수크랄페이트

위장관 보호제

수크랄페이트는 국소적으로 작용하는 **위장관 보호제**로, 주로 구강, 식도, 위, 십이지장 궤양의 치료 및 관리에 사용됩니다. 약물(예: NSAID 또는 아스피린)로 인한 위 미란을 예방하기 위해 간혹 사용되기도 하지만, 예방 효과는 불규칙한 것으로 간주됩니다. > **임상 팁:** 수의학에서 수크랄페이트는 종종 위장관의 "액체 반창고"로 묘사됩니다. 궤양 부위에 제대로 중합되어 코팅되려면 산성 환경이 필요하므로, 식사 및 다른 제산제(H2 수용체 길항제 또는 양성자 펌프 억제제 등)와의 투여 간격이 매우 중요합니다. 인의학에서는 신부전에 속발하는 고인산혈증 환자의 인 결합제로 사용되어 왔으나, 수의학 연구(예: 건강한 고양이 대상)에서는 혈청 인 농도 저하 효과에 대해 혼재되거나 유의미하지 않은 결과를 보였습니다.

작용 기전: 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.*

동물 종별 용량

Cats

General dosing · 0.25-0.5 grams PO q8-12h · PO · q8-12h
Empirical dosage · ¼ of a 1 gram tablet per cat PO three to four times a day. · PO · TID-QID
For gastric ulcers, esophagitis · 0.25-0.5 grams PO per cat PO q8-12h · PO · q8-12h

Ferrets

General dosing · 75 mg/kg PO q4-6h; give 10 minutes prior to feeding · PO · q4-6h

Horses

For adjunctive treatment (used with acid suppressive drugs) for preventing stress-induced ulcers in foals · 10-20 mg/kg PO q6-8h · PO · q6-8h
For treating equine gastric ulcer syndrome · 20-40 mg/kg PO q8h · PO · q8h
Right dorsal colitis (colonic ulcers) · 22 mg/kg PO q6-8h · PO · q6-8h · Sucralfate alone may not be beneficial in treatment of equine gastric ulcer syndrome, but can be used in conjunction with acid-suppressive therapy and may be more suited for treatment of right dorsal colitis.

Dogs

For esophagitis · 0.5-1 gram PO three times a day. Suspensions are more therapeutic than intact tablets. · PO · TID
General dosing · For large dogs: 1 gram PO q8; for smaller dogs: 0.5 gram PO q8h · PO · q8h

투여 경로

금기

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

이상반응

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

약물 상호작용

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
Digoxin · Decreased oral absorption; separate dosing by at least 2 hours · moderate
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

모니터링

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)

과용량

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.

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