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スクラルファート

Sucralfate

Aluminum sucrose sulfate, basic

胃腸粘膜保護薬PO犬猫フェレット爬虫類馬

別名: Carafate · Antepsin · Aluminum sucrose sulfate, basic · Sucralfato · Sucralfatum

VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス

監査済み v13 用量エビデンス

構造化された用量計算エビデンス

Prevention of stress-induced ulcers (used with acid-suppressive drugs) in foals — Right dorsal colitis | colonic ulcers

22 mg/kgPO
  • q6-8h

NA

必ず考慮する臨床コンテキスト (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.
formularyプロトコル 2023監査 dose-audit-plumb-v13

用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。

診察中ですか？VetSheet の AI が薬剤・用量・投与期間を構造化された診察記録に直接記入します。VetSheet の仕組みを見る

概要

スクラルファートは、局所的に作用する​胃腸粘膜保護薬​であり、主に口腔、食道、胃、十二指腸の潰瘍の治療および管理に使用されます。また、薬物（NSAIDsやアスピリンなど）による胃のびらんを予防するために使用されることもありますが、予防効果は不安定であると考えられています。

​臨床のポイント：​ 獣医学において、スクラルファートはしばしば胃腸管の「液体絆創膏」と表現されます。潰瘍を適切にコーティングするためには酸性環境が必要であるため、食事や他の制酸薬（H2ブロッカーやプロトンポンプ阻害薬など）との投与間隔が非常に重要です。

ヒト医療では、腎不全に続発する高リン血症の患者に対するリン吸着薬として使用されてきましたが、獣医学的研究（健康な猫など）では、血清リン濃度を低下させる効果について一貫性のない、または有意でない結果が示されています。

作用機序

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.​

安全性・警告

禁忌

  • 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

有害事象

  • Constipation (most common in dogs and humans)
  • Vomiting (reported primarily in cats)
  • Hypophosphatemia (rare, with prolonged use)

注意事項

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.

医薬品相互作用

Azithromycin

Decreased oral absorption; separate dosing by at least 2 hours

Ciprofloxacin / Enrofloxacin (and other oral fluoroquinolones)

Decreased oral absorption; separate dosing by at least 2 hours

Diclofenac

Decreased oral absorption; separate dosing by at least 2 hours

DigoxinModerate

Decreased oral absorption; separate dosing by at least 2 hours

Doxycycline

Decreased oral absorption; separate dosing by at least 2 hours

Erythromycin

Decreased oral absorption; separate dosing by at least 2 hours

Ketoconazole

Decreased oral absorption; separate dosing by at least 2 hours

Levothyroxine

Decreased oral absorption; separate dosing by at least 2 hours

Penicillamine

Decreased oral absorption; separate dosing by at least 2 hours

Tetracycline

Decreased oral absorption; separate dosing by at least 2 hours

Theophylline

Decreased oral absorption; separate dosing by at least 2 hours

Vitamins (fat soluble)

Decreased oral absorption; separate dosing by at least 2 hours

Warfarin

Decreased oral absorption; separate dosing by at least 2 hours

Fluoroquinolones (e.g., Enrofloxacin, Ciprofloxacin)Major

Significantly decreased absorption of the antibiotic due to chelation

Tetracyclines (e.g., Doxycycline)Major

Significantly decreased absorption of the antibiotic due to chelation

H2-receptor antagonists / Proton Pump InhibitorsMinor

May alter the acidic environment needed for initial sucralfate activation, though clinical significance is debated

監視

  • 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)

薬物動態

吸収

Only 3-5% of an oral dose is absorbed systemically, as the drug primarily acts locally in the gastrointestinal tract.

分布

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.

代謝

By reacting with hydrochloric acid in the gut, the unabsorbed remainder of the drug is converted to sucrose sulfate.

消失

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.

過剰投与

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.

製品

製剤

  • Tablets
  • 1 g oral tablet
  • 0.2 g/ml oral suspension

ヒト用医薬品

  • 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

規制ステータス

European Union✓ 承認済み処方箋医薬品EMA

POM (Prescription Only Medicine)

United Kingdom✓ 承認済み処方箋医薬品VMD

POM (Prescription Only Medicine)

規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

保管・安定性

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'.

飼主向け情報

  • ​投与のタイミング：​ この薬の最大の効果を得るために、獣医師から別の指示がない限り、​空腹時​（食前の少なくとも1時間前、または食後2時間）および就寝前に投与してください。
  • ​規則正しい投与：​ 投与を忘れると、胃の不調や潰瘍の臨床症状が再発する可能性があります。必ず処方通りに投与してください。
  • ​他の薬との間隔：​ スクラルファートは他の多くの薬の吸収を妨げる可能性があります。ペットが他の薬を服用している場合は、スクラルファートの投与から少なくとも2時間の間隔を空けてください。
  • ​投与のヒント：​ 錠剤を処方された場合、獣医師から、シリンジで与える前に少量のぬるま湯で錠剤を溶かして「スラリー（懸濁液）」にするよう指示されることがあります。この液状の形態は、固形の錠剤よりも食道や胃をはるかに効果的にコーティングします。
  • ​副作用：​ この薬は一般的に非常に安全です。最も一般的な副作用は軽度の便秘です。ペットが排便時にいきんだり、嘔吐が悪化したりした場合は、獣医師に連絡してください。

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