Understanding Carafate: What is Carafate? A Guide to Its Use and Action

October 7, 2025 •

4 min read

Carafate, a brand name for the generic drug sucralfate, is a prescription medication primarily used to treat duodenal ulcers. Unlike antacids that neutralize stomach acid or proton pump inhibitors that reduce acid production, Carafate functions by forming a protective barrier over the damaged tissue to shield it from further harm. This unique mechanism helps facilitate the healing of ulcers by creating a safe, localized environment for tissue repair.

Quick Summary

Carafate is a prescription anti-ulcer medication (sucralfate) that creates a protective barrier over ulcers and damaged gastrointestinal linings, shielding them from stomach acid and pepsin to promote healing. It is used for active and recurrent duodenal ulcers, gastritis, and GERD. It must be taken on an empty stomach to be effective.

Key Points

Protective Barrier: Carafate forms a physical protective layer over ulcers and damaged mucosal lining in the stomach and duodenum.
Local Action: Unlike drugs that reduce acid systemically, Carafate works directly at the site of injury and is minimally absorbed into the body.
Primary Use: The medication is primarily prescribed for the short-term treatment and maintenance of duodenal ulcers.
Dosage Timing: It must be taken on an empty stomach to be effective.
Avoid Drug Interactions: It can interfere with the absorption of other oral medications, which should be taken at least two hours before or after Carafate.
Most Common Side Effect: The most frequent adverse effect reported is constipation.
Other Uses: Carafate is also used off-label for conditions such as gastritis, GERD, and esophagitis.

What is Carafate? An Overview of Sucralfate

Carafate is the brand name for the generic drug sucralfate, a prescription medication classified as a mucosal protective agent. Sucralfate is derived from an aluminum salt of sucrose sulfate and works locally within the gastrointestinal (GI) tract to protect damaged tissue. It is minimally absorbed into the bloodstream, which is why it has a relatively mild side-effect profile compared to other GI medications. It is available in both oral tablet and liquid suspension forms.

How does Carafate work?

Carafate's primary mechanism of action is non-systemic, meaning it works directly at the site of injury rather than throughout the body. When Carafate is exposed to stomach acid, it undergoes a chemical change, forming a thick, viscous paste that binds to positively charged proteins found in the exudate of an ulcer. This results in several beneficial actions:

Protective Barrier: It creates an ulcer-adherent complex, which acts as a physical barrier over the ulcerated tissue. This protective layer shields the ulcer from further damage by gastric acid, pepsin, and bile salts, allowing it to heal.
Promotes Healing: Carafate stimulates the local production of prostaglandins, which are compounds that increase the secretion of protective mucus and bicarbonate. It also binds to growth factors, facilitating tissue growth, regeneration, and repair.
Reduces Enzyme Activity: It inhibits pepsin activity, a digestive enzyme that can contribute to ulcer aggravation.

Indications and Off-Label Uses of Carafate

The Food and Drug Administration (FDA) has specifically approved Carafate for the short-term treatment and maintenance therapy of duodenal ulcers. A doctor might also prescribe it for other, off-label conditions, where the local protective action is beneficial to the GI tract.

FDA-Approved Use

Active Duodenal Ulcers: Short-term treatment, typically for 4 to 8 weeks, to promote healing of existing duodenal ulcers.
Duodenal Ulcer Maintenance: After an active ulcer has healed, Carafate can be prescribed for maintenance therapy to prevent recurrence.

Common Off-Label Uses

Gastritis: Treatment for the inflammation of the stomach lining.
Gastroesophageal Reflux Disease (GERD): Managing symptoms of acid reflux and protecting the esophagus from acid damage.
Esophagitis: Treatment for inflammation of the esophagus.
Stress Ulcer Prophylaxis: Prevention of stress-induced ulcers in critically ill or ventilated patients.
Radiation Proctitis: Treatment for rectal bleeding caused by radiation therapy.

How to Take Carafate and Potential Drug Interactions

For Carafate to be effective, it must be taken on an empty stomach. This allows the medication to bind directly to the ulcer site without interference from food.

Guidelines for Proper Administration:

Take on an empty stomach, at least one hour before or two hours after a meal.
Shake the liquid suspension well before measuring a dose.
Do not take other medications within two hours before or after Carafate, as it can hinder their absorption.
Take antacids at least 30 minutes before or after Carafate.

