Sucralfate interactions to avoid

Drug interactions | Food interactions | Other interactions | Avoiding interactions | When to see a doctor

Sucralfate is approved by the U.S. Food and Drug Administration (FDA) for the short-term treatment of stomach ulcers. Also known by its brand name, Carafate, sucralfate comes in two dosage forms: an oral tablet and oral suspension. Sucralfate is composed of a sucrose sulfate-aluminum. It belongs to a class of medications called protectants, which create a protective layer over the ulcer and intestines to shield it from bile salts, acids, and enzymes to speed up healing.

Although sucralfate is considered a safe and effective treatment option, it can interact with other medications, including certain antibiotics, HIV medications, and levothyroxine. It’s important to be aware of sucralfate interactions as they can interfere with other drugs’ effectiveness and cause or worsen side effects, such as constipation, dry mouth, skin rash, or hives.

Let’s explore potential sucralfate interactions.

Sucralfate drug interactions

The interactions are the same whether you take sucralfate tablets or the suspension. Sucralfate can interact with several drugs. 

Certain antibiotics

Antibiotics are drugs used to treat bacterial infections. There are many different classes of antibiotics, such as fluoroquinolones, tetracyclines, and penicillins. Each class of antibiotics works differently to kill bacteria. 

Sucralfate can interact with certain antibiotics by interfering with their absorption into the body. This is most likely due to sucralfate binding to the antibiotic in the digestive tract, which prevents the antibiotic from being fully absorbed into the bloodstream. This can make the antibiotic less effective.

Examples of antibiotics that may interact with sucralfate include:

• Levaquin (levofloxacin)
• Tetracycline
• Avelox (moxifloxacin)
• Cipro (ciprofloxacin)
• Ofloxacin
• Ketoconazole

Due to these interactions, doctors may recommend separating the administration of sucralfate and your antibiotic. 

Certain proton pump inhibitors

Proton pump inhibitors (PPIs) are drugs used to treat various conditions, such as heartburn, gastroesophageal reflux disease (GERD), and certain types of ulcers. Sucralfate can interact with some PPIs, potentially interfering with their absorption. This interaction can cause the PPI to be less effective, which may result in unmanaged heartburn, GERD, or stomach ulcers. 

Examples of proton pump inhibitors include:

• Prilosec (omeprazole)
• Nexium (esomeprazole)
• Lansoprazole

Although some proton pump inhibitors interact with sucralfate, they can still be taken together as long as their administration is separated. Before starting sucralfate, let your healthcare provider know if you take a proton pump inhibitor so they can properly manage the potential interaction.

Antacids

Antacids neutralize stomach acid to relieve symptoms of heartburn and indigestion. According to The Prescribers’ Digital Reference (PDR), combining antacids with sucralfate can decrease the effects of sucralfate by interfering with its binding to the stomach wall. A healthcare provider may recommend separating sucralfate and antacids to prevent this from happening. 

Examples of antacids include: 

• Maalox
• Tums
• Alka-Seltzer

Certain HIV medications

Human immunodeficiency virus (HIV) is treated with antiretroviral drugs. However, according to PDR, the aluminum component of sucralfate can bind to certain antiretrovirals in the digestive tract and prevent the antiretroviral from being fully absorbed. This can make the HIV medication less effective, which can lead to an increased HIV viral load. 

Examples of antiretrovirals include:

• Tivicay (dolutegravir)
• Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide)

Healthcare providers may monitor you more closely if these drugs are taken together, and they will likely advise you to separate the administration of the two drugs. 

Alendronate

Alendronate (Fosamax) is a bisphosphonate drug used to treat osteoporosis. Similar to other interactions, taking sucralfate with alendronate can disrupt alendronate’s absorption. To avoid this, your medical team will likely recommend separating your dose of sucralfate and alendronate.

Levothyroxine

Levothyroxine (Synthroid) is a medication used to treat an underactive thyroid gland (hypothyroidism). Sucralfate can interact with levothyroxine by delaying or preventing its absorption. This can lead to reduced effectiveness of the thyroid drug, which can worsen hypothyroidism. Due to this interaction, a healthcare professional may not prescribe sucralfate if you take levothyroxine. But if these drugs are prescribed together, their administration should be separated by at least four hours, according to the Prescribers’ Digital Reference (PDR). Doctors may also monitor your thyroid function more closely. 

Quinidine

Quinidine is a drug prescribed for certain types of irregular heartbeats. If taken with sucralfate, the two medications can bind in the gastrointestinal tract, leading to decreased quinidine absorption. As a result, quinidine may be less effective at maintaining a healthy heart rhythm. 

Digoxin

Digoxin (Lanoxin) is used to treat heart failure and certain types of irregular heartbeats. Like its interaction with quinidine, sucralfate can bind to digoxin in the digestive tract, impeding its absorption into the bloodstream. Because of this, a healthcare provider will likely recommend separating the administration of the medications. They may also adjust your digoxin dose and measure your digoxin blood levels before and during sucralfate treatment. 

Theophylline

Theophylline (Theo-24) is prescribed for asthma and other lung problems. Combining theophylline and sucralfate can reduce the effectiveness of theophylline. Similar to other interactions, this occurs because theophylline can bind to theophylline in the digestive tract and impede its absorption. 

Warfarin

Warfarin (Coumadin) is a blood thinner used to prevent blood clots. There is some evidence that sucralfate can interact with warfarin by interfering with its absorption into the bloodstream. If these two drugs are prescribed together, your healthcare provider will likely monitor your prothrombin time (PT) and international normalized ratio (INR) more closely. 

Sucralfate food interactions

Foods can sometimes interact with medications. However, sucralfate isn’t known to interact with any foods. Sucralfate is most effective if it’s taken on an empty stomach. 

Other sucralfate interactions

In addition to prescription drugs, sucralfate can interact with certain vitamins and diseases. 

Sucralfate and alcohol

There aren’t any known interactions between the use of sucralfate and alcohol. However, it’s typically recommended to avoid alcohol if you have an ulcer, which sucralfate is used to treat. This is because alcohol can worsen the symptoms of an ulcer, including stomach bleeding. 

Sucralfate and vitamins

Sucralfate can interact with certain vitamins, such as vitamin D (cholecalciferol, ergocalciferol). Taking these medications together can increase the levels of aluminum in the body and increase the risk of aluminum toxicity. This can lead to serious side effects, such as muscle weakness, mental changes, and seizures. 

Sucralfate and disease

Certain health conditions or health factors can increase your risk of sucralfate interactions. 

These include:

• Past allergic reaction to sucralfate or any other ingredients in the drug
• Kidney disease
• Dialysis
• Age 65 years or older

How to minimize sucralfate interactions

Although sucralfate has several potential interactions, it may still be taken safely with certain precautions. 

• Consult a healthcare provider. Before starting any new prescription or over-the-counter drugs, vitamins, supplements, or herbal products, consult a healthcare professional so they can screen for interactions and provide additional drug information.

• Keep a list of medications and medical conditions. Include all drugs and medical conditions on your list. 

• Understand warning signs. Potential warning signs of a sucralfate interaction include new or worsening adverse effects, changes in a drug’s effectiveness, and changes in your condition. Report any of these signs to a healthcare professional. 

• Adhere to prescribed dosing. Take sucralfate only as directed. If a dose is missed, take the missed dose as soon as possible. Avoid taking additional or twice the recommended dosage.

When to talk to a healthcare provider about sucralfate interactions

Although several sucralfate interactions were discussed in this article, this is only a partial list of all possible interactions. Share a list of all your medications and medical conditions with your healthcare provider before you start sucralfate. This way, they can help prevent interactions before they occur.