Sucralfate

By clicking the “I Agree” button below, you certify under penalty of perjury that the following statements are true and correct and understand that a medical provider will rely on the truthfulness of your statements when determining whether a prescription is warranted and appropriate.

I agree that I:

• am 18 years or older
• have not had a hypersensitivity reaction to sucralfate or any component of the formulation

• have a diagnosis of gastrointestinal ulcer and have already been taking sucralfate as prescribed by an authorized healthcare provider for maintenance therapy
• Am taking sucralfate as prescribed for my own personal use 

• am not pregnant or breastfeeding
• do not have renal (kidney) impairment or a creatinine clearance of less than 30 ml/min
• understand sucralfate is an aluminum complex and prolonged use of sucralfate can lead to aluminum accumulation in patients with advanced kidney impairment; use should be avoided in patients with kidney impairment
• understand caution should be used in the elderly due to reduced renal function
• understand to take sucralfate tablets with caution in patients with conditions that may impair swallowing (eg, recent or prolonged intubation, tracheostomy, dysphagia, history of aspiration) or other conditions that may alter gag/cough reflexes, or diminish oropharyngeal coordination or motility
• understand that because sucralfate acts locally at the ulcer, successful therapy with sucralfate should not be expected to alter the posthealing frequency of recurrence or the severity of duodenal ulceration.
• Understand sucralfate has the potential to cause increased blood sugar levels in patients with diabetes
• Will not take nor intend to take the following concurrently with sucralfate due to severe or major drug-drug interactions: antacids, baloxavir, bictegravir, bisphosphonate derivatives, cabotegravir, cholic acid, deferiprone, digoxin, dolutegravir, eltrombopag, elvitegravir, furosemide, levoketoconazole, levonadifloxacin, multivitamins with fluoride and vitamins A,D, and E; penicillamine, phenytoin, phosphate supplements, quinidine, quinolones, raltegravir, Roxadustat, sulpiride, tetracyclines, trientine, unithiol, vitamin D analogs

• understand this is not a comprehensive list of severe or major drug interactions and I can find more information regarding drug-drug interactions at https://www.drugs.com/drug_interactions.html 

• understand this is not a comprehensive list of precautions, risks, side effects, or details about taking this medication
• understand that only major drug interactions are listed and have not been reviewed against the other medications, supplements, or herbal products I may be taking unless also filled by TelyRx