Sucralfate causes malabsorption of L-thyroxine
Abstract
Purpose To determine if sucralfate causes malabsorption of L-thyroxine.Patients and methods Five healthy volunteers ingested L-thyroxine, 1,000 micrograms, administered orally (1) without sucralfate, (2) with sucralfate, 1 g, and (3) 8 hours after sucralfate, 2 g. The amount of L-thyroxine absorbed was calculated from the peak increase in serum T4 levels within 6 hours of hormone ingestion multiplied by the volume of distribution for the hormone.Results Peak absorption of L-thyroxine in the absence of sucralfate was 796 micrograms (95% confidence interval (CI): 515-1,074 micrograms). Coadministration of sucralfate, 1 g, with L-thyroxine reduced thyroid hormone absorption to 225 micrograms (95% CI: 151-299 micrograms) (P = 0.0029 compared with control). Peak hormone absorption was delayed 2 hours by simultaneous sucralfate ingestion. Separation of administered L-thyroxine and sucralfate doses by 8 hours returned hormone absorption to control values. Maximum T3 levels did not differ, regardless of drug regimen, but suppression of thyroid-stimulating hormone (TSH) by L-thyroxine was reduced by coadministration of sucralfate.Conclusions Sucralfate causes malabsorption of L-thyroxine, presumably by intraluminal binding of hormone.
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Studies of sucralfate are consistent with impaired absorption (144,145).
“Studies of sucralfate are consistent with impaired absorption (144,145).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [144]
A case report of elevated TSH levels and an absorption study in healthy volunteers showing decreased and delayed LT4 absorption are consistent with binding of LT4 by sucralfate (144).
“Both a case report of elevated TSH levels and an absorption study in healthy volunteers showing decreased and delayed LT4 absorption are consistent with binding of LT4 by sucralfate (144).”
From Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement (2014) · cites this paper as [144]
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- Authors
- Sherman, S. I., Tielens, E. T., & Ladenson, P. W.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Sherman, Steven I.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 1994-06
- Volume
- 96
- Issue
- 6
- Pages
- 531-535
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W1971880037
- Cited by
- 105
- References
- 17
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 7 · 2014: 4 · 2013: 4 · 2012: 5
- FWCI
- 2.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- National Institutes of Health
- National Center for Research Resources (RR 00035)
- NIH Clinical Center
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Drug Solubulity and Delivery Systems
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacogenetics and Drug Metabolism
- Keywords
- sucralfate, levothyroxine, drug malabsorption, thyroid hormone absorption, drug-drug interactions, serum thyroxine, TSH suppression, antacids
- MeSH terms
- Adult, Female, Humans, Intestinal Absorption, Malabsorption Syndromes, Male, Middle Aged, Reference Values, Sucralfate, Thyroxine
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