Enzyme inhibitors and Prostaglandins

Sucralfate - Carafate®

• Indications: a mucosal protectant for active duodenal ulcer

• MOA: under acidic pH the aluminum is split off producing sulfated sucrose which forms a complex with proteinaceous exudate protecting the ulcer against acid, pepsin and bile salts

• Relatively non-absorbable with 90% excreted in the feces and the small amount absorbed excreted into the urine

• Take on an empty stomach at least 1 hour before meals and at bedtimeDo NOT take antacids 30 minutes before or after taking sucralfate, also absorption decrease with H2-antagonists, quinolines, warfarin and phenytoin

Sucralfate - Carafate® structure

Misoprostol - Cytotec®

• Indications: prevention of ASA- and NSAID- induced gastric ulcers

• Warning: absolutely contraindicated in pregnant women due to abortifacient properties

• MOA: synthetic prostaglandin E1 analog with anti-secretory andmucosal protective properties by decreasing bicarbonate and mucous production - counters histamine and increases adenylate cyclase activity

• Prodrug which undergoes esterase activation, renally excreted with a half-life of 20-40 minutes

Misoprostol - Cytotec® structure