Sucralfate with PPI's contraindication (for Howard)
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From: Peter on 26 Dec 2007 20:02 Hi Howard, and Merry Christmas to you and the rest of the group, Here is a statement I have pasted from marci-kids.com - 2. Sucralfate (Carafate) This is an aluminum-containing, sticky sugar that binds to open, irritated areas in the esophagus or stomach. The catch is that sucralfate requires acid to become active. It also requires an irritated area. Because of these two factors and since it has to be given quite frequently (4-6 times/day), it is not highly useful for the treatment of acid related disorders. Note sucralfate should not be used with antacids or with H-2 blockers or with PPI drugs. This is because as was stated earlier, sucralfate requires an acid environment to work. ------------------------------------------------------------------------------------------------------ I understand that sucralfate forms a paste formed from gastric acid, that binds to ulcer sites and creates a protective film, and that it works best in an acid environment, preferably a pH below 4.0 (but I have also read in one source that it may not require acid to work). The statement above says sucralfate should not be used with antacids or H2 blockers or PPI drugs. The package insert for sucralfate references separating antacids (by 30 minutes), and H2's and other drugs by two hours (does not mention PPI's which are about 10 times more effective at blocking acid than the H2 blockers). If this is true (eg sucralfate should not be used with PPI drugs) then would you please explain why some gastroenterologists and surgeons (including yourself) immediately prescribe BOTH nexium 40 mg bi-daily, AND sucralfate four times a day (for adults), when they find duodenal ulcers on endoscopic examination (kind of like a double whammy, even though I understand the PPI's are the drugs of choice and sucralfate is fading out). But if the high dose of nexium raises the pH significantly above 4 (which it will if it is working properly on the person taking it), than why would the gastro's or surgeon prescribe the sucralfate in addition to the nexium, if it would just be blunted by the nexium creating the higher pH and not allowing the acid paste to form. Does the sucralfate still have some capability of forming the paste and have the binding effect, even at a higher pH above 4 or 5. If not then what a waste of time and effort, especially since sucralfate is so hard to take with it's one hour before and two to three hours after restrictions on eating, and don't take other pills within two hours of it to be safe, etc. It becomes almost impossible to eat and take other pills if you take the sucralfate four times a day. I would also like to know how sucralfate can bind to the esophagus if you swallow the "pill form" with a glass of water and it immediately goes to your gut (I believe the pills are way better than two teaspoons of the suspension since the pill immediately dissolves in the water and IMO will be able to disperse better and form the paste in the stomach and duodenum). The package inserts indicate the healing rates for duodenal ulcers are much higher for the pills than the suspension (at four weeks) and it also says that equivalency of the suspension to the pill has not been demonstrated. I understand that swallowing two teaspoons of the suspension may cling to the esophagus briefly but I would think the effect would be negligible if you had esophageal erosions. The drug is old and the data is old and calling Axcan (the current pharma that owns it) is next to useless. I would appreciate a response to my concerns. Thank you...Pete
From: H McCollister on 26 Dec 2007 21:57 In article <fkutj602es1(a)enews2.newsguy.com>, "Peter" <peter(a)nospam.net> wrote: > > If this is true (eg sucralfate should not be used with PPI drugs) then would > you please explain why some gastroenterologists and surgeons (including > yourself) immediately prescribe BOTH nexium 40 mg bi-daily, AND sucralfate > four times a day (for > adults), when they find duodenal ulcers on endoscopic examination (kind of I don't think it's true, Pete. I think Carafate works fine in the stomach. It may interfere with the absorption of H2 receptor antagonists, but I'm of the opinion that it works fine in conjunction with PPI's and I have never heard or read otherwise. HMc
From: Peter on 27 Dec 2007 13:43
H McCollister wrote: > In article <fkutj602es1(a)enews2.newsguy.com>, "Peter" > <peter(a)nospam.net> wrote: > > >> >> If this is true (eg sucralfate should not be used with PPI drugs) >> then would you please explain why some gastroenterologists and >> surgeons (including yourself) immediately prescribe BOTH nexium 40 >> mg bi-daily, AND sucralfate four times a day (for >> adults), when they find duodenal ulcers on endoscopic examination >> (kind of > > I don't think it's true, Pete. I think Carafate works fine in the > stomach. It may interfere with the absorption of H2 receptor > antagonists, but I'm of the opinion that it works fine in conjunction > with PPI's and I have never heard or read otherwise. > > HMc Thanks Howard. Various sites do indicate it forms a paste with HCL to bind properly with the ulcers, and I would guess the lower the pH the better (for the sucralfate). And it certainly makes sense to take the PPI to raise the pH and reduce the acid (which I would think is more critical). Perhaps they can work together. I guess it would be difficult to know which one is helping to heal the ulcer more when taking both. A pharmacist told me she has only prescribed sucralfate a couple times in the last few years (I think most docs just use the PPI's nowadays). In my case where I don't believe PPI's are effective anymore, perhaps it was the sucralfate that may have helped more if the PPI's were not working up to par. Thanks again...Pete |