Sucrose

(BAN)
Sucrose Chemical formula

💊 Chemical information

Azúcar; Cane Sugar; Refined Sugar; Sacarosa; Saccharose; Saccharosum; Saccharum; Sacharosa; Sacharoza; Sacharoze˙; Sackaros; Sakkaroosi; Sucre; Sucrosum; Szacharóz; Zucker.
Chemical formula: FructofuranosylC12H22O11 = 342.3.
CAS — 57-50-1.

Description.

Sucrose is obtained from sugar-cane, Saccharum officinarum (Gramineae), sugar-beet, Beta vulgaris (Chenopodiaceae), and other sources.

Pharmacopoeias.

In Chin., Eur., Jpn, and Viet. Also in USNF. Br. also contains Compressible Sugar. Eur. also includes Sugar Spheres. USNF also includes Compressible Sugar, Confectioner’s Sugar, and Sugar Spheres.

Ph. Eur. 6.2

(Sucrose). A white or almost white, crystalline powder or shiny, colourless or white or almost white crystals. Very soluble in water; slightly soluble in alcohol; practically insoluble in dehydrated alcohol.

USNF 26

(Sucrose). A sugar obtained from Saccharum officinarum (Gramineae), Beta vulgaris (Chenopodiaceae), and other sources. White, crystalline powder or lustrous, dry, colourless or white crystals. Soluble 1 in 0.5 of water, 1 in 0.2 of boiling water, and 1 in 170 of alcohol; practically insoluble in dehydrated alcohol.

Incompatibility.

Sucrose may be contaminated by traces of heavy metals or sulfites and this can lead to incompatibility with other ingredients when it is used as a pharmaceutical excipient. Syrup preserved with hydroxybenzoates has been reported to be incompatible with a range of compounds.

💊 Adverse Effects and Precautions

Sucrose consumption increases the incidence of dental caries. Sucrose use should be avoided in patients with the glucose-galactose malabsorption syndrome, fructose intolerance, or sucrase-isomaltase deficiency. The intake of sucrose from dietary and other sources must be controlled in patients with diabetes mellitus.

Dietary sugar.

The Panel on Dietary Sugars reviewed the evidence relating to sugars in the diet and the health of the population in the UK.1 No evidence was found that the consumption of most sugars naturally incorporated into the cellular structure of foods (intrinsic sugars) represented a threat to health and consideration was therefore mainly directed towards the dietary use of sugars not so incorporated (extrinsic sugars), of which sucrose was the principal non-milk extrinsic sugar. There was extensive evidence suggesting that sugars were the most important dietary factor in the cause of dental caries and it was recommended that consumption of non-milk extrinsic sugars should be decreased. It was considered that dietary sugars may contribute to the development of obesity, a condition which plays an important part in the aetiology of a number of diseases. For the majority of the population, who had normal plasma lipids and normal glucose tolerance, the consumption of sugars within the present range carried no special metabolic risks but those persons consuming more than about 200 g daily should replace the excess with starch. It was, however, recommended that those with special medical problems such as diabetes or hypertriglyceridaemia should restrict non-milk extrinsic sugar to less than about 20 to 50 g daily unless otherwise instructed by their own physician or dietitian. It was also concluded that current consumption of sugars, particularly sucrose, played no direct causal role in the development of cardiovascular (atherosclerotic coronary, peripheral, or cerebral vascular) disease, essential hypertension, or diabetes mellitus, and also had no significant specific effects on behaviour or psychological function. Although links between sucrose intake and certain other diseases (such as colorectal cancer, renal and biliary calculi, and Crohn’s disease) had been proposed it was not felt that the evidence was adequate to justify any general dietary recommendations. The conclusions of a joint FAO/WHO consultation on carbohydrates in human nutrition2 were broadly in agreement with the above. However, they noted that the terms intrinsic and extrinsic sugars had not gained wide acceptance, either in the UK or other countries in the world, and they recommended against the use of these terms.
1. DoH. Dietary sugars and human disease: report of the panel on dietary sugars of the committee on medical aspects of food policy. Report on health and social subject
37. London: HMSO, 1989
2. FAO/WHO. Carbohydrates in human nutrition: report of a joint FAO/WHO expert consultation. FAO Food and Nutritio
66. Rome: Food and Agriculture Organization of the United Nations, 1998.

Effects on the kidneys.

Acute renal failure with severe hyponatraemia has followed the use of granulated sugar to treat an infected pneumonectomy wound cavity.1 It was noted that intravenous sucrose had long been known to be nephrotoxic in both animal models and man and that mild renal insufficiency before sucrose intoxication might have contributed to the nephrosis. Others, however, considered that the nephrotoxicity might have been caused by gentamicin, a solution of which had been used to irrigate the cavity before packing the wound.2 Intravenous immunoglobulin preparations containing sucrose (as a stabilising agent) have also caused acute renal failure.3,4
1. Debure A, et al. Acute renal failure after use of granulated sugar in deep infected wound. Lancet 1987; i: 1034–5
2. Archer H, et al. Toxicity of topical sugar. Lancet 1987; i: 1485–6
3. Ahsan N, et al. Intravenous immunoglobulin-induced osmotic nephrosis. Arch Intern Med 1994; 154: 1985–7
4. Zhang R, Szerlip HM. Reemergence of sucrose nephropathy: acute renal failure caused by high-dose intravenous immune globulin therapy. South Med J 2000; 93: 901–4.

