Drugs in this Class
Sucralfate Oral Suspension (Carafate Oral Suspension)
Misoprostol Tablets (Cytotec Tablets)
Sucralfate Tablets (Carafate Tablets)

Summarizing the Evidence

• Although effective for the treatment and prevention of recurrence of PUD, cytoprotective agents are not usually the first choice of medication for treating ulcers, especially ulcers caused by Helicobacter pylori (H. pylori), a bacteria responsible for more than 90% of ulcers.

• Cytoprotective agents are more commonly used to prevent ulcers from developing rather than to treat existing ulcers. These medications are mainly used for preventing ulcers in patients who chronically take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and high doses of aspirin.

• Cytoprotective agents or proton pump inhibitors (like Aciphex, Nexium, Prevacid, Prilosec, and Protonix) can be used for NSAID-induced ulcer prevention. Clinical trials suggest equal effectiveness between these two drug classes.

• Studies have shown that misoprostol is generally more effective than sulcralfate for preventing NSAID-induced ulcer formation. Misoprostol use is limited by its side effects, which include diarrhea and abdominal cramping.

Dosing Administration

• Misoprostol is usually taken four times daily with food. Sucralfate is usually taken twice daily or four times daily one hour before meals. Avoid taking antacids within 30 minutes before or after taking sucralfate. Also avoid taking any other medications within 2 hours before or after taking sucralfate.

Generic Availability

• Misoprostol (Cytotec) and sucralfate are both available in generic versions.

Drug Interactions

Some interactions between medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how the drugs interact and the severity of the interaction, please use our Drug Interactions Checker.

Side Effects

To view specific side effect information, please use our Side Effect Checker.

Additional Information

References

1. Drugdex Database. In: Thomson-Micromedex. Greenwood Village, CO. 2006.

2. Drug Facts and Comparisons. Wolters Kluwer Health. St. Louis, MO; 2007.

3. Berardi RR, Welage LS. Peptic Ulcer Disease. In: Pharmacotherapy A Pathophysiologic Approach. 6th ed. Dipiro JT, Talbert RL, Yee GC et al. (eds). McGraw-Hill. New York. 2005. pg. 629-648.

4. Graham DY, Agrawal NM, Campbell DR, et al. Ulcer prevention in long-term users of nonsteroidal anti-inflammatory drugs: results of a double-blind, randomized, multicenter, active- and placebo-controlled study of misoprostol vs lansoprazole. Arch Intern Med 2002 Jan 28;162(2):169-75.

5. Naesdal J, Wilson I. Gastro-duodenal protection in an era of cyclo-oxygenase-2-selective nonsteroidal anti-inflammatory drugs. Eur J Gastroenterol Hepatol 2001 Dec;13(12):1401-6.

6. Rostom A, Wells G, Tugwell P, et al. Prevention of NSAID-induced gastroduodenal ulcers. Cochrane Database Syst Rev 2000;(4):CD002296.

7. Agrawal NM, Roth S, Graham DY et al. Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. A randomized, controlled trial. Ann Intern Med. 1991;115(30:195-200.

8. Lanza F, Peace K, Gustitus L et al. A blinded endoscopic comparative study of misoprostol versus sucralfate and placebo in the prevention of aspirin-induced gastric and duodenal ulceration. Am J Gastroenterol. 1988; 83(2):143-6.

Last Updated: March 2008

Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It should not be construed to indicate that the use of the product is safe, appropriate, or effective for you. Consult your healthcare professional before taking any medication.

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