🩹 Sucralfate (Carafate) Vet Guide 2025 — by Dr Duncan Houston

Revised: April 4, 2024 • Vet Info Only • No dosing online

Introduction

Stomach ulcers are painful and dangerous for pets. Sucralfate—marketed as Carafate—is a protective compound that acts like a bandage over ulcers in the stomach, esophagus, and upper small intestine. Dr Duncan Houston explains how it works, when to give it, side effects, drug interactions, and 2025 best practices for pet ulcer care. 🐶🐱

1. What Is Sucralfate?

Sucralfate is a sucrose aluminum hydroxide complex that transforms in the acidic environment of the stomach into a viscous gel-like film. This “bandage” adheres to ulcerated tissue, protects it from acid and enzymes, and promotes healing by concentrating growth factors from the pet’s own system.

Key Benefits

• Local action only: Minimal absorption, low risk of systemic side effects;
• Protective coat: Shields ulcerated surfaces;
• Heals faster: Encourages tissue repair;
• Safe to use: Few side effects; generally well tolerated.

2. When and Why to Use Sucralfate

Indications include:

• 🌡️ Stomach or duodenal ulcers from disease or ingestion (e.g., aspirin, toxins);
• Esophageal ulcers or reflux-related irritation;
• Post-toxic ingestion treatment support;
• Adjunct to other ulcer therapies like proton-pump inhibitors or cimetidine.

Sucralfate works best as part of a multi-modal treatment plan—protecting the ulcer while other medicines reduce acid production.

3. Proper Use & Timing 🕰️

3.1 Product Forms

• Tablets: 1 g each—must be crushed and mixed into slurry;
• Oral suspension: more convenient but similar timing rules apply.

3.2 Administration Schedule

• Frequency: Generally four times daily (~every 6 hours);
• Empty stomach: at least 1 hour before or 2 hours after feeding to allow gel formation;
• Consistency: Maintain timing to ensure ulcer remains coated.

3.3 If a Dose Is Missed

• Resume next scheduled dose—do not double up;
• Missing a dose means no protection for ~6 hours—ulcer healing may stall.

3.4 Pre‑Procedure Use

Avoid giving sucralfate 12–24 hours before endoscopy or imaging—the gel may mask ulcers and hinder diagnosis.

4. How Sucralfate Works

In the presence of gastric acid, sucralfate transforms into an adhesive gel that:

• Binds tightly to ulcerated tissue (lasting ~6 hours);
• Shields from stomach acid, pepsin, and bile;
• Attracts reparative proteins and growth factors;
• Helps restore mucosal integrity and reduce bleeding.

5. Side Effects

Side effects are rare due to minimal absorption:

• Constipation (~2% in humans): most common—monitor stools;
• Vomiting (in cats): due to chalky taste—mix well in water;
• Metal toxicity: unlikely, except in rare cases of prolonged high doses in pets with kidney failure.

6. Drug Interactions ⚠️

Sucralfate binds certain medications and prevents their absorption. To avoid this:

Give Other Meds ≥2 Hours Before/After Sucralfate:

• Tetracyclines (e.g., doxycycline);
• Fluoroquinolones (enrofloxacin, orbifloxacin);
• Phenytoin;
• Digoxin;
• Azithromycin;
• Theophylline;
• Thyroxine (levothyroxine);
• Ketoconazole.

Antacids

Sucralfate needs acid to work. Wait ≥30 minutes after sucralfate before giving antacids or acid reducers like proton-pump inhibitors.

7. Storage & Handling

• Store tablets or suspension at room temperature away from light;
• Tablets should be crushed fresh, mixed with water into slurry;
• Avoid refrigerating;
• Discard any unused slurry after preparation.

8. Best Practice Tips 🧠

• Follow schedule strictly: to maintain ulcer coverage;
• Crush tablets thoroughly: prevents loose grittiness and improves taste;
• Empty stomach: enhances coating action;
• Manage constipation: consider dietary fiber if needed;
• Check drug timing: always space out a minimum of 2 hours from other meds;
• Watch for vomiting: if slurry taste causes gagging, add a small amount of mild flavoring (with vet approval);
• Stop before endoscopy: to ensure clear visualization of mucosa;
• Monitor kidney–liver health: ensure safe metabolism if used long-term.

9. Clinical Scenarios

9.1 Pet with NSAID-induced Ulcer

A dog with GI bleeding after NSAIDs was started on sucralfate four times daily, alongside omeprazole and dietary rest. Ulceration resolved in 10 days, with improved appetite and stool health.

9.2 Toxin-Induced Gastric Damage

A cat exposed to aspirin took sucralfate slurry every six hours. Providers staggered antibiotics 2 hrs apart. Healing confirmed on follow-up endoscopy after 1 week.

9.3 Chronic Kidney Patient

Cat with CKD and chronic gastritis received sucralfate. Constipation was managed with fiber supplements. No signs of aluminum toxicity were noted.

9.4 Pre-endoscopy Case

A dog scheduled for endoscopy had sucralfate discontinued 24 hrs prior. Ulcers were visible and treated after procedure started.

10. FAQs

Q: How soon does it work?

A: Coating begins immediately after administration, lasting ~6 hours. Healing visible after several days.

Q: Can I mix slurry with food?

A: No—food prevents adhesion. Use plain water for slurry.

Q: What if pet spits the slurry?

A: Try small syringe doses, or flavor lightly with vet‑approved broth.

Q: Can diabetic pets take it?

A: Yes—despite sucrose in the name, sucralfate doesn't affect blood sugar and is safe for diabetics.

Q: Can I stop early?

A: No—premature discontinuation may allow ulcer recurrence. Follow your vet’s full treatment plan.

Q: Long-term use safe?

A: Generally yes, under vet supervision. Monitor class risks—especially in kidney disease.

11. 2025 Vet‑Approved Recommendations

• Use only under vet guidance;
• Crush tablets fresh & mix with water;
• Give on empty stomach every 6 hours;
• Space other meds 2+ hrs apart;
• Stop 12–24 hrs before diagnostics like endoscopy;
• Watch for constipation & manage as needed;
• Avoid in pets with severe kidney impairment;
• Store properly & discard prepared slurry;
• Communicate with vet throughout treatment;
• Adhere to complete treatment to ensure healing.

12. Summary

• Sucralfate is a local ulcer‑coating bandage for pets;
• Minimal side effects, main risk is constipation;
• Frequent dosing on empty stomach ensures healing;
• Drug interactions require careful timing;
• Stop before procedures that inspect the GI lining;
• Follow vet’s full protocol for safe, effective ulcer care.

🩹 With responsible use under Dr Duncan Houston’s guidance, sucralfate helps pets recover from gastric distress and return to comfort and health in 2025.