💊 Pharmacokinetics

Sucrose is hydrolysed in the small intestine by the enzyme sucrase to glucose and fructose, which are then absorbed. Sucrose is excreted unchanged in the urine when given intravenously.

💊 Uses and Administration

Sucrose, a disaccharide, is used as a sweetening agent. It is commonly used as household sugar. If the sweetness of sucrose is taken as 100, fructose has a value of about 173, glucose 74, maltose 32, galactose 32, and lactose 16. Sucrose is used as a tablet excipient and lozenge basis, and as a suspending and viscosity-increasing agent. Syrups prepared from concentrated solutions of sucrose form the basis of many linctuses. Treacle (molasses), a byproduct of sugar production that contains sucrose and minerals, has also been used. Sucrose 30% eye drops have been used as a hypertonic agent for clearing corneal oedema.

Cough.

Sucrose syrups are used as demulcents in linctuses used for treating cough.

Diagnostic test for gastrointestinal damage.

Sucrose is not absorbed from the healthy gastrointestinal tract. It has been proposed that the absorption of sucrose could be used as a diagnostic test of gastric damage.1-3
1. Sutherland LR, et al. A simple non-invasive marker of gastric damage: sucrose permeability. Lancet 1994; 343: 998–1000
2. Meddings JB, et al. Sucrose permeability: a novel means of detecting gastroduodenal damage noninvasively. Am J Ther 1995; 2: 843–9
3. Kawabata H, et al. Sucrose permeability as a means of detecting diseases of the upper digestive tract. J Gastroenterol Hepatol 1998; 13: 1002–6.

Gastrointestinal spasm.

For mention of a beneficial effect of sucrose solution in infant colic.

Glycogen storage disease type V.

Glycogen storage disease type V (McArdle’s disease) is a rare autosomal recessive disorder characterised by mutations in the gene for myophosphorylase, an enzyme essential for glycogenolysis.1,2 Patients present with exercise-induced pain, cramps, fatigue, and myoglobinuria which, if severe, can cause acute renal failure.2 Low-dose creatine supplementation (60 mg/kg daily) produced modest benefits during ischaemic exercise testing, but higher doses (150 mg/kg daily) worsened symptoms.2 Sucrose 75 g by mouth improved exercise tolerance in 12 patients in a randomised crossover study.1 Uncooked corn starch, either alone or with sucrose, has been suggested as an alternative in order to avoid any pronounced increase in serum insulin,3 but this has been rejected on the basis that the necessary rapid increase in blood glucose will not be produced.4
1. Vissing J, Haller RG. The effect of oral sucrose on exercise tolerance in patients with McArdle’s disease. N Engl J Med 2003; 349: 2503–9
2. Quinlivan R, Beynon RJ. Pharmacological and nutritional treatment for McArdle’s disease (glycogen storage disease type V). Available in The Cochrane Database of Systematic Reviews; Issu
2. Chichester: John Wiley; 2008 (accessed 21/07/08)
3. Gaglia JL, Wolfsdorf JI. Oral sucrose and exercise tolerance in McArdle’s disease. N Engl J Med 2004; 350: 1575
4. Vissing J, Haller RG. Oral sucrose and exercise tolerance in McArdle’s disease. N Engl J Med 2004; 350: 1575–6.

Hiccup.

Giving a teaspoon of dry granulated sugar resulted in the immediate cessation of hiccup in 19 of 20 patients;1 12 of the patients had suffered from hiccup for less than 6 hours but in the remaining 8 persistent hiccup had been present for 24 hours to 6 weeks. The effect may be due to stimulation of the pharynx. An early protocol for the treatment of intractable hiccup suggests that swallowing dry granulated sugar is one of the first treatments that should be tried.
1. Engleman EG, et al. Granulated sugar as treatment for hiccups in conscious patients. N Engl J Med 1971; 285: 1489.

Pain.

