Key takeaways:
Sucralfate (Carafate) is a medication that helps ulcers in your small intestine heal. It does this by coating them to create a protective barrier.
Because of how it works, sucralfate can prevent your body from absorbing other medications you’re taking. And some interactions can affect how well sucralfate works.
Most interactions can be avoided by simply separating when you take sucralfate and your other medications. Your pharmacist can help you make a schedule for taking your medications safely.
Save on related medications
Sucralfate (Carafate) is a prescription medication that’s used to treat duodenal ulcers (ulcers in your small intestine). It’s thought to work in several different ways. Most simply, it helps coat and protect the lining of your stomach and intestines so ulcers can heal.
Your body doesn’t absorb very much sucralfate. Instead, it works locally to treat your ulcers. The downside is that it contains aluminum. And aluminum can bind to other medications that you take. This can prevent your body from absorbing them, and affect how well they work.
There are two oral forms of sucralfate — tablets and an oral suspension. Interactions can happen with both of them. But the good news is that there are ways to avoid many of these interactions.
6 sucralfate interactions to know about
Below we review several common sucralfate interactions you should know about. Some interactions can make other medications less effective. Others can prevent sucralfate from coating your ulcers properly.
Keep in mind this isn’t a complete list. Check with your healthcare provider or pharmacist before combining medications.
1. Food
If you’ve been prescribed sucralfate, you’ve likely been told to take it on an empty stomach. That’s because food can prevent it from working as well. When you have food in your stomach, sucralfate isn’t able to properly coat your ulcers to allow them to heal.
The fix is pretty simple: Take sucralfate on an empty stomach, at least 1 hour before or 2 hours after you eat.
2. Warfarin
Warfarin (Coumadin, Jantoven) interacts with a lot of medications and foods. It’s no surprise that sucralfate is one of them.
Warfarin is a blood thinner that helps prevent blood clots. And your blood is regularly monitored while taking it to make sure you’re getting the right dose. That’s because small changes in foods you eat and medications you take can affect how well it works.
Sucralfate may prevent you from properly absorbing your warfarin when taken together. Less warfarin can mean a higher chance of a blood clot or stroke.
To lower this risk, your healthcare provider may have you take warfarin at least 2 hours before sucralfate. They’ll also be monitoring your blood and adjusting your dosage as needed. Don’t adjust your own warfarin dose to counteract this potential interaction. And don’t start or stop taking sucralfate unless instructed by your healthcare provider.
3. Digoxin
Digoxin (Lanoxin) is a medication that’s used to treat heart failure and atrial fibrillation. Like warfarin, small changes in your blood levels can have serious effects. When taken together, sucralfate can lower digoxin absorption. This can prevent digoxin from working as well.
Similar to the other interactions we’ve discussed, this can be managed by separating your medications’ doses. Your healthcare provider can give you specific instructions. But the general rule of thumb is to take your digoxin at least 2 hours before you take sucralfate.
Digoxin is another medication that requires blood level monitoring. Your healthcare provider can confirm with blood tests whether or not sucralfate is affecting your digoxin. Don’t start or stop sucralfate unless instructed to do so.
4. Thyroid medications
Like sucralfate, thyroid medications should be taken on an empty stomach. This is to ensure that you’re absorbing your full dose.
When taken together, sucralfate can reduce the absorption of thyroid medications, like levothyroxine (Synthroid). This may result in hypothyroidism symptoms, like fatigue, dry skin, and weight gain.
Thyroid medications also interact with food, beverages, and many other medications. It’s best to take them in the morning at least 30 minutes before breakfast. But you’ll need to wait at least 4 hours before taking sucralfate to help prevent this interaction.
5. Bisphosphonates
Bisphosphonates are medications commonly used to treat osteoporosis. Examples include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva). Certain foods, beverages, and medications can prevent them from being fully absorbed.
When taken together, sucralfate can lower bisphosphonate absorption. So, you may not get the same amount of bone-building benefits from treatment.
Bisphosphonates should be taken on an empty stomach first thing in the morning. Depending on the bisphosphonate, you typically need to wait 30 to 60 minutes before eating, drinking, or taking medications.
But you’ll need to wait longer to take sucralfate. Separate your sucralfate and bisphosphonate doses by at least 2 hours to help prevent this interaction.
6. Certain antibiotics
Yes, even short-term antibiotics can be affected by sucralfate. Most commonly, these include fluoroquinolones and tetracyclines. When taken together, sucralfate can bind to these antibiotics and lower absorption. This can potentially lead to antibiotic resistance — when an antibiotic stops working against a germ.
Below are a few examples of how to manage this interaction:
| Antibiotic | Directions |
|---|---|
| Ciprofloxacin (Cipro) | Take at least 2 hours before or 6 hours after sucralfate |
| Moxifloxacin (Avelox) | Take at least 4 hours before or 8 hours after sucralfate |
| Levofloxacin (Levaquin) Tetracycline Doxycycline (Monodox, Oracea) Minocycline (Minocin, Solodyn) |
Take at least 2 hours before or after sucralfate |
Ask your healthcare provider or pharmacist how to separate your antibiotic from sucralfate.
When should I contact my healthcare provider about a sucralfate interaction?
Before taking sucralfate, make sure to discuss potential interactions with your healthcare provider or pharmacist. They can tell you how to safely separate your medication doses.
As covered above, sucralfate can affect how your body absorbs other medications. This may prevent them from working as well. Let your healthcare provider know if your symptoms feel like they’re not being controlled. They can discuss next steps with you.
How can I avoid or manage potential interactions with sucralfate?
One of the best ways to avoid medication interactions is to give your healthcare provider and pharmacist your current medication list. This includes over-the-counter (OTC) products and herbal supplements. Knowing what you’re taking can help them identify potential interactions.
Keep in mind: Timing your medications correctly can prevent most of these sucralfate interactions. However, sucralfate is usually taken several times a day. It also interacts with food. So, it can be tricky keeping the timing straight. Ask your pharmacist to help you create a medication schedule. And a medication reminder app may be helpful, too.
The bottom line
Sucralfate can interact with warfarin, thyroid medications, and digoxin. Interactions with bisphosphonates like Fosamax, antibiotics like ciprofloxacin, and food are also possible. This is likely due to how sucralfate coats your stomach and intestines to help ulcers heal. This can prevent other medications from being absorbed.
Many sucralfate interactions can be managed by separating when you take certain medications and eat meals.
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References
Bayer HealthCare Pharmaceuticals Inc. (2021). Cipro [package insert].
Bryant Ranch Prepack. (2020). Levothyroxine sodium [package insert].
Bryant Ranch Prepack. (2020). Moxifloxacin [package insert].
Bryant Ranch Prepack. (2021). Sucralfate [package insert].
Kudaravalli, P., et al. (2022). Sucralfate. StatPearls.
