Cimetidine with sucralfate

The most common side effect of sucralfate is constipation (-2%). some aluminum can be absorbed, sucralfate should be avoided in patients with renal failure who are at risk for aluminum overload. Likewise, aluminum-containing antacids should not be combined with sucralfate in these patients. Sucralfate forms a viscous layer in the stomach that may inhibit absorption of other drugs, including phenytoin, digoxin, cimetidine, ketoconazole, and fluoroquinolone antibiotics. 

Kappstein I, Friedrich T, Helfinger P, Benzing A, Geiger K, Schulgen G, et al. Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding bacterial colonization of the stomach. Am J Med 1991 91(suppl 2A) 125-131. 

Drug therapy, if necessary, may be initiated with aluminum, calcium, or magnesium antacids sucralfate or cimetidine or ranitidine. Lansoprazole, omeprazole, and metoclopramide are also options if the patient does not respond to histamine-2 receptor blockers. 

Cimetidine overdose should be treated with gastric lavage, emesis induction as an early measure, and should be followed by supportive and symptomatic treatment. Cimetidine interacts with antimuscarinics, antacids, sucralfate, antiarrhythmics, antiepileptics, antidiabetics, and alcohol.173... 

Simultaneous administration of sucralfates with other nonantacid medication should be given after an interval of at least 2 hours. Sucralfates interact with rantidine, cimetidine, digoxin, quinidine, theophylline, and warfarin. Sulfasalazine should be administered with caution with antibacterials and antineoplastics.179... 

In another study of stress ulcer prophylaxis, 53 critically ill patients were randomized to receive sucralfate 1 g 6-hourly, cimetidine 300 mg 8-hourly, or cimetidine 900 mg/day by continuous intravenous infusion (14). Although bacterial colonization was increasingly likely in patients with a persistent alkaline gastric environment, gastric luminal pH and the degree of bacterial colonization of the stomach were similar in the three groups. 

Clinically important, potentially hazardous interactions with amprenavir, aprepitant, bedomethasone, buprenorphine, calcium, chloramphenicol, cimetidine, dobazam, clorazepate, cyclosporine, cyproterone, darunavir, dasatinib, delavirdine, dexamethasone, diazoxide, disulfiram, dopamine, fesoterodine, fluconazole, flunisolide, fluoxetine, fosamprenavir, ginkgo biloba, hydrocortisone, imatinib, indinavir, influenza vaccines, isoniazid, isradipine, itraconazole, lacosamide, lapatinib, lopinavir, meperidine, methylprednisolone, midazolam, mivacurium, nelfinavir, nilotinib, nilutamide, phenylbutazone, piracetam, posaconazole, prednisolone, prednisone, primrose, ritonavir, rivaroxaban, sage, saquinavir, solifenacin, St John s wort, sucralfate, telithromycin, temsirolimus, teniposide, ticlopidine, tizanidine, tolvaptan, triamcinolone, uracil/tegafur, vigabatrin... 

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