Sucralfate

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.

กลไกการออกฤทธิ์: 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.*

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