Sucralfate: Difference between revisions

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included new use -- button battery ingestions, to slow the rate of injury to the esophagus prior to endoscopic removal
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A recent study in mice suggests that a modified version of sucralfate may find use in treating obesity.<ref>{{Cite journal|title = Surgery-in-a-pill could treat diabetes|url = https://www.future-science.com/btn/news/jun18/23|journal = Future Science (web site)|date = 2018-06-27|first = Surat|last = Parvatam}}</ref><ref>{{Cite journal|title = Therapeutic luminal coating of the intestine|url = https://www.nature.com/articles/s41563-018-0106-5|journal = Nature Materials|date = 2018-06-11|issn = 1476-4660|pmid = |pages = |volume = |issue = |first = Yuhan|last = Lee|first2 = Tara E.|last2 = Deelman|first3 = Keyue|last3 = Chen|first4 = Dawn S. Y.|last4 = Lin|first5 = Ali|last5 = Tavakkoli|first6 = Jeffrey M.|last6 = Karp|doi=10.1038/s41563-018-0106-5}}</ref>
A recent study in mice suggests that a modified version of sucralfate may find use in treating obesity.<ref>{{Cite journal|title = Surgery-in-a-pill could treat diabetes|url = https://www.future-science.com/btn/news/jun18/23|journal = Future Science (web site)|date = 2018-06-27|first = Surat|last = Parvatam}}</ref><ref>{{Cite journal|title = Therapeutic luminal coating of the intestine|url = https://www.nature.com/articles/s41563-018-0106-5|journal = Nature Materials|date = 2018-06-11|issn = 1476-4660|pmid = |pages = |volume = |issue = |first = Yuhan|last = Lee|first2 = Tara E.|last2 = Deelman|first3 = Keyue|last3 = Chen|first4 = Dawn S. Y.|last4 = Lin|first5 = Ali|last5 = Tavakkoli|first6 = Jeffrey M.|last6 = Karp|doi=10.1038/s41563-018-0106-5}}</ref>

In June 2018, the US-based National Capital Poison Center (Poison Control) updated its triage and treatment guideline for [[Button cell|button battery]] ingestions.<ref name=":1">{{Cite web|url=https://www.poison.org/battery/guideline|title=Guideline|website=www.poison.org|language=en|access-date=2018-07-05}}</ref> It now recommends the administration of 10 mL (~ 2 teaspoons) of [[honey]] or sucralfate suspension in 10 minute intervals as soon as possible after a known or suspected ingestion to possibly reduce the rate, and therefore the severity, of injury to the esophagus.<ref name=":1" /> The change to guidelines was based on a study out of [[Children's Hospital of Philadelphia]] by Rachel R. Anfang and colleagues, which found that early and frequent ingestion of honey or sucralfate suspension prior to removal can reduce the injury severity to a significant degree.<ref name=":1" /><ref>{{Cite journal|last=Anfang|first=Rachel R.|last2=Jatana|first2=Kris R.|last3=Linn|first3=Rebecca L.|last4=Rhoades|first4=Keith|last5=Fry|first5=Jared|last6=Jacobs|first6=Ian N.|date=2018-06-11|title=pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury|url=https://doi.org/10.1002/lary.27312|journal=The Laryngoscope|language=en|doi=10.1002/lary.27312|issn=0023-852X}}</ref>


==Side effects==
==Side effects==

Revision as of 18:47, 5 July 2018

Sucralfate
Clinical data
Trade namesCarafate
AHFS/Drugs.comMonograph
MedlinePlusa681049
Pregnancy
category
  • B
Routes of
administration		oral, suspension, rectal suspension
ATC code
Legal status
Legal status
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability3-5% (local acting)
MetabolismGI; liver: unknown
Elimination half-lifeunknown
Excretionfeces, urine
Identifiers
  • Hexadeca-μ-hydroxytetracosahydroxy[μ8-[1,3,4,6-tetra-O-sulfo-β-Dfructofuranosyl-α-D-glucopyranoside tetrakis(hydrogen sulfato)8-)]]hexadecaaluminum[1]
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.053.636 Edit this at Wikidata
Chemical and physical data
FormulaC12H54Al16O75S8
Molar mass2086.75 g/mol[1] g·mol−1
 ☒NcheckY (what is this?)  (verify)