Common Drug Interactions to be Aware of:

Antacids: Antacids, especially those containing aluminum, should be separated from Carafate to prevent decreased efficacy.
Antibiotics: Certain antibiotics, like ciprofloxacin and norfloxacin, can have their absorption reduced.
Digoxin: A medication used for heart conditions.
Levothyroxine: Thyroid hormone replacement therapy.
Phenytoin: An anti-epileptic medication.
Warfarin: A blood thinner.

Carafate vs. Other Medications

Understanding how Carafate differs from other ulcer treatments is important for both patients and healthcare providers. The table below compares Carafate with two other common classes of gastrointestinal drugs: Proton Pump Inhibitors (PPIs) and Antacids.


Feature	Carafate (Sucralfate)	Proton Pump Inhibitors (PPIs)	Antacids
Mechanism	Forms a protective barrier over ulcers; works locally.	Reduces stomach acid production systemically.	Neutralizes existing stomach acid.
Action	Protects and promotes healing of existing ulcers.	Reduces acid secretion to create an environment for healing.	Provides rapid, short-term relief of symptoms.
Absorption	Minimally absorbed into the bloodstream.	Absorbed into the bloodstream to work systemically.	Not absorbed systemically.
Primary Use	Treatment of duodenal ulcers; maintenance therapy.	GERD, erosive esophagitis, H. pylori eradication.	Heartburn and indigestion.
Administration	Requires specific timing related to meals.	Usually once daily; 30-60 min before a meal.	As needed; provides quick relief.
Onset of Relief	Delayed; requires consistent use for ulcer healing.	Slower than antacids but provides longer-lasting relief.	Immediate relief.
Side Effects	Constipation, dry mouth, nausea, rash.	Headache, stomach pain, nausea, long-term risks.	Diarrhea or constipation.

Side Effects and Precautions

The side effect profile for Carafate is generally mild due to its minimal systemic absorption. The most frequently reported adverse effect is constipation, which occurs in a small percentage of patients. Other less common side effects include:

Diarrhea, nausea, vomiting
Dry mouth
Dizziness, drowsiness, headache
Rash or itching

Serious side effects are rare but can include allergic reactions (hives, difficulty breathing, swelling). In patients with chronic kidney disease, there is a risk of aluminum accumulation, and it should be used with caution.

Conclusion

Carafate (sucralfate) offers a unique, local-acting approach to treating gastrointestinal ulcers by creating a protective physical barrier over damaged tissue. Its mechanism of action allows the ulcer to heal, promoting tissue regeneration and protecting against further irritation from stomach acid and pepsin. As a prescription medication, it is most commonly used for duodenal ulcers but has proven useful in treating other related conditions like gastritis and GERD. While generally well-tolerated, it is crucial to follow proper administration instructions, especially taking it on an empty stomach and separating it from other oral medications, to ensure its effectiveness and minimize the risk of interactions. Understanding what is Carafate and how it works empowers patients to engage more actively with their healthcare providers about their treatment options.

Frequently Asked Questions

Carafate is primarily used for the short-term treatment of active duodenal ulcers and for maintenance therapy to prevent ulcer recurrence. It is also used off-label for conditions like gastritis, GERD, and esophagitis.

You should take Carafate on an empty stomach, either one hour before or two hours after meals. If using the liquid suspension, shake it well before use. Always follow your doctor's specific instructions.

No, Carafate can inhibit the absorption of many other oral medications. It is crucial to separate the timing by at least two hours. Antacids should be taken at least 30 minutes before or after Carafate.

The most common side effect of Carafate is constipation. Other possible side effects include nausea, dry mouth, headache, and dizziness.

No, Carafate is not an antacid. While it has some minimal acid-neutralizing capacity, its main function is to form a protective barrier over ulcerated tissue, unlike antacids, which primarily neutralize existing stomach acid.

Carafate begins to form its protective barrier soon after ingestion, but it may take 4 to 8 weeks of consistent use for an ulcer to fully heal. It does not provide immediate symptomatic relief like an antacid.

Carafate works locally to form a protective coating over ulcers, while a PPI like omeprazole works systemically to reduce the amount of stomach acid produced. Carafate promotes healing by protecting the injury, whereas a PPI allows healing by reducing the acidic environment.