
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PO (Adults and Children): 5–10 mL of suspension swish and spit or swish and swallow qid.

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