In this article
💊 Vet’s 2025 Guide to Sucralfate Use in Horses
By Dr Duncan Houston BVSc
1. What Is Sucralfate?
Sucralfate is a mucosal‑protective medication—a sucrose octasulfate aluminum salt—that reacts with gastric acid (pH <4) forming a viscous “band‑aid” over ulcers in the stomach and colon. It binds to proteins at ulcer sites, shields tissues from acid, pepsin, and bile, while stimulating protective factors like prostaglandins and mucus :contentReference[oaicite:3]{index=3}.
2. When & Why It's Used
- Oral therapy for **equine gastric squamous & glandular ulcers**, as well as **hindgut lesions**—especially alongside omeprazole :contentReference[oaicite:4]{index=4}.
- Prevention in horses on **NSAIDs or long‑distance travel**, reducing ulcer risk :contentReference[oaicite:5]{index=5}.
- During stress episodes—competition, rest, management changes :contentReference[oaicite:6]{index=6}.
3. Mechanism of Action
When ingested, sucralfate forms a protective gel over ulcerated tissue, lasting 6–8 hours per dose :contentReference[oaicite:7]{index=7}. It buffers acid, inactivates pepsin, absorbs bile, stimulates mucus and bicarbonate secretion—all aiding mucosal healing :contentReference[oaicite:8]{index=8}.
4. Dosing & Administration
| Species/Use | Dosage | Frequency | Tips |
|---|---|---|---|
| Gastric ulcers | 10–20 mg/kg | Every 6–8 h | Empty stomach, separated from other meds by ≥2 h :contentReference[oaicite:9]{index=9} |
| Hindgut ulcers | 22 mg/kg | Every 6–8 h | Liquid form preferred; tablets can be crushed :contentReference[oaicite:10]{index=10} |
| NSAID protection | Same as gastric dosage | 3–4× daily during NSAID therapy | Begin before NSAID; continue during and after course :contentReference[oaicite:11]{index=11} |
5. Use With Acid‑Suppressants
Sucralfate is an adjunct—not replacement—for acid suppressants like omeprazole. It provides symptomatic relief while acid reduction supports healing. Separate dosing and never give simultaneously :contentReference[oaicite:12]{index=12}.
6. Effectiveness: What the Evidence Shows
Studies show sucralfate alone is inferior to PPIs in healing glandular ulcers and may increase colon wall thickness during NSAID use :contentReference[oaicite:13]{index=13}. However, combined use with omeprazole improves glandular ulcer outcomes substantially, often reaching up to 93% healing :contentReference[oaicite:14]{index=14}.
7. Safety & Side Effects
- Generally well‑tolerated; **constipation** is the most common side effect :contentReference[oaicite:15]{index=15}.
- Use cautiously in horses with **renal disease**, as aluminum absorption may occur :contentReference[oaicite:16]{index=16}.
- May interfere with absorption of other drugs—space dosing ≥2 h apart :contentReference[oaicite:17]{index=17}.
8. Monitoring & Storage
- Expect benefits in 1–2 hours, though endoscopic healing requires weeks :contentReference[oaicite:18]{index=18}.
- Monitor appetite, faecal consistency; investigate if signs worsen or blood appears :contentReference[oaicite:19]{index=19}.
- Follow endoscopy at 3–4 weeks; extend therapy if needed.
- Store tablet or suspension at room temperature, shield from light; shake well :contentReference[oaicite:20]{index=20}.
9. Practical Tips for Owners
- Administer on an **empty stomach**, ideally 30–60 min before feeding.
- Use between medicines—avoid giving with omeprazole or antibiotics.
- Liquid/suspension has better coverage; crush tablets if used.
- Coordinate with omeprazole dosing early morning fasting routines.
10. Ask A Vet Support 🩺
At Ask A Vet, we assist with:
- Choosing dosing schedules and forms.
- Coordinating drug spacing and combining with PPIs.
- Setting up endoscopic follow‑ups.
- Monitoring side effects and stool changes.
- Creating NSAID-protection protocols around travel, competition, or illness.
Use our app to share treatment photos, receive reminders, and access expert follow-up all through 2025 and beyond! ❤️
11. Quick Reference Table
| Use Case | Dosage | Frequency | Notes |
|---|---|---|---|
| Gastric ulcers | 10–20 mg/kg | q6–8h | Empty‑stomach; separate from meds |
| Hindgut ulcers | 22 mg/kg | q6–8h | Liquid preferred |
| NSAID prophylaxis | Same dose | During NSAID use | Start early, continue post‑therapy |
| Omeprazole combo | N/A | Use separately | Avoid mixing doses |
12. Final Thoughts
Sucralfate remains a cornerstone mucosal protectant in equine ulcer management—particularly when paired with acid-suppressants and thoughtful NSAID planning. With correct dosing, scheduling, and monitoring, it supports quicker healing and lasting gut health. And with **Ask A Vet** at your side, tailored protocols, reminders, and expert oversight are always just a tap away. 🐴