Sucralfate is a medication primarily taken to treat active duodenal ulcers.[2] Sucralfate is also used for the treatment of gastroesophageal reflux disease (GERD) and stress ulcers.[3]

Sucralfate is a sucrose sulfate-aluminium complex that binds to the ulcer, creating a physical barrier that protects the gastrointestinal tract from stomach acid and prevents the degradation of mucus.[4][5] It also promotes bicarbonate production and acts like an acid buffer with cytoprotective properties.[6]

Medical uses

Sucralfate is used for the treatment of active duodenal ulcers not related to the use of nonsteroidal anti-inflammatory drugs (NSAIDs), as the mechanism behind these ulcers is due to acid oversecretion.[2] It is not FDA approved for gastric ulcers, but is widely used because of evidence of efficacy.[7] The use for sucralfate in peptic ulcer disease has diminished recently, but it is still the preferred agent for stress ulcer prevention.[8][9][10][11]

Sucralfate has also been used for the following conditions:

A recent study in mice suggests that a modified version of sucralfate may find use in treating obesity.[19][20]

In June 2018, the US-based National Capital Poison Center (Poison Control) updated its triage and treatment guideline for button battery ingestions.[21] It now recommends the administration of 10 mL (~ 2 teaspoons) of honey or sucralfate suspension in 10 minute intervals as soon as possible after a known or suspected ingestion to possibly reduce the rate, and therefore the severity, of injury to the esophagus.[21] The change to guidelines was based on a study out of Children's Hospital of Philadelphia by Rachel R. Anfang and colleagues, which found that early and frequent ingestion of honey or sucralfate suspension prior to removal can reduce the injury severity to a significant degree.[21][22]

Side effects

The most common side effect seen is constipation (2-3%). Less commonly reported side effects (<0.5%) include flatulence, headache, hypophosphatemia, xerostomia (dry mouth), and bezoar formation.[23][24][25] Avoid using this drug in people with chronic kidney failure, as it might cause aluminium accumulation and toxicity. There is a limited number of well-controlled studies investigating the safety and efficacy of sucralfate in children and pregnant women (Pregnancy Category B).[2][26][27]

Mechanism of action

Sucralfate is a locally acting substance that in an acidic environment (pH < 4) reacts with hydrochloric acid in the stomach to form a cross-linking, viscous, paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose.[4] It also attaches to proteins on the surface of ulcers, such as albumin and fibrinogen, to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing further damage from acid, pepsin, and bile.[4] In addition, sucralfate prevents back diffusion of hydrogen ions, and adsorbs both pepsin and bile acids.

Recently, it has been thought that sucralfate also stimulates the production of prostaglandin E2, epidermal growth factors (EGF), bFGF, and gastric mucus.[2][5]

Pharmacokinetics

Onset: 1-2 hr (initial onset for peptic ulcer disease (PUD))

Absorption: <5% Orally

Duration: Up to 6 hours due to high affinity for defective mucosa (PUD)

Bioavailability: 5% as sucralfate is considered non-systemic, sucrose octasulfate: 5%, aluminum:0.005%

Metabolism: Not metabolized, excreted unchanged in urine

Excretion: Primarily in urine as unchanged drug[27][28]

Names

Brand names include Carafate in U.S.A., Sucramal in Italy, Sucrafil, Sufrate, Sucralpro, Sucralcoat, Pepsigard, Sucral, Hapifate, Sucralpro in India, Sutra or Musin in parts of South-East Asia, Sulcrate in Canada, Ulsanic in South Africa and Israel, Andapsin in Sweden and Antepsin in Turkey.

