How sucralfate works
Sucralfate is a mucosal protective agent. In an acid environment it forms a sticky, paste-like barrier that binds to the ulcer base and protects it from acid, pepsin, and bile while it heals. It acts locally and is minimally absorbed. Because it binds to proteins, it works best on an empty stomach, before food arrives. Sucralfate is taken 1 hour before meals and at bedtime.
Building the schedule
With meals at 07:00, 12:00, and 18:00 and bedtime at 22:00, the four doses fall 1 hour before each meal and at bedtime.
| Event | Time | Sucralfate dose |
|---|
| Breakfast | 07:00 | 06:00 |
| Lunch | 12:00 | 11:00 |
| Dinner | 18:00 | 17:00 |
| Bedtime | 22:00 | 22:00 |
Why the other schedules are wrong
Doses taken with meals (07:00, 12:00, 18:00) bind to food proteins instead of forming a coating over the ulcer. Doses taken 1 hour after meals miss the empty-stomach period that the coating needs. Watch out! The schedule 06:00, 11:00, 17:00, and 19:00 has the first three doses right, but the fourth falls just after dinner. The bedtime dose is especially important, because the night is the longest empty-stomach period, and acid secretion continues during sleep; a coating in place overnight protects the ulcer when it is most exposed.
Other administration points
Antacids are not taken within 30 minutes of a sucralfate dose, because they raise gastric pH and interfere with the formation of the protective barrier. Sucralfate can also bind other oral drugs and reduce their absorption, so other drugs are generally given 2 hours before sucralfate. The most common side effect is constipation, so the nurse encourages fluids, fiber, and activity unless contraindicated. Tablets may be dissolved in water if swallowing is difficult.
Exam takeaway
Key point! Sucralfate: 1 hour before meals and at bedtime, on an empty stomach; separate from antacids by 30 minutes; watch for constipation. When calculating times, subtract one hour from each meal and keep the last dose at bedtime.