The efficacy, safety and dosage of sucralfate in ulcer therapy

This paper reviews the results of placebo and cimetidine/ranitidine controlled studies in the short-term healing and maintenance therapy of duodenal (DU) and gastric (GU) ulcer, the status of newer dosage regimens, and safety aspects of the drug. The efficacy of sucralfate 1g qid in DU and GU healing has been amply confirmed in placebo and cimetidine or ranitidine-controlled studies. Healing rates have been reported in 60 to 83% DU patients after 4 weeks treatment with sucralfate but as with other drugs the rates tend to be lower in GU patients. The DU relapse rate after sucralfate healing is perhaps lower than after cimetidine healing, and sucralfate healing rates in DU are not compromised by concomitant cimetidine therapy, or by smoking. The value of maintenance therapy with sucralfate 1 g bd in reducing the relapse rate in patients with recently healed DU is well documented. The relapse rate is reduced from the order of 60 to 20% after 6 months, and from 81% to about 30% after one year. Available data also suggests that sucralfate is at least as effective as cimetidine in maintenance therapy. Sucralfate is effective in the prevention of GU relapse in the dose of 1g in the morning and 2g nocte. Sucralfate is particularly well tolerated. Constipation occurs in 2% of patients and nausea is occasionally encountered. The more convenient dose of sucralfate 2g bd is as effective as the conventional one of 1g qid in DU healing and recent evidence suggests that a single nocturnal dose of 2g nocte offers effective maintenance therapy in DU and GU disease.