Sucralfate Shortage: What Providers and Prescribers Need to Know in 2026

Sucralfate (brand name Carafate) remains a clinically valuable mucosal protectant with unique advantages over acid-suppressing therapies in certain contexts — particularly for stress ulcer prophylaxis in ventilated patients where maintaining gastric pH is desirable to reduce bacterial overgrowth and ventilator-associated pneumonia risk. However, intermittent supply disruptions are affecting patients across practice settings. This article provides a clinical summary of the current supply situation and actionable guidance for managing patients who cannot obtain sucralfate.

Current Supply Status

As of early 2026, sucralfate is not on the FDA Drug Shortage Database as a formally declared, active shortage. However, ASHP has reported that Teva Pharmaceuticals placed sucralfate 1g tablets on intermittent back order due to increased demand. Viatris (among other generic manufacturers) continues to supply product, but uneven distribution across pharmacy wholesaler networks is creating localized gaps that patients are experiencing acutely.

The sucralfate oral suspension (1g/10mL) has fewer competing generic manufacturers than the tablet and may be more difficult to source. Providers should be aware that patients who are prescribed the suspension — particularly those with dysphagia, mucositis, or esophageal indications — may face a higher barrier to access.

Who Is Most Affected?

Availability gaps are most likely to affect the following patient populations:

• Outpatients on maintenance therapy (1g BID) for duodenal ulcer recurrence prevention — typically stable but dependent on consistent pharmacy supply
• Oncology patients receiving sucralfate suspension for chemotherapy-induced mucositis or radiation proctitis — often on the suspension, which has more limited supply
• ICU patients requiring stress ulcer prophylaxis when institutional formularies specifically include sucralfate
• Pregnant patients for whom sucralfate was chosen due to its minimal systemic absorption and favorable safety profile

Clinical Alternatives by Indication

If sucralfate is unavailable for a patient, the appropriate substitute depends heavily on the indication:

Active duodenal ulcer or gastric ulcer: Standard-dose PPI therapy (e.g., omeprazole 20mg daily for 4–6 weeks for duodenal ulcer, 8 weeks for gastric ulcer) is the most evidence-based substitution. Multiple RCTs confirm PPIs are at least as effective as sucralfate for ulcer healing, and superior for NSAID-induced ulcers in patients who must continue NSAID therapy.

Maintenance therapy to prevent ulcer recurrence: H. pylori eradication, if not previously completed, is the priority. If H. pylori-negative, low-dose PPI or famotidine 20–40mg BID is an acceptable maintenance alternative.

NSAID-induced ulcer prevention: PPIs are the preferred class. Misoprostol (200mcg QID) is the only alternative proven to prevent both gastric and duodenal NSAID-induced ulcers but is limited by GI side effects and is absolutely contraindicated in pregnancy.

Stress ulcer prophylaxis (ICU/ventilated): Sucralfate's advantage is its lack of effect on gastric pH, which reduces ventilator-associated pneumonia (VAP) risk compared to PPIs. However, it is less effective than PPIs for preventing GI bleeding. If sucralfate is unavailable, IV or enteral PPI therapy (e.g., pantoprazole 40mg IV daily) is the standard substitute, with the understanding that VAP risk may be modestly increased.

Chemotherapy-induced mucositis: The evidence base for sucralfate in mucositis is mixed; the 2013 ISOO guidelines do not recommend sucralfate for oral mucositis prevention. For radiation-induced oral mucositis and proctitis, supportive care protocols should be followed per institutional guidelines.

Pregnancy: Sucralfate's minimal absorption makes it particularly desirable in pregnant patients. If unavailable, famotidine 20mg BID is generally considered safe. Misoprostol is absolutely contraindicated. PPIs should be used only when the benefit clearly outweighs risk, with omeprazole being the most studied.

Formulation Considerations

If a patient's prescription is for the suspension but it's unavailable, consider whether the tablet formulation is clinically appropriate for their indication. The suspension is not bioequivalent to tablets per the manufacturer, but for most upper GI indications where the patient can swallow tablets, the tablet form is preferred anyway and more readily available.

For patients who specifically require the suspension (e.g., those with swallowing dysfunction, NG tube administration), hospital outpatient pharmacies and compounding pharmacies may be additional sources worth contacting.

Prescriber Drug Interaction Reminder

When transitioning patients from sucralfate to an acid-suppressing alternative, note that sucralfate's significant drug interaction profile may no longer apply — this can be clinically meaningful for patients on:

• Levothyroxine (which was dosed at least 2 hours separate from sucralfate — timing restrictions can relax)
• Fluoroquinolone antibiotics (no longer need 2–6 hour separation)
• Phenytoin, digoxin (monitor levels — absorption may change without the binding effect of sucralfate)

Helping Patients Find Sucralfate

For patients who specifically need sucralfate and can't fill their prescription locally, medfinder for providers is a service that calls pharmacies on behalf of patients to locate which ones have the medication in stock. See our guide on how to help your patients find sucralfate in stock for additional strategies you can share with patients at the point of prescribing.