Sucralfate Cimetidine

Side effects Side effects such as erosions, superficial ulceration or mucosal necrosis can be expected in > 80% of cases. Sucralfate, cimetidine, ranitidine and omeprazole (116) as well as fibrin adhesive have been used both for prevention and to promote healing. From a morphological viewpoint, these inflammatory tissue reactions are to a certain extent necessary to induce thrombosis and vessel wall fibrosis. Fever, leucocytosis, chest pain and tension occur as frequent yet usually insignificant concomitant reactions. Dysphagia or dysfunction of the oesophagus are of no clinical significance. The develop-... 

Assess for potential drug interactions whenever there is a change in the patient s medications, particularly for patients taking cimetidine, omeprazole, or sucralfate. 

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. 

Drugs that affect NSAIDs include the following Bisphosphonates, cholestyramine, cimetidine, colestipol, cyclosporine, diflunisal, DMSO, fluconazole, ketoconazole, phenobarbital, phenylbutazone, probenecid, rifampin, ritonavir, salicylates, sucralfate. 

Drugs that may be affected by sucralfate include aluminum-containing antacids, anticoagulants, diclofenac, digoxin, histamine H2 antagonists (eg, cimetidine,... 

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... 

Gastrointestinal drugs. Avoid cimetidine and omeprazole which inhibit the clearance of R warfarin, and sucralfate which may impair its absorption. Ranitidine may be used but INR should be checked if the dose is high. Most antacids are safe. 

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... 

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. 

Most in vitro and human studies have found that sucralfate does not affect the absorption of either cimetidine, ranitidine,or roxatidine, but two studies found 22 to 29% reductions in ranitidine bioavaiiabiiity due to concurrent use of sucraifate. There is no ciear reason for avoiding concurrent use. 

Albin H, Vincon G, Lalague MC, Couzigou P, Amouretti M. Effect of sucralfate on the bioavailability of cimetidine. EurJ Clin Pharmacol (1986) 30, 493-4. 

D Angio R, Mayersohn M, Conrad KA, Bliss M, Cimetidine absorption in humans during sucralfate coadministtation. BrJ Clin Pharmacol (1986) 21, 515-20. 

Beck CL, Dietz AJ, Carlson JD, Letendre PW, Evaluation of potential cimetidine sucralfate interaction. Clin Pharmacol Ther( 9Sl) A, 168,... 

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. 

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