Carafate (Sucralfate) Guideline Summary

Off-Label Uses and Recommendations

• The American College of Cardiology recommends PPIs as the preferred agents for therapy and prophylaxis of NSAID- and ASA-associated GI injury 1
• Sucralfate is not effective in the treatment or prevention of NSAID-related gastric ulcers 1
• Some European trials showed decreased diarrhea in patients receiving 1-2g sucralfate during pelvic radiation therapy, while other studies showed no improvement or worsening of GI symptoms 2, 3, 4

Administration and Alternatives

• Sucralfate should be administered at least 2 hours apart from drugs that decrease gastric acidity (PPIs or H2-blockers) to avoid interaction 7
• PPIs are generally considered first-line agents for treating and preventing gastrointestinal ulcers, with sucralfate recommended as a second-line agent 5, 6
• For H. pylori-associated ulcers, eradication therapy should be used in addition to sucralfate 6
• For NSAID-induced ulcers, discontinuation of NSAIDs is recommended when possible 6