What is Sulfazalazine?
Sulfasalazine (Azulfidine) is a rheumatic disease-modifying medication (DMARD). It can help alleviate arthritic pain and swelling, prevent joint degeneration and lower the chance of long-term impairment. Sulfasalazine is a sulfa medication. You should not use it if you are allergic to sulfa. Sulfasalazine is used to treat rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and a few other autoimmune diseases. It acts as an anti-inflammatory agent in the body.
Sulfasalazine uses
Sulfasalazine is used to treat intestinal inflammation, diarrhea (frequent stools), rectal bleeding, and abdominal pain in people who have ulcerative colitis, an inflammatory disorder of the intestine.
Mechanism of action
The mechanism of action of Sulfasalazine or its metabolites, 5-aminosalicylic acid (5-ASA) and sulfapyridine (SP), is unknown, but may be related to the anti-inflammatory and/or immunomodulatory properties observed in animal and in vitro models, to its affinity for connective tissue, and/or to the relatively high concentrations found in serous fluids, the liver, and intestinal walls, as demonstrated in animal autoradiographic studies. Clinical investigations involving rectal administration of Sulfasalazine, SP, and 5-ASA have revealed that the 5-ASA moiety may exert the majority of the therapeutic effect in ulcerative colitis. It is unknown what role the parent drug and key metabolites play in rheumatoid arthritis.
Dosage of Sulfasalazine
Tablet:
500mg
enteric-coated tablet (delayed-release):
500mg
Ulcerative colitis
In mild to moderate cases, additional therapy is used, and remission is prolonged.
3-4 g/day PO split TID after meals; may begin with 1-2 g/day; dosages greater than 4 g/day may increase the risk of toxicity.
2 g daily in split doses at 8-hour intervals until endoscopic examination reveals improvement
Modifications to the dosage
Reduce dose by 50% and gradually increase to desired amount over several days; if GI intolerance persists, discontinue medication for 5-7 days and reintroduce at a lower daily dose.
Rheumatoid arthritis
Inadequate response to or sensitivity to salicylates or other nonsteroidal anti-inflammatory drugs
Delayed-release: 0.5-1 g/day PO divided BID; gradually increase to a maintenance dose of 2 g/day PO divided BID; if the response is insufficient, may be increased to 3 g/day after 12 weeks.
The Crohn’s Disease (Off-label)
3-6 g PO daily in split dosages for a maximum of 16 weeks
Administration
Consume immediately following meals. Distribute dosages evenly.
Sulfasalazine side effects
The most frequently reported adverse effects of sulfasalazine are as follows:
- Diarrhea
- Stomach ache
- Dizziness
- Headaches
These adverse events typically occur during the first three months of treatment and frequently resolve when the dose is reduced. After a period of time, you may be allowed to increase the dose again if your reaction to sulfasalazine improves and it helps your symptoms.
Interaction with other medications
Sulfasalazine oral tablet may interact with certain drugs, vitamins, or herbal supplements that you are currently using. When a chemical alters the way a drug functions, this is referred to as an interaction. This can be hazardous or impair the drug’s effectiveness.
Typically, these drugs are not taken concurrently. For additional information, consult your healthcare provider (e.g., doctor or pharmacist).
- Selected photosensitizing substances/tretinoin-mequinol
- Antimicrobials/vaccines for live typhoids
- Sulfonamides/methenamine
Interactions That Are Serious
These drugs may interact, resulting in extremely serious side effects. For additional information, consult your healthcare provider (e.g., doctor or pharmacist).
- Oral BCRP substrates/oral tedizolid selected
- BCRP substrates selected/darolutamide
- Immunomodulators/sodium iodide I 131 myelosuppressives
- Porfimers/photosensitizers selected
- Oral inhibitors of BCRP/talazoparib selected
- Aminolevulinic acid/selected photosensitizers
- Sulfasalazine/methotrexate sulfasalazine/methotrexate (oncology-injection)
- Myelosuppressive agents selected/clozapine
- Agents activated by iodide/radioactive iodide
- Myelosuppressive agents selected/deferiprone
- Sulfonamides/cyclosporine
- Sulfonamides/selected anticoagulants sulfonamides (vit k antagonists)
Precautions/ safety information
It is critical that your doctor monitors your or your child’s progress during routine visits. This enables your doctor to determine whether the medication is working appropriately. Blood and urine tests will be required to monitor for adverse reactions.
Call your doctor immediately if you get a persistent cough, weight loss, night sweats, fever, chills, runny or stuffy nose, headache, impaired vision, or an overall sense of being unwell. These symptoms may indicate that you have an infection.
Consult your physician immediately if you experience trouble breathing or swallowing, a rapid heartbeat, itching, rash, or redness of the skin, or swelling of the face, throat, or tongue. These symptoms could be the result of an allergic reaction to this medication.
This medication may result in significant skin reactions such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug response with eosinophilia and systemic symptoms (DRESS), and acute widespread exanthematous pustulosis (AGEP).
Storage
Keep at room temperature and out of direct sunlight and moisture. Keep out of the bathroom. Keep all medications out of the reach of youngsters.
Contraindications
Sulfasalazine is contraindicated in the following situations:
- Infants younger than two years of age.
- Patients are known to be allergic to sulfasalazine, its metabolites, or any of the excipients, as well as sulfonamides or salicylates.
- Porphyria patients.
Pregnancy or lactation
During pregnancy and breastfeeding, women who intend to become pregnant may continue to take sulfasalazine. Sulfasalazine has not been shown to raise the risk of pregnancy problems or birth abnormalities. Pregnant women who are on sulfasalazine should increase their daily folic acid intake to 2 mg. If you have inflammatory bowel disease, you should consult your physician.
