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sucralfate

Sold as Carafate. First FDA approval 10/30/1981: 45 years on the US market.

This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.

B

Score breakdown (77/100)

Safety ×35%
B
Evidence ×25%
D
Regulatory ×15%
B
Money & lawsuits ×15%
A
Options ×10%
C

Safety: 85

Evidence: 50

Regulatory history: 82

Money & lawsuits: 100

Options: 70

What the FDA label says

Approved uses

INDICATIONS AND USAGE Sucralfate Oral Suspension is indicated in the short-term (up to 8 weeks) treatment of active duodenal ulcer.

Contraindications

CONTRAINDICATIONS Sucralfate Oral Suspension is contraindicated for patients with known hypersensitivity reactions to the active substance or to any of the excipients.

Warnings and precautions

WARNINGS Fatal complications, including pulmonary and cerebral emboli have occurred with inappropriate intravenous administration of Sucralfate Oral Suspension. Administer Sucralfate Oral Suspension only by the oral route. Do not administer intravenously.

Adverse reactions (label)

ADVERSE REACTIONS Adverse reactions to sucralfate tablets in clinical trials were minor and only rarely led to discontinuation of the drug. In studies involving over 2700 patients treated with sucralfate, adverse effects were reported in 129 (4.7%). Constipation was the most frequent complaint (2%). Other adverse effects reported in less than 0.5% of the patients are listed below by body system: Gastrointestinal: diarrhea, dry mouth, flatulence, gastric discomfort, indigestion, nausea, vomiting Dermatological: pruritus, rash Nervous System: dizziness, insomnia, sleepiness, vertigo Other: back pain, headache Post-marketing cases of hypersensitivity have been reported with the use of Sucralfate Oral Suspension, including anaphylactic reactions, dyspnea, lip swelling, edema of the mouth, pharyngeal edema, pruritus, rash, swelling of the face and urticaria. Cases of bronchospasm, laryngeal edema and respiratory tract edema have been reported with an unknown oral formulation of sucralfate. Cases of hyperglycemia have been reported with sucralfate. Bezoars have been reported in patients treated with sucralfate. The majority of patients had underlying medical conditions that may predispos...

Source: FDA SPL label for Sucralfate (Precision Dose, Inc.), effective 20250128. Full label on DailyMed.

Side-effect reports sent to the FDA

These are counts of reports people filed, not rates of harm. Anyone can file one, and nobody checks whether the drug was the cause. Millions of doses are taken for every report sent, so the useful part is how this drug compares with the average across all drugs.

19,907reports that mention this drug
19,878of those blame this drug, not another one the person was taking
67%of reports describe a serious outcome, such as a hospital stay (average for all drugs: 57%)
9.2%of reports include a death, from any cause (average for all drugs: 9.1%)

Problems reported most often

Nausea · 1,931Fatigue · 1,523Diarrhoea · 1,477Off Label Use · 1,336Headache · 1,264Pain · 1,183Drug Ineffective · 1,161Dyspnoea · 1,102Vomiting · 1,073Chronic Kidney Disease · 987Weight Decreased · 873Malaise · 867Dizziness · 839Death · 827Constipation · 805

Reports per year

20192020202120222023202420252026
2,2141,9811,5241,3441,4041,3371,506697

1,495 reports blaming this drug for every million Medicare prescriptions filled, which is 0.5× the typical drug on this site. (3,527 reports in 2024–2026, against 2,358,705 Medicare fills in one year. This is the one number here that accounts for how many people take the drug.)

Source: the FDA's Adverse Event Reporting System (FAERS). Reports are voluntary and unverified. Drugs that are prescribed a lot, in the news, or in lawsuits attract more reports, so the percentages are compared with the whole database to correct for that partly, not fully.

Recalls and regulatory record

2recall actions on file
2 / 15brand / generic applications
1label changes since 2021
NoREMS program
DateClassFirmReason
10/2023Class IVistaPharm LLCMicrobial Contamination of Non-Sterile Products: identified as Bacillus cereus.
08/2023Class IIVistaPharm LLCSuperpotent/Subpotent single ingredient Drug: Out of Specification Assay results

Class I = reasonable probability of serious harm. Class II = temporary or reversible harm. Class III = unlikely to harm. Most generic recalls are manufacturing or labeling defects for one lot, not a verdict on the molecule.

Evidence base

292randomized trials (PubMed)
12systematic reviews
30registered trials
12%of completed trials posted results
10%terminated or withdrawn
13%industry-funded

Counts measure how much evidence exists and how transparent it is, not how big the benefit is. For that, ask your prescriber: if 100 people like me took this, how many would get better because of it, and how many would be harmed? (Doctors call these the "number needed to treat" and "number needed to harm.") It differs by condition and is the number drug ads leave out. Sources: PubMed, ClinicalTrials.gov.

Money and lawsuits

In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this drug across 0 transactions.

No pending federal MDL names this drug or its brands.

Not named in any federal pharmaceutical settlement of $100M or more on record.

Sources: CMS Open Payments (Sunshine Act); Judicial Panel on Multidistrict Litigation pending docket list; DOJ settlements as tabulated on Wikipedia with links to the primary record. State-court and individual suits are not included.

Who takes it and what it costs

851,256Medicare Part D patients (2024)
2,358,705prescriptions filled
$55average cost per fill
$130Mtotal Medicare spend
ProductFills$/fill
Sucralfate2,355,764$55
Carafate2,941$428

Same-class alternatives

No same-class alternatives found in RxClass.

Questions to ask your prescriber

  1. The most-reported problems in FDA's adverse event data are nausea, fatigue, diarrhoea. How would we recognize and handle those?
  2. Off-label use is among the most-reported items for this drug. Is my use on-label, and if not, what evidence supports it?
  3. What result are we expecting, by when, and what is the plan if it does not happen?
  4. If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)