References

  1. ^ a b Merck Index, 12th Edition, 9049.
  2. ^ a b c d "DailyMed - CARAFATE - sucralfate suspension". dailymed.nlm.nih.gov. Retrieved 2015-11-04.
  3. ^ Maton PN (2003). "Profile and assessment of GERD pharmacotherapy". Cleve Clin J Med. 70 Suppl 5: S51–70. doi:10.3949/ccjm.70.Suppl_5.S51. PMID 14705381.
  4. ^ a b c Brogden, R. N.; Heel, R. C.; Speight, T. M.; Avery, G. S. (1984-03-01). "Sucralfate. A review of its pharmacodynamic properties and therapeutic use in peptic ulcer disease". Drugs. 27 (3): 194–209. doi:10.2165/00003495-198427030-00002. ISSN 0012-6667. PMID 6368184.
  5. ^ a b Korman, M. G.; Bolin, T. D.; Szabo, S.; Hunt, R. H.; Marks, I. N.; Glise, H. (1994-08-01). "Sucralfate: the Bangkok review". Journal of Gastroenterology and Hepatology. 9 (4): 412–415. doi:10.1111/j.1440-1746.1994.tb01264.x. ISSN 0815-9319. PMID 7948825.
  6. ^ Lam, Shiu Kum; Ching, Chi Kong (1994). "Sucralfate in clinical practice". Journal of Gastroenerology and Hepatology. 9 (4).
  7. ^ Hixson, LJ; Kelley, CL; Jones, WN; Tuohy, CD (April 1992). "Current trends in the pharmacotherapy for peptic ulcer disease". Archives of Internal Medicine. 152 (4): 726–32. doi:10.1001/archinte.152.4.726. PMID 1558429.
  8. ^ Hunt, R. H. (1991-08-08). "Treatment of peptic ulcer disease with sucralfate: a review". The American Journal of Medicine. 91 (2A): 102S–106S. doi:10.1016/0002-9343(91)90459-b. ISSN 0002-9343. PMID 1882894.
  9. ^ Fashner, Julia; Gitu, Alfred C. (2015-02-15). "Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection". American Family Physician. 91 (4): 236–242. ISSN 1532-0650. PMID 25955624.
  10. ^ "ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998". American Journal of Health-System Pharmacy. 56 (4): 347–379. 1999-02-15. ISSN 1079-2082. PMID 10690219.
  11. ^ Monnig, Andrea A.; Prittie, Jennifer E. (2011-10-01). "A review of stress-related mucosal disease". Journal of Veterinary Emergency and Critical Care (San Antonio, Tex.: 2001). 21 (5): 484–495. doi:10.1111/j.1476-4431.2011.00680.x. ISSN 1476-4431. PMID 22316196.
  12. ^ Jian-Min, Si; Liang-Jing, Wang; Shu-Jie, Chen; Lan, Zhao; Ning, Dai (2003). "Quality of life and cost-effectiveness of combined therapy for reflux esophagitis". Journal of Zhejiang University SCIENCE A. 4 (5): 602–6. doi:10.1631/jzus.2003.0602. PMID 12958722.
  13. ^ Saunders, Deborah P.; Epstein, Joel B.; Elad, Sharon; Allemano, Justin; Bossi, Paolo; van de Wetering, Marianne D.; Rao, Nikhil G.; Potting, Carin; Cheng, Karis K.; Freidank, Annette; Brennan, Michael T.; Bowen, Joanne; Dennis, Kristopher; Lalla, Rajesh V. (6 July 2013). "Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients". Supportive Care in Cancer. 21 (11): 3191–3207. doi:10.1007/s00520-013-1871-y.
  14. ^ Mendenhall, William M.; McKibben, Brian T.; Hoppe, Bradford S.; Nichols, Romaine C.; Henderson, Randal H.; Mendenhall, Nancy P. (2014-10-01). "Management of radiation proctitis". American Journal of Clinical Oncology. 37 (5): 517–523. doi:10.1097/COC.0b013e318271b1aa. ISSN 1537-453X. PMID 23241500.
