Sucralfate is an aluminum salt of a sulfated disaccharide. Although its action is primarily local on the gastrointestinal mucosa, a small amount of aluminum is absorbed systemically. In patients with normal kidney function, this absorbed aluminum is excreted by the kidneys. However, in patients with chronic renal failure or those on dialysis, the excretion of aluminum is impaired. Chronic administration of sucralfate in this patient population can lead to the accumulation of aluminum to toxic levels, potentially causing serious adverse effects such as aluminum-induced osteomalacia, adynamic bone disease, and encephalopathy.

B. Bismuth subgallate: This medication contains bismuth, not aluminum. Overuse can lead to bismuth toxicity, which has different clinical manifestations.

C. Docusate sodium: This is a surfactant-type stool softener that does not contain aluminum or affect its systemic absorption or excretion.

D. Lactulose: This is an osmotic laxative used for constipation and hepatic encephalopathy; it has no association with aluminum metabolism.

E. Alginates: Alginates are used for gastroesophageal reflux. While some formulations may be combined with aluminum-containing antacids, alginates themselves are not a source of aluminum.

1. U.S. Food and Drug Administration (FDA). (2013). CARAFATE® (sucralfate) Tablets Prescribing Information. Section: WARNINGS. "In patients with chronic renal failure or those receiving dialysis

aluminum accumulation and toxicity (aluminum osteodystrophy

osteomalacia

encephalopathy) have been described." Available from the FDA website.

2. Brunton

L. L.

Dandan

R.

& Knollmann

B. C. (Eds.). (2017). Goodman & Gilman's The Pharmacological Basis of Therapeutics (13th ed.). McGraw-Hill Education. Chapter 49

Pharmacotherapy of Gastric Acidity

Peptic Ulcers

and Gastroesophageal Reflux Disease

Section: Mucosal Protective Agents. "Because a small amount of Al3+ is absorbed

sucralfate should be used with caution in patients with renal insufficiency

who are at risk for Al3+ overload."

3. DiPiro

J. T.

Yee

G. C.

Posey

L. M.

Haines

S. T.

Nolin

T. D.

& Ellingrod

V. (Eds.). (2020). Pharmacotherapy: A Pathophysiologic Approach (11th ed.). McGraw-Hill Education. Chapter 25

Peptic Ulcer Disease

Section: Mucosal Protective Agents. "Systemic absorption of aluminum is minimal but may be problematic in patients with chronic renal failure because of the risk of accumulation and toxicity."