Keal (Sucralfate)

Sucralfate acts on the gastrointestinal mucosa to protect ulcerated tissue and reduce reflux injury.

• Duodenal ulcer: promotes healing by shielding the ulcer base from acid and pepsin.
• Gastric ulcer: forms a protective barrier that facilitates mucosal repair.
• Gastro‑oesophageal reflux disease (GERD): reduces mucosal irritation by limiting exposure to gastric contents.

• Sucralfate binds to ulcer exudate and mucosal proteins, creating a viscous, adherent coating that isolates the lesion from gastric acid, pepsin, and bile salts. The coating also stimulates local prostaglandin synthesis and mucus production, enhancing mucosal defense and promoting ulcer healing.

Sucralfate is generally well tolerated, but adverse reactions can occur.

Common Side Effects

• Constipation: mild to moderate difficulty passing stool.
• Dry mouth: reduced salivary flow.
• Nausea: transient feeling of queasiness.
• Indigestion: mild dyspeptic symptoms.
• Flatulence: increased intestinal gas.
• Taste alteration: temporary metallic or bitter taste.

Serious or Rare Side Effects

• Severe constipation leading to bowel obstruction.
• Allergic reactions: rash, itching, or swelling.
• Hypersensitivity: anaphylaxis in rare cases.
• Hypermagnesemia: elevated magnesium levels, especially with renal impairment.
• Severe abdominal pain: may indicate complications.
• Persistent vomiting: could signal intolerance or obstruction.

Before prescribing Sucralfate, consider patient-specific factors and safety measures.

• Renal impairment: monitor magnesium levels and adjust use if needed.
• Gastrointestinal obstruction: avoid use in patients with known obstruction or severe constipation.
• Drug absorption: administer on an empty stomach, separate from other oral medications by at least 2 hours.
• Pregnancy and lactation: use only if the potential benefit outweighs risk, as safety data are limited.
• Elderly patients: start with caution due to higher risk of constipation and renal issues.
• Store at ambient temperature: keep below 25°C, retain in original packaging, and protect from moisture.

Sucralfate can affect the absorption of several concomitant drugs.

Major Interactions (Avoid)

• Antibiotics (e.g., quinolones, tetracyclines): may reduce their bioavailability.
• Antifungal agents (e.g., fluconazole): absorption can be markedly decreased.
• Iron supplements: binding reduces iron absorption.

Moderate Interactions (Monitor Closely)

• Digoxin: potential reduction in absorption; monitor serum levels.
• Levothyroxine: may decrease absorption; check thyroid function.
• Antacids containing aluminum or magnesium: may interfere with Sucralfate binding; separate dosing times.