  15. ^ Richter, J. E. (2005-11-01). "Review article: the management of heartburn in pregnancy". Alimentary Pharmacology & Therapeutics. 22 (9): 749–757. doi:10.1111/j.1365-2036.2005.02654.x. ISSN 0269-2813. PMID 16225482.
  16. ^ Safdar, Nasia; Crnich, Christopher J.; Maki, Dennis G. (2005-06-01). "The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention". Respiratory Care. 50 (6): 725–739, discussion 739-741. ISSN 0020-1324. PMID 15913465.
  17. ^ Temir, Z. Günyüz; Karkiner, Aytaç; Karaca, Irfan; Ortaç, Ragip; Ozdamar, Aykut (2005-01-01). "The effectiveness of sucralfate against stricture formation in experimental corrosive esophageal burns". Surgery Today. 35 (8): 617–622. doi:10.1007/s00595-004-3005-0. ISSN 0941-1291. PMID 16034539.
  18. ^ Chun, Mison; Kang, Seunghee; Kil, Hoon-Jong; Oh, Young-Taek; Sohn, Jeong-Hye; Ryu, Hee-Suk (2004-01-01). "Rectal bleeding and its management after irradiation for uterine cervical cancer". International Journal of Radiation Oncology, Biology, Physics. 58 (1): 98–105. doi:10.1016/s0360-3016(03)01395-6. ISSN 0360-3016. PMID 14697426.
  19. ^ Parvatam, Surat (2018-06-27). "Surgery-in-a-pill could treat diabetes". Future Science (web site).
  20. ^ Lee, Yuhan; Deelman, Tara E.; Chen, Keyue; Lin, Dawn S. Y.; Tavakkoli, Ali; Karp, Jeffrey M. (2018-06-11). "Therapeutic luminal coating of the intestine". Nature Materials. doi:10.1038/s41563-018-0106-5. ISSN 1476-4660.
  21. ^ a b c "Guideline". www.poison.org. Retrieved 2018-07-05.
  22. ^ Anfang, Rachel R.; Jatana, Kris R.; Linn, Rebecca L.; Rhoades, Keith; Fry, Jared; Jacobs, Ian N. (2018-06-11). "pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury". The Laryngoscope. doi:10.1002/lary.27312. ISSN 0023-852X.
  23. ^ http://medsfacts.com/study-SUCRALFATE-causing-BEZOAR.php
  24. ^ "Carafate Package Insert" (PDF). September 12, 2013. Retrieved November 2, 2015.
  25. ^ "ASHP Therapeutic Guidelines on Stress Ulcer Prophylaxis. ASHP Commission on Therapeutics and approved by the ASHP Board of Directors on November 14, 1998". American Journal of Health-System Pharmacy. 56 (4): 347–379. 1999-02-15. ISSN 1079-2082. PMID 10690219.
  26. ^ Phupong, Vorapong; Hanprasertpong, Tharangrut (2015-01-01). "Interventions for heartburn in pregnancy". The Cochrane Database of Systematic Reviews. 9: CD011379. doi:10.1002/14651858.CD011379.pub2. ISSN 1469-493X. PMID 26384956.
  27. ^ a b Steiner, K.; Bühring, K. U.; Faro, H. P.; Garbe, A.; Nowak, H. (1982-01-01). "Sucralfate: pharmacokinetics, metabolism and selective binding to experimental gastric and duodenal ulcers in animals". Arzneimittel-Forschung. 32 (5): 512–518. ISSN 0004-4172. PMID 6896647.
  28. ^ McEvoy, GK (2007). AHFS drug information McEvoy GK, ed. Sucralfate. AHFS. pp. 2983–5.

External links

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