A systematic review1 concluded that sucrose solutions could reduce physiological and behavioural indicators of stress and pain in neonates undergoing painful procedures although there had been some doubt expressed2 over whether this indicated effective analgesia. The review1 was unable to determine an optimal dose, but 1 mL of a 25% solution or 2 mL of a 50% solution has been reported to reduce crying time in premature3 and full-term4 infants, respectively, when given 2 minutes before heel-prick sampling. Similarly, 2 mL of a 75% sucrose solution by mouth reduced crying time in infants given intramuscular vaccines,5 and 2 mL of oral sucrose 24% reduced pain scores in premature infants undergoing eye examinations for retinopathy of prematurity.6 One literature review7 suggested that a dose of 500 mg sucrose provided effective analgesia for neonates. However, a randomised study found pacifiers (dummies) to have a better analgesic effect than 2 mL of a 30% sucrose solution; a synergistic effect was found with a combination of sucrose and pacifiers.8 Another review9 recommended that, along with a pacifier, 0.1 to 0.4 mL of a 24% sucrose solution be given to premature infants, and up to 2 mL be given to term infants. Others have recommended the use of 0.5 mL/kg of a 33% sucrose solution (about 170 mg/kg), stating that more dilute solutions carry a risk of bacterial contamination.10 The route by which sucrose solution is given may also be important: a reduced pain response was only noted after intraoral doses; giving it via a nasogastric tube was ineffective.11 A study in preterm infants found that, while there were no differences on neurobehavioural developmental outcomes between infants given repeated sucrose analgesia or placebo, higher number of doses of sucrose predicted lower scores in motor development, vigour, alertness and orientation. The authors postulated that repeated stimulation by sucrose may interfere with normal functioning and maturation of the preterm infant’s endogenous opiate system, and cautioned against the routine use of sucrose analgesia in this population.12 For choice of analgesic in children.
1. Stevens B, et al. Sucrose for analgesia in newborn infants undergoing painful procedures. Available in The Cochrane Database of Systematic Reviews; Issu
3. Chichester: John Wiley; 2004 (accessed 08/11/05)
2. Anonymous. Pacifiers, passive behaviour, and pain. Lancet 1992; 339: 275–6
3. Ramenghi LA, et al. Reduction of pain response in premature infants using intraoral sucrose. Arch Dis Child 1996; 74: F126–F128
4. Haouari N, et al. The analgesic effect of sucrose in full term infants: a randomised controlled trial. BMJ 1995; 310: 1498–1500
5. Lewindon PJ, et al. Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation. Arch Dis Child 1998; 78: 453–6
6. Gal P, et al. Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother 2005; 39: 1029–33
7. Masters-Harte LD, Abdel-Rahman SM. Sucrose analgesia for minor procedures in newborn infants. Ann Pharmacother 2001; 35: 947–52
8. Carbajal R, et al. Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999; 319: 1393–7
9. Prince WL, et al. Treatment of neonatal pain without a gold standard: the case for caregiving interventions and sucrose administration. Neonatal Netw 2004; 23: 33–45
10. Shann F. Suckling and sugar reduce pain in babies. Lancet 2007; 369: 721–3
11. Ramenghi LA, et al. "Sucrose analgesia": absorptive mechanism or taste perception. Arch Dis Child Fetal Neonatal Ed 1999; 80: F146–F147
12. Johnston CC, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics 2002; 110: 523–8.

Wound healing.

Sugar, either in the form of granulated sugar1-5 or pastes composed of caster sugar and icing sugar,6,7 has been used successfully in the treatment of wounds including mediastinitis after cardiac surgery,1,3 large abscesses and bed sores,6,7 diabetic ulcers,2,4 and recurrent bone infections after surgical debridement in patients with leprosy.5 Debridement of the wound is believed to be due partly to the osmotic effect of sugar and partly to the mechanical cleansing action but it is not known how sugar stimulates granulation tissue to form.6,7 Once granulation tissue is well established and the wound is shrinking, an alternative wound preparation, such as an alginate, hydrocolloid, or hydrogel, should be used as sugar pastes cause bleeding.8Sugar is also effective at deodorising malodorous wounds. The use of the combined caster and icing sugar pastes, of which details of the formulas used are provided in the original publications,6,7 has been advocated as a way to overcome the problems of possible non-sterility and contamination of commercial granulated sugar.6,7 Honey has been used similarly.
1. Trouillet JL, et al. Use of granulated sugar in treatment of open mediastinitis after cardiac surgery. Lancet 1985; ii: 180–4
2. Quatraro A, et al. Sugar and wound healing. Lancet 1985; ii: 664
3. De Feo M, et al. Treatment of recurrent postoperative mediastinitis with granulated sugar. J Cardiovasc Surg 2000; 41: 715–19
4. Kilic A. Healing of diabetic ulcers with granulated sugar. Plast Reconstr Surg 2001; 108: 585
5. Grauwin MY, et al. Comment guérir les ostéites et ostéo-arthrites des extrémités des anciens malades de la lèpre par le sucre cristallisé alimentaire? Acta Leprol 1999; 11: 147–52
6. Gordon H, et al. Sugar and wound healing. Lancet 1985; ii: 663–4
7. Middleton KR, Seal D. Sugar as an aid to wound healing. Pharm J 1985; 235: 757–8
8. Seal DV, Middleton K. Healing of cavity wounds with sugar. Lancet 1991; 338: 571–2.

💊 Preparations

BP 2008: Compressible Sugar; Syrup; Ph. Eur.: Sugar Spheres; USNF 26: Compressible Sugar; Confectioner’s Sugar; Sugar Spheres; Syrup.

Proprietary Preparations

Fr.: Gelodiet. Multi-ingredient: Arg.: Equalsweet; Sucaryl; Austral.: Nyal Chesty Cough†; Irl.: Venos Expectorant; Jpn: U-Pasta; S.Afr.: Emetrol; UK: Honey & Molasses; Venos Cough Mixture; Venos Expectorant.
Published January 28, 2019.