Sucralfate
Aluminum sucrose sulfate, basic
Also known as: Carafate · Antepsin · Aluminum sucrose sulfate, basic · Sucralfato · Sucralfatum
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Audited v13 dosing evidence
Structured calculator evidencePrevention of stress-induced ulcers (used with acid-suppressive drugs) in foals — Right dorsal colitis | colonic ulcers
- q6-8h
NA
Governing clinical context (3)
- b) Prevention of stress-induced ulcers (used with acid-suppressive drugs) in foals:
- ■ This medicine is best given on an empty stomach and not at the same time as other medications. If you are giving your animal any other medication, be sure to give the other medications 2 hours before you give the sucralfate.
- Store sucralfate tablets in tight containers at room temperature (15°C-30°C [59°F-86°F]). Store sucralfate suspension at controlled room temperature (20°C-25°C [68°F-77°F]); do not freeze.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Sucralfate is a locally-acting gastroprotectant primarily used in the treatment and management of oral, esophageal, gastric, and duodenal ulcers. It is also occasionally employed to prevent drug-induced (e.g., NSAID or aspirin) gastric erosions, though its efficacy for prophylaxis is considered sporadic.
Clinical Pearl: Sucralfate is often described in veterinary medicine as a "liquid band-aid" for the gastrointestinal tract. Because it requires an acidic environment to properly polymerize and coat ulcers, the timing of administration relative to feeding and other antacids (like H2-receptor antagonists or proton pump inhibitors) is critical.
While it has been used in human medicine as a phosphate binder for patients with hyperphosphatemia secondary to renal failure, veterinary studies (such as in healthy cats) have shown mixed or insignificant results regarding its ability to lower serum phosphorus levels.
Mechanism of action
Sucralfate exerts a local, non-systemic effect on the gastrointestinal mucosa.
- Polymerization: After oral administration, sucralfate reacts with hydrochloric acid (HCl) in the stomach → undergoes cross-linking → forms a highly viscous, paste-like complex.
- Barrier Formation: This complex carries a strong negative charge and binds tightly to the positively charged proteinaceous exudates (like albumin and fibrinogen) found at ulcer sites. This forms an insoluble physical barrier that protects the ulcerated tissue from further degradation by pepsin, acid, and bile salts.
- Enzyme & Bile Acid Inactivation: Sucralfate directly inactivates pepsin and binds to bile acids, reducing their mucosal toxicity.
- Cytoprotection: It exhibits cytoprotective properties, likely mediated through the local stimulation and release of prostaglandin E2 (PGE2) and prostaglandin I2 (PGI2), which enhance mucosal blood flow and mucus/bicarbonate secretion.
Note: Sucralfate does not significantly alter gastric acid output or pancreatic enzyme activity.
Safety & warnings
Contraindications
- No absolute contraindications
- Use with caution in patients with decreased gastrointestinal transit times (e.g., megacolon, ileus) due to the risk of constipation
- Known hypersensitivity to sucralfate
Adverse effects
- Constipation (most common in dogs and humans)
- Vomiting (reported primarily in cats)
- Hypophosphatemia (rare, with prolonged use)
Precautions
There are no known absolute contraindications to the use of sucralfate.
- GI Motility: Because it may cause constipation, it should be used with caution in animals where decreased intestinal transit times might be deleterious.
- Pregnancy & Nursing: FDA Category B in humans. Categorized as Class A (Probably safe) in dogs and cats. It is unknown if it is excreted in milk, but due to minimal systemic absorption, it is unlikely to be of concern in nursing animals.
- Timing of Administration: Because it requires an acidic environment to activate, it should ideally be given before acid-suppressing drugs (like H2 blockers or PPIs), typically separated by 30-60 minutes.
Drug interactions
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Decreased oral absorption; separate dosing by at least 2 hours
Significantly decreased absorption of the antibiotic due to chelation
Significantly decreased absorption of the antibiotic due to chelation
May alter the acidic environment needed for initial sucralfate activation, though clinical significance is debated
Monitoring
- Clinical efficacy (resolution of vomiting, melena, anorexia, or abdominal pain)
- Endoscopic examination of ulcer healing
- Fecal occult blood
- Resolution of clinical signs of GI ulceration (e.g., vomiting, melena, anorexia)
- Fecal consistency (monitor for constipation)
Pharmacokinetics
Absorption
Only 3-5% of an oral dose is absorbed systemically, as the drug primarily acts locally in the gastrointestinal tract.
Distribution
Acts locally at the site of ulceration. The duration of action (binding to the ulcer site) may persist for up to 6 hours after oral dosing.
Metabolism
By reacting with hydrochloric acid in the gut, the unabsorbed remainder of the drug is converted to sucrose sulfate.
Elimination
The small absorbed fraction (3-5%) is excreted unchanged in the urine within 48 hours. The unabsorbed sucrose sulfate is excreted in the feces within 48 hours.
Overdose
Overdosage is highly unlikely to cause any significant systemic problems due to minimal absorption. Laboratory animals receiving massive doses up to 12 grams/kg orally demonstrated no incidence of mortality. The primary concern with a massive overdose would be constipation.
Available products
Formulations
- Tablets
- 1 g oral tablet
- 0.2 g/ml oral suspension
Human-labeled
- Sucralfate Tablets: 1 gram; Carafate® (Axcan Sandipharm); generic
- Sucralfate Suspension: 1 gram/10 mL in 10 mL unit dose cups & 415 mL; Carafate® (Axcan Scandipharm); generic (Precision Dose)
- Antepsin 1 g tablet
- Antepsin 0.2 g/ml suspension
Regulatory status
POM (Prescription Only Medicine)
POM (Prescription Only Medicine)
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store sucralfate tablets in tight containers at room temperature. An extemporaneously prepared aqueous suspension (200 mg/mL) made by crushing tablets in distilled water (without suspending agents like acacia or tragacanth, which inactivate the drug) is stable for 14 days when refrigerated. Label 'shake well'.
Client information
- Administration Timing: To maximize the benefit of this medication, give it on an empty stomach (at least 1 hour before feeding or 2 hours after) and at bedtime, unless otherwise instructed by your veterinarian.
- Consistency: Clinical signs of stomach upset or ulcers may reoccur if dosages are missed. Administer exactly as prescribed.
- Separating Medications: Sucralfate can block the absorption of many other drugs. If your pet is taking other medications, give them at least 2 hours apart from the sucralfate.
- Administration Tip: If you are given tablets, your veterinarian may instruct you to dissolve the tablet in a small amount of warm water to create a "slurry" before giving it via syringe. This liquid form coats the esophagus and stomach much better than a solid tablet.
- Side Effects: This medication is generally very safe. The most common side effect is mild constipation. Contact your vet if your pet strains to defecate or if vomiting worsens.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.