Sucralfate, commonly known by the brand name Carafate, is a prescription medication used to treat and prevent ulcers in the stomach and small intestine. This drug is classified as a cytoprotective agent because it works by creating a physical barrier rather than neutralizing stomach acid. In the presence of stomach acid, sucralfate transforms into a viscous, sticky gel that selectively binds to proteins found at the base of an ulcer. This action forms a protective coating, shielding the tissue from gastric acid, pepsin, and bile salts, thereby promoting healing. A slurry, or suspension, is often prepared from the solid tablet for patients who have difficulty swallowing pills or require administration through a feeding tube.
Necessary Supplies for Preparation
Preparing the slurry requires assembling the correct materials for an accurate dose. The preparation starts with the 1-gram sucralfate tablet, which must be reduced to a fine powder using a pill crusher or a mortar and pestle. Clean tap water or distilled water is required as the sterile liquid for the suspension. The liquid must be measured accurately, typically using a measuring spoon or a small oral syringe marked in milliliters (mL). For a single 1-gram tablet, approximately 10 mL (about two teaspoons) of liquid is sufficient for dispersion.
Step-by-Step Slurry Creation
The physical preparation of the slurry must be precise, starting with fully pulverizing the tablet. Crush each 1-gram tablet into a fine, uniform powder and transfer it to a clean container suitable for mixing. Next, add the measured volume of water, typically 10 mL per tablet. Stir or gently swirl the mixture immediately until the powder is thoroughly suspended, forming a cloudy, uniform suspension. The goal is to create a smooth, lump-free slurry that must be prepared just before the dose is due to be taken.
Guidelines for Ingestion and Timing
The prepared sucralfate slurry must be taken immediately after mixing to prevent settling and ensure the full dose is received. Timing is crucial, as sucralfate works best when the stomach is relatively empty, requiring ingestion at least one hour before a meal or two hours after eating. Separating sucralfate from other oral medications is important because its physical coating action can interfere with drug absorption. Most medications, including digoxin, phenytoin, fluoroquinolone antibiotics, and levothyroxine, require administration at least two hours before or after the sucralfate dose. Antacids must also be separated by at least 30 minutes, as taking them too close raises the stomach pH and prevents sucralfate from activating correctly to form its protective barrier.
Handling Unused Slurry
Once prepared, the sucralfate slurry should be ingested immediately for the best therapeutic effect. The extemporaneously prepared suspension has a very limited shelf life, and any unused portion must be discarded. If the mixture begins to settle, it should be quickly stirred or swirled again before being taken. In contrast, unmixed sucralfate tablets have a long shelf life when stored correctly. Tablets should be kept at room temperature, ideally between 68°F and 77°F (20°C to 25°C), in a cool, dry place and in the original container to protect them from moisture.