How to take sucralfate the right way

In this article:

• Taking sucralfate
• Should it be taken on an empty stomach?
• Food interaction
• Timing for food
• Timing for other meds
• Can you lie down?
• Foods to avoid
• Cost and savings

In this article

• Taking sucralfate
• Should it be taken on an empty stomach?
• Food interaction
• Timing for food
• Timing for other meds
• Can you lie down?
• Foods to avoid
• Cost and savings

The last thing you need when you have an ulcer is a complicated list of instructions on how to take the medicine that helps you. Sucralfate (brand name Carafate) has instructions that can seem overwhelming and almost impossible (Take this on an empty stomach four times a day? Is that even possible?)

Below is a simple, straightforward guide on how to take sucralfate. You’ll know how to time it around food and medications, and even glean some tips on saving on medication costs.

What should you take sucralfate with?

Sucralfate, which is FDA-approved to treat duodenal ulcers, comes in two forms: tablets and a liquid suspension.

No matter the form you’re taking, the only thing you should swallow sucralfate with is a glass of water. That means no eating before your dose or along with the medication. Plus, follow these tips:

• Swallow the tablets whole; do not dissolve them in water unless instructed by your healthcare provider.
• If you take the suspension form, shake the liquid well to evenly distribute the medication.
• Take sucralfate an hour before meals so it has time to activate and create a protective barrier over the damaged tissue of your ulcer.
• Time your doses at consistent intervals so the medication can continuously coat your gastrointestinal tract.
• Store the medication at room temperature, away from moisture, and out of reach of children.

The typical sucralfate dosage in adults is 1 gram (or 10 milliliters) four times a day, always on an empty stomach (more on that below). 

Should sucralfate be taken on an empty stomach?

Yes, you should always take sucralfate on an empty stomach. 

Some anti-ulcer medications work to reduce acid in your system. Not sucralfate. This drug forms a sticky, protective barrier over irritated tissue in your stomach, esophagus, and intestines to protect them from stomach acid.  

“Sucralfate forms a protective shield over ulcers to allow them to heal,” explains Nilesh Shukla, MD, gastroenterologist at Holy Name Medical Center in New Jersey.
“Sucralfate needs exposure to the injured gut lining and therefore requires an empty stomach. It also needs acid to trigger its protective effect.”

There are a few reasons why taking sucralfate on an empty stomach ensures it works best:

• Less likely to become diluted: Food or liquid in your stomach can prevent the drug from forming a protective layer.
• Stronger coating: On an empty stomach, sucralfate can bind directly to your tissue rather than to food particles in your system.
• Fewer interactions: Without food or other medications in your system, sucralfate is far less likely to lead to an adverse interaction.

So, how long do you need to wait before or after eating before taking sucralfate?

The best course of action is to take it one hour before your meals. You might see information online that suggests that waiting just 45 minutes before eating is enough time. However, most prescribing guidance states you should take it one hour before meals.

Now, for post-meal medicating and ensuring an empty stomach: It could take four to five hours for your stomach to completely empty. This is variable and can depend on factors such as meal size and individual physiology. Clinicians recommend waiting at least two hours after a meal before taking your dose.

What happens if you take sucralfate with food?

If you happen to take sucralfate with food, don’t panic. 

“Taking sucralfate with food can make the medication significantly less effective, but it is not going to cause harm,” explains Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics.com.

Taking sucralfate with food may prevent it from forming the proper coating. This is because food moves the medication through your system faster. Also, consider that sucralfate forms a sticky substance, and it can actually trap nutrients (and even medications), affecting their absorption. 

What happens if you miss a dose of sucralfate

“In the pharmacy world, we always tell our patients, ‘If you miss a dose, take it as soon as you remember.’ However, with a four-times-a-day schedule, that can be challenging,” Dr. Gray says. “If the next scheduled dose is coming up soon, I suggest skipping the missed one and continuing with your regular schedule. Taking two doses at once does not improve the medication’s effectiveness. The goal is to keep doses evenly spaced, so picking back up with the next scheduled dose is all that is needed.”

If you do happen to miss a dose of sucralfate, take it as soon as you can, as long as it’s been a few hours since you last ate. However, if it’s almost time for your next dose, or you’ve recently eaten, do not double up or take the missed dose. Instead, just take the next scheduled dose. 

When can you eat or drink after taking sucralfate?

Wait at least an hour after taking sucralfate to eat or drink anything other than the water you need to take the medication. If you have to eat sooner, it’s likely okay; however, it may mean the medicine may not work as well as it otherwise would.

This is where it gets tricky. You have to take it an hour before each meal, four times a day, waiting long enough for your meals to clear your stomach before taking your next dose. 

