Back to the Top
Hello all,
Drug Utilization Review Consultants make a lot of hay about the
prescribing of sucralfate (which requires an acidic medium for activation
in the stomach) and a proton pump inhibitor such as omeprazole or
lansaprazole (which decrease H+ production significantly). However, I
can't find a whole lot of information searching Medline for the actual
numbers. Can anybody on this list provide me with:
1) The minimum effective acidity required for sucralfate activation?
2) The usual attainable gastric pH after a PPI is administered?
3) Any references to journal articles which actually report on the
results of using this combination vs. monotherapy?
I'm very appreciative of any responses. TIA!
Richard Molitor, R.Ph.
http://www.angelfire.com/wa/pharmacist
Seattle, WA
Back to the Top
Richard Molitor,
I have included part of the information you have requested.
From Goodman and Gilman's Pharmacological basis of therapeutics. (reference
McCarthy: Sucralfate. N Eng J Med. 325:1017)
"When pH is below 4, there is extensive polymerization and cross-linking of
sucralfate to form a sticky viscid yellow-white gel."
Ash Patel, Student.
ash.aaa.oaktree.net
Butler University College of Pharmacy and Health Sciences.
Back to the Top
Have you tried Wyeth (Antepsin) - The only manufacturers of this complex
of sucrose sulphate and aluminium hydroxide.
Otherwise two oldish references any use?
I have no professional interest in this area so I cannot give you any
other information,
Charles Gilbert
ANN. R. COLL. SURG. ENGL. Volume 70, Issue 6Abstract 1988
$Order Document Pages 343-344
EMBASE =A9 1997 Elsevier Science B.V. All Rights Reserved
Medical treatment of stomal ulcers
Hjortrup A.; Kjersgaard P.; Bredesen J.
Gastrosurgical Department F, Bispebjerg Hospital, DK 2400 Copenhagen,
Denmark
Abstract
Thirty-five patients with anastomotic ulcer after gastric resection for
benign ulcer disease were treated with sucralfate (Antepsin(TM)) and
endoscopically controlled over a 6-month period after termination of the
medical treatment. The healing frequency of 75% makes this model a
suitable alternative in the treatment of stomal ulcers.
Index Terms: gastroenterostomy; peptic ulcer; recurrent peptic ulcer;
sucralfate
OMNIA MED.THER. (Pisa) Volume 50, Issue 4 spec.Abstract 1973
$Order Document Pages 120-128
EMBASE =A9 1997 Elsevier Science B.V. All Rights Reserved
Antiulcer action of a new preparation 'Antepsin'
[SULL'ATTIVITA ANTIULCERA DI UN NUOVO PREPARATO FARMACEUTICO: ANTEPSIN ]
Verme G.
Div. Gastroenterol., Osp. Magg. S. Giovanni Battista, Torino, Italy
Index Terms: stomach ulcer; duodenum ulcer; dose response; diet; drug
efficacy; peptic ulcer; 4 bromoacetanilide; pharmacology; antipeptic
agent
Charles Gilbert
Bioanalysis and DMPK Development
* 01509 644106
* 01509 645576 (FAX)
Back to the Top
1) How much acid is required for activation ?
I do not believe it's an on/off effect and I don't think you'll find a firm,
neat answer. Consdier that sucralfate suspensions are effective in healing
oral
mucosal and esophageal lesions in the absence of acidification. The particles
themselves are synergistic with mucin in the absence of acidification. The
idea
that acidification is required comes from early work showing that in vitro
acidification of sucralfate dispersed in water leads to formation of a "sticky
paste" material. There is some disagreement that acification is required for
gastric or duodenal cytoprotection. (see page 72 in the ref. below) As a
reference I would look at the book "Sucralfate, from basic science to the
bedside" (D. Hollander and G.N.J. Tytgat, eds., Chugai Pharmaceutical Co. Ltd.
and Plenum Medical Book Co., NY. 1995., ISBN 0-306-44740-1. Chapter
bibliographies will be a good starting place). See page 53, on behavior on
addition of acid. 0.06 meq HCl per meq sucralfate are where effects are first
observed according to work cited there. My own work shows increase in
viscosity
of sucralfate-water suspensions begins when the pH is decreased below about
5.0.
I'm very interested in understanding better the mucosal binding of sucralfate
as it's the subject of my dissertation, in progress.
Good luck.
Douglas Dobrozsi
Doctoral candidate,
Univesity of Cincinnati
College of Pharmacy
dobrozsi.dj.-at-.pg.com
Doug:
Thought you might be able to answer this one.
Angela
PharmPK Discussion List Archive Index page
Copyright 1995-2010 David W. A. Bourne (david@boomer.org)