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Sucralfate for Veterinary Use
by Barbara Forney, VMD
Sucralfate is a hydroxy aluminum salt of sucrose octasulfate that acts as a local mucosal adherent. In an acidic environment, sucralfate forms a sticky viscose gel that adheres to protenacious exudates within an ulcer crater. This Band-Aid® effect lasts about six hours. At a higher pH, sucralfate may remain in suspension, but may improve the gastric environment by adsorbing pepsin, buffering hydrogen ions, stimulating prostaglandin E, increasing bicarbonate secretion, stimulating mucous secretion and binding epidermal growth factor. The absorption of sucralfate is minimal; its actions are local rather than systemic and it does not affect gastric-acid output or enzyme activity. Sucralfate is used to treat oral, esophageal, gastric, duodenal and colonic ulcers. Usually, sucralfate is given on an empty stomach.
Dogs and Cats
Sucralfate is used to treat ulcers and upper GI disorders of dogs and cat. Common causes of GI erosion and ulceration in dogs include drugs (particularly NSAIDs and corticosteroids), toxic chemical ingestion, liver disease, renal failure, carcinoma, stress (trauma, shock, sepsis and burns), inflammatory bowel disease, mast cell tumors, hypoadrenocorticism and any condition causing an excessive secretion of gastric acid.
Sucralfate is used in neonatal medicine as a local mucosal protectant. The protective role of sucralfate in the sick equine neonate may be related to local protection against ischemia reperfusion injury. Sucralfate has been shown to be beneficial in lesions of the glandular mucosa and less so for lesions of the squamous gastric mucosa.
The gastric environment in the normal neonatal foals is acidic, while the gastric environment in the critically ill neonate is more variable. Recent research in the rat and in humans supports the use of sucralfate and calls into question the use of H2 receptor antagonists and proton pump inhibitors in the neonatal population. H2 receptor antagonists and proton pump inhibitors are thought to be more appropriate in the older foal.
Sucralfate is used to treat gastric ulcers and ulcers of the right dorsal colon in adult horses. It usually is used with an H2 receptor antagonist or a proton pump inhibitor such as omeprazole. Sucralfate appears to provide significant pain relief in horses that show abdominal pain due to ulcers.
Sucralfate Side Effects
Side effects are rare. Constipation and hypophosphatemia may occur in a small percentage of patients.
Sucralfate may decrease the rate of gastric emptying and slow GI transit time.
Sucralfate may affect the absorption of many drugs and, in general, administration should be separated for other oral drugs including: NSAIDs, H2 receptor antagonists, fluoroquinolones, digoxin, ketoconazole, levothyroxine, penicillamine, tetracyclines, fat soluble vitamins and warfarin.
It is unlikely that an overdose of sucralfate will cause clinical problems because it is so poorly absorbed. Very high doses (50X) have been administered to laboratory animals without mortality.
About the Author
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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