Here’s a suggested schedule to help (and here’s hoping you like getting up early):

• 6 a.m.: Take your first dose
• 7 a.m.: Eat breakfast
• 11 a.m.: Take your second dose
• 12 p.m.: Eat lunch
• 4:30 p.m.: Take your third dose
• 5:30 p.m.: Eat dinner
• 10:30 p.m.: Take your fourth dose

This keeps a consistent five to six hours between your doses, and it helps ensure your stomach is empty.

“The recommended approach is to take it one hour before breakfast, one hour before lunch, one hour before dinner, and at bedtime. However, this can be very difficult to juggle around eating and activities of daily living,” says Dr. Gray. “What I often suggest to patients is to take sucralfate before their largest meals or meals that might be most irritating to their stomach, like spicy foods and, black coffee.”

How long after taking sucralfate can you take other medications?

As if there weren’t already enough rules with sucralfate, now you have to consider taking other medications. The good news is, this can also be simplified. 

Wait either two hours before or two hours after taking sucralfate to take another medication. This is because sucralfate can reduce your medication’s absorption and efficacy. 

A dosing schedule that includes other medications throughout the day could be: 

• 6 a.m.: Take your first dose
• 7 a.m.: Eat breakfast
• 8 a.m.: Take other medications
• 11 a.m.: Take your second dose
• 12 p.m.: Eat lunch
• 2 p.m.: Take other medications if needed
• 4:30 p.m.: Take your third dose
• 5:30 p.m.: Eat dinner
• 7 p.m.: Take other medications if needed
• 10:30 p.m.: Take your fourth dose

“An additional wrinkle with Sucralfate is it also needs to be separated from other medications by at least two hours and taken with a full glass of water, which can be very difficult with medications that need an empty stomach such as thyroid medications,” Dr. Gray explains. “In that situation, I will often suggest taking the empty stomach medication in the middle of the night if possible or immediately upon waking; then I suggest they wait 30 to 45 minutes before taking the Sucralfate if needed before the meals.”

Sucralfate may interact with or need separation from a number of medications, including:

• Thyroid medications like levothyroxine
• Heart-related medications like digoxin, quinidine, and warfarin 
• Antibiotics like tetracyclines and fluoroquinolones, including norfloxacin, ciprofloxacin, and ofloxacin
• Seizure medications like phenytoin
• Acid-reducing medications like cimetidine, omeprazole, and pantoprazole
• Antacids
• Antifungals like ketoconazole
• Bone health medications like bisphosphonates. 

If you are on any prescriptions, dietary supplements, or over-the-counter medications, be sure to consult with your healthcare provider to discuss timing and potential drug interactions with sucralfate.

Can you lie down after taking sucralfate?

Yes, you can lie down after taking sucralfate, especially after the bedtime dose, but you may not want to do so immediately.

“In order to allow sucralfate to have maximum exposure to the gut lining, it is recommended that one does not lie down for 30 minutes after taking the medication,” Dr. Shukla advises.

Additionally, people who have GI issues, specifically acid reflux and heartburn, may need to stay upright for 30 to 60 minutes after taking their dose. If you experience those issues, talk to your provider about whether or not you should remain upright after your last dose. 

Sucralfate is generally very well tolerated, mostly because it goes to work in your stomach and isn’t absorbed in your bloodstream. 

Even still, there are some sucralfate side effects you should know about, such as:

• Constipation
• Dry mouth
• Mild nausea and stomach pain
• Indigestion
• Gas

Less common side effects include allergic reactions such as hives, skin rash, swelling of the face, and itching. Rare side effects include bezoar formation and aluminum toxicity. These are more common in people with diabetes-related gastroparesis and kidney disease, respectively. If you experience any symptoms, consult with a healthcare professional for medical advice. 

Foods to avoid while taking sucralfate

There aren’t “never” foods when taking sucralfate, so you don’t have to completely restrict your diet. However, there are some “rarely” foods you should limit while you’re in treatment and recovery. 

If you’re taking the medication, it means you either have ulcers or gastritis, or you’re trying to prevent them. Therefore, foods that could irritate your GI tract should be avoided. This includes:

• Acidic foods: Tomatoes, tomato sauces, citrus, vinegar-heavy foods
• Fried foods: Fast foods and greasy meals
• Spicy foods: Hot sauce, curries, and hot peppers
• Caffeinated and alcoholic drinks: Coffee, sodas, energy drinks, beer, wine, and liquor

Dr. Shukla also warns against consuming dairy within an hour of taking your medicine to avoid counteracting the medicine. “Dairy products such as milk, as well as calcium-containing tablets, could bind and deactivate sucralfate, and should be avoided immediately after taking sucralfate,” he says.

Sucralfate cost and savings

Sucralfate prices can vary depending on the pharmacy you choose and your prescribed dose. You can reduce out-of-pocket costs by using a SingleCare sucralfate coupon on your prescription.