Elephant specific information, if available, is in blue.

Chemistry – A basic, aluminum complex of sucrose sulfate, sucralfate occurs as a white, amorphous powder. It is practically insoluble in alcohol or water.

Sucralfate is structurally related to heparin, but does not posses any appreciable anticoagulant activity. It is also structurally related to sucrose, but is not utilized as a sugar by the body. Sucralfate is also known as aluminum sucrose sulfate, basic .

Storage/Stability/Compatibility – Store sucralfate tablets in tight containers at room tem­perature.

Pharmacology – While the exact mechanism of action of sucralfate as an antiulcer agent is not known, the drug has a local effect rather than a systemic one. After oral administration, sucralfate reacts with hydrochloric acid in the stomach to form a paste-like complex that will bind to the proteinaceous exudates that generally are found at ulcer sites. This insoluble complex forms a barrier at the site and protects the ulcer from further damage caused by pepsin, acid or bile. Sucralfate may have some cytoprotective effects, possibly by stimulation of prostaglandin E2 and I2. Sucralfate also has some antacid activity, but it is believed that this is not of clinical importance. Sucralfate does not significantly affect gastric acid output, or trypsin or pancreatic amy­lase activity. It may decrease the rate of gastric emptying.

Uses/Indications – Sucralfate has been used in the treatment of oral, esophageal, gastric and duodenal ulcers. It has also been employed to prevent drug-induced (e.g., aspirin) gas­tric erosions.

Pharmacokinetics – Animal studies have indicated that only 3-5% of an oral dose is ab­sorbed which is excreted in the urine unchanged within 48 hours. The remainder of the drug is converted to sucrose sulfate in the gut by reacting with hydrochloric acid and is excreted in the feces within 48 hours. The duration of action (binding to ulcer site) may persist up to 6 hours after oral dosing.

Contraindications/Precautions – There are no known contraindications to the use of sucralfate. Because it may cause constipation, it should be used with caution in animals where decreased intestinal transit times may be deleterious.

It is unknown if sucralfate crosses the placenta and whether it may be used safely during pregnancy. In rats, dosages up to 38 times those used in humans caused no impaired fertility and doses up to 5O times normal caused no symptoms of teratogenicity.

Adverse Effects/Warnings – Adverse effects are uncommon with sucralfate therapy. Constipation is the most prominent adverse effect reported in humans (2%) and dogs tak­ing the drug.

Overdosage – Overdosage is unlikely to cause any significant problems. Laboratory animals receiving up to 12 grams/kg orally demonstrated no incidence of mortality.

Drug Interactions – Cimetidine, tetracycline, phenytoin and digoxin bioavailability may be reduced if administered with sucralfate. To avoid this problem, give sucralfate at least 2 hours apart from these other drugs. Because sucralfate requires an acidic environ­ment to be effective, give sucralfate doses before (at least 1/2 hour) cimetidine (or other H2 antagonist) or antacids.

Doses –

Horses:

a)   Foals: 1 – 2 grams PO qid (Clark and Becht 1987)

b)   2 mg/kg PO tid (Robinson 1987)

Monitoring Parameters –

1)   Clinical efficacy (dependent on reason for use); monitored by decrease in symp­tomatology, endoscopic examination, blood in feces, etc.

Client Information – To maximize the benefit of this medication, it must be administered as prescribed by the veterinarian; symptoms may reoccur if dosages are missed. Unless otherwise instructed, give this medication on an empty stomach (1 hour before feeding or 2 hours after) and at bedtime.

Dosage Forms/Preparations/FDA Approval Status/Withholding Times –

Veterinary-Approved Products: None

Human-Approved Products:

Sucralfate  1 gram tablets (scored); Carafate®  (Hoechst Marion Roussel); Generic.  (Rx)

Sucralfate Suspension: 1 g/10 ml in 420 ml; Carafate® (Hoechst Marion Roussel) (Rx)