Sucralfate: veterinary dose and monograph

At a glance

Drug class

Gastrointestinal

Also known as

Carafate, Sucrabest

Species with doses

Dogs, Cats, Horses, Ferrets and Reptiles

General dose range

25–50 mg/kg PO q6–8h — check the species tables for the indication

Routes

PO

Last reviewed

1 October 2026

Indications

• Gastric / duodenal ulceration (NSAID, stress, uraemic gastritis)
• Oesophagitis (megaoesophagus, persistent vomiting, post-anaesthetic reflux)
• Equine glandular gastric ulcer syndrome (EGGUS) — adjunct
• GI bleeding from any cause
• Adjunct to PPI / H2-blocker therapy

Sucralfate dose by species

Doses are per administration unless stated. mg/kg doses scale with body weight; per-animal, per-quarter and infusion-rate doses are shown as the reference writes them.

Dogs

• Gastric / oesophageal ulcer: Papich 5e: 0.5–1 g per dog q8–12h PO. Plumb’s p.1084: 0.5 g for smaller dogs, 1 g for large dogs PO q8h; 1 g per 30 kg q6h for uraemic ulcers (Waddell 2007); severe GI bleeding — 3–6 g loading dose, then 1 g three to four times daily. Crush tablets into a suspension. Give 30–60 min apart from H2 blockers and other oral drugs.

Cats

• Gastric / oesophageal ulcer: Papich 5e: 0.25 g (¼ tablet) q8–12h PO. Plumb’s p.1084: 0.25–0.5 g per cat PO q8–12h. Suspension preferred for oesophagitis.

Horses

• EGGUS / hindgut ulcer: Plumb’s p.1084: equine gastric ulcer syndrome 20–40 mg/kg PO q8h (≈10–20 g for a 500 kg horse), used with acid suppression; right dorsal colitis 22 mg/kg PO q6–8h (Videla & Andrews 2009). Of limited value on its own.
• Foals — stress-ulcer prevention (adjunct): Plumb’s p.1084 (Sanchez 2004): foals 10–20 mg/kg PO q6–8h with acid-suppressive drugs. Papich 5e: foals 1 g q8h PO.

Ferrets

• Gastric ulcer / Helicobacter gastritis: Plumb's p.1085 (Williams 2000): 75 mg/kg PO q4–6h; give 10 minutes before feeding. Often part of Helicobacter mustelae therapy.

Reptiles

• GI irritation / ulceration: Plumb's p.1085 (Gauvin 1993): most species 500–1,000 mg/kg PO q6–8h.

Contraindications

Hypersensitivity. Severe renal failure (aluminium accumulation — rare but real). Caution in patients on multiple oral medications (sucralfate impairs absorption of many drugs).

Species-specific warnings

Dogs: Give 30 min before food and before omeprazole. Tablet or suspension acceptable. Standard in NSAID toxicity / pancreatitis protocols.

Cats: Suspension preferred for oesophagitis / megaoesophagus reflux. 0.25–0.5 g per cat PO q8h.

Horses: Adjunct to GastroGard for glandular ulcers (EGGUS). 2–4 g per 500 kg PO q8h.

Adverse effects

• Constipation (most common)
• Drug interactions: REDUCES absorption of many oral drugs (fluoroquinolones, tetracyclines, digoxin, phenytoin, thyroxine, ketoconazole)
• Aluminium accumulation in severe renal failure (rare)
• Bezoar formation at very high doses (rare)
• Nausea, dry mouth

Drug interactions

• PPI (omeprazole, pantoprazole): sucralfate requires acidic gastric pH for activation — give sucralfate 30 min BEFORE the PPI, or 2 h after
• Fluoroquinolones (enrofloxacin, ciprofloxacin, marbofloxacin): chelation — separate by 2 h
• Tetracyclines (doxycycline, oxytetracycline): chelation — separate by 2 h
• Digoxin, phenytoin, thyroxine, ketoconazole, theophylline: reduced absorption — separate by 2 h
• Other antacids: minimal additive effect; can combine
• Multivitamins / minerals (iron, zinc): chelation — separate by 2 h

Pregnancy and lactation

Considered safe in pregnancy — minimal systemic absorption. FDA Category B (human). Widely used in pregnant patients with GI ulceration.

Monitoring

• GI bleeding signs (melaena, haematemesis) — improvement expected within 1–2 weeks
• Constipation — common; address with hydration / stool softener
• Concurrent oral drug administration timing — sucralfate impairs absorption of many drugs
• Renal function in CKD patients on chronic sucralfate — aluminium accumulation theoretical
• Endoscopic re-evaluation at 4–8 weeks for severe ulceration

Toxicity and overdose

Very wide therapeutic margin. Acute overdose: usually only constipation. Chronic high doses in severe CKD: theoretical aluminium toxicity (rare). Bezoar formation in patients with delayed gastric emptying. No respiratory, cardiac, or hepatic toxicity at any dose.

Management: Supportive — usually only mild constipation. Hydration. Lactulose / stool softener if persistent constipation. No specific antidote needed. Activated charcoal not useful (sucralfate not absorbed).

Clinical pearls

• TIMING IS EVERYTHING: give sucralfate 30 min BEFORE food and 30 min BEFORE omeprazole (sucralfate needs acid to activate)
• Dogs: tablet form is fine; cats / oesophagitis: SUSPENSION coats mucosa better — preferred for megaoesophagus reflux
• Sucralfate + omeprazole + maropitant + IV fluids = standard inpatient ulcer protocol for NSAID toxicity / pancreatitis
• Separate from fluoroquinolones, tetracyclines, digoxin, levothyroxine by 2 h — chelation prevents drug absorption
• Megaoesophagus: sucralfate suspension q6–8h is gold-standard adjunct to reduce reflux oesophagitis
• Equine EGGUS: 2–4 g per 500 kg PO q8h alongside GastroGard — glandular ulcers respond poorly to PPI alone
• Safe in pregnancy and lactation (minimal absorption)
• Constipation is the main side effect — increase fibre / water intake

Mechanism of action

Aluminium hydroxide-sulphated sucrose complex. In the acid environment of the stomach (pH <4), sucralfate becomes activated, polymerises into a viscous sticky gel, and selectively binds to positively-charged proteins exposed at sites of ulceration / inflammation. Forms a protective coating that resists penetration by acid, pepsin, and bile. Also stimulates endogenous prostaglandin E2 synthesis, bicarbonate secretion, and mucus production at the ulcer site. NO systemic absorption — acts locally.

Formulations and products

• Carafate 1 g tablet
• Carafate 100 mg/mL oral suspension
• Sucrabest 1 g tablet (generic)
• Carafate — 1 g, Tablet (human-label)
• Carafate Suspension — 100 mg/mL, Oral suspension (human-label)

Storage

Tablets: 15–30 °C, dry. Oral suspension: 15–25 °C, shake well before use. Do not refrigerate (gelation).

Before you use this dose

Reference doses for veterinary professionals. Confirm the dose against the product label, the patient’s condition, current guidance and local regulations before use; the attending veterinarian remains responsible for every clinical decision.

Other gastrointestinal drugs

• Pantoprazole
• Ranitidine
• S-Adenosylmethionine (SAMe)
• Silymarin (Milk Thistle / Silybin)
• Sulfasalazine
• Tylosin
• Ursodiol (Ursodeoxycholic Acid)

Frequently asked questions