Sulfasalazine

Generic name: Sulfasalazine

Drug class: 5-aminosalicylates, Antirheumatics

Dosage forms: Delayed-release tablet, Tablet.

Root of administration: Oral

Dose: 500 mg

Mechanism of action: Sulfasalazine is a disease-modifying anti-rheumatic drug (DMARD). It is a slow-acting DMARD, taking time to build up and start working. Sulfasalazine helps to reduce pain and swelling and lowers inflammation in your body. It limits the damage that rheumatoid arthritis causes to your joints, helping to prevent disease progression. Sulfasalazine consists of the anti-inflammatory agent 5-aminosalicylic acid (5-ASA, mesalamine or mesalazine) and the antibiotic sulfapyridine, which are linked by a bond.

Drug usage cases: Inflammatory Bowel Disease (IBD): Sulfasalazine is frequently prescribed for the treatment of ulcerative colitis and Crohn’s disease, which are chronic inflammatory conditions affecting the digestive tract. It helps to reduce inflammation and symptoms such as abdominal pain, diarrhea, and rectal bleeding. Rheumatoid Arthritis (RA): Sulfasalazine can be used as a disease-modifying antirheumatic drug (DMARD) in the treatment of rheumatoid arthritis. It helps to control joint inflammation, reduce pain, and slow down the progression of the disease. Juvenile Idiopathic Arthritis (JIA): Sulfasalazine may be used in children with juvenile idiopathic arthritis, a form of arthritis that affects individuals under the age of 16. It can help to reduce joint inflammation and improve symptoms in pediatric patients. Ankylosing Spondylitis: Sulfasalazine can also be prescribed for ankylosing spondylitis, a type of arthritis that primarily affects the spine and sacroiliac joints. It helps to reduce inflammation, relieve pain, and improve mobility in affected individuals.

Drug contra indications: Hypersensitivity or Allergy: Sulfasalazine is contraindicated in individuals who have a known hypersensitivity or allergy to sulfasalazine, sulfonamides, or any of its components. Allergic reactions can range from mild skin rashes to severe systemic reactions and can be life-threatening in some cases. Intestinal or Urinary Obstruction: Sulfasalazine is contraindicated in individuals with known or suspected intestinal or urinary obstruction. It may exacerbate these conditions or interfere with their management. Porphyria: Sulfasalazine is contraindicated in individuals with porphyria, a group of rare genetic disorders that affect the production of heme, a component of hemoglobin. Sulfasalazine can potentially worsen symptoms or trigger an acute attack of porphyria. Azo Dye Allergy: Sulfasalazine contains an azo dye component, and individuals with a known allergy to azo dyes may also be contraindicated from using sulfasalazine due to the potential for allergic reactions. Severe Liver or Kidney Impairment: Sulfasalazine should be used with caution or avoided in individuals with severe liver or kidney impairment. The medication is metabolized and eliminated by these organs, and impaired function can affect its clearance from the body.

Side effects: Sulfasalazine can cause serious side effects including:

Hepatic, renal, and hematologic toxicity or other conditions: Treatment with sulfasalazine has been reported to cause hypersensitivity reactions, agranulocytosis, aplastic anemia, other blood dyscrasias, renal and liver damage, irreversible neuromuscular and central nervous system changes, and fibrosing alveolitis, and these side effects have been linked to the death of some patients. Tell your doctor if you get a sore throat, fever, pallor, purpura, or jaundice while taking sulfasalazine. These symptoms may be signs of a serious blood disorder or hepatotoxicity (liver toxicity). Complete blood counts and urinalysis should be done frequently while on sulfasalazine. Treatment should be stopped while waiting for blood test results. Oligospermia and Infertility: Treatment with sulfasalazine may cause oligospermia (low sperm count) and infertility in men. Stopping sulfasalazine appears to reverse these effects. Serious Infections: Treatment with sulfasalazine may cause serious infections, including fatal sepsis and pneumonia. Tell your doctor straight away if you develop signs of an infection. Sulfasalazine treatment should be stopped if you develop a serious infection. Tests for infection and myelosuppression should be done if an infection is suspected. Hypersensitivity Reactions: Treatment with sulfasalazine may cause severe hypersensitivity reactions which may include internal organ involvement, such as hepatitis, nephritis, myocarditis, mononucleosis-like syndrome, hematological abnormalities, and/or pneumonitis including eosinophilic infiltration. Severe Cutaneous Adverse Reactions: Drug Reactions with Eosinophilia and Systemic Symptoms (DRESS) Treatment with sulfasalazine can cause severe, life-threatening, systemic hypersensitivity reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS). Early signs of such a reaction include fever or swollen lymph nodes (lymphadenopathy) and these may be seen even if a rash hasn’t developed yet. Tell your doctor straight away if you develop signs of systemic. Other Severe Cutaneous Adverse Reactions: Treatment with sulfasalazine can cause other severe cutaneous adverse reactions, including exfoliative dermatitis, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP). Severe cutaneous adverse reactions can be serious and are sometimes fatal. You are at highest risk for these events early in therapy, with most events occurring within the first month of treatment. Tell your doctor straight away if you develop symptoms of a severe cutaneous adverse reaction. Treatment with sulfasalazine should be stopped at the first sign of such reactions. hypersensitivity. Treatment with sulfasalazine should be stopped if another reason for your symptoms can’t be identified.

Warnings: Allergic Reactions: Sulfasalazine contains a sulfa component, and some individuals may be allergic or hypersensitive to sulfa drugs. Allergic reactions to sulfasalazine can range from mild skin rashes to severe systemic reactions. It’s important to inform your healthcare professional if you have a known allergy to sulfa drugs or any other medications. Blood Disorders: Sulfasalazine can cause various blood disorders, including reduced red blood cell count (anemia), reduced white blood cell count (leukopenia), and reduced platelet count (thrombocytopenia). Regular blood tests may be necessary to monitor blood cell counts during treatment with sulfasalazine. Liver Function: Sulfasalazine can affect liver function, and in rare cases, it may cause liver damage. Liver function tests should be performed periodically to monitor liver enzymes while taking sulfasalazine. Gastrointestinal Effects: Sulfasalazine can cause gastrointestinal side effects, such as nausea, vomiting, diarrhea, and abdominal discomfort. In some cases, these side effects can be severe. It’s important to report any persistent or severe gastrointestinal symptoms to your healthcare professional. Hypersensitivity Pneumonitis: Sulfasalazine has been associated with a rare condition called hypersensitivity pneumonitis, which causes inflammation of the lungs. Symptoms may include cough, shortness of breath, and fever. If you experience these respiratory symptoms while taking sulfasalazine, seek medical attention promptly.

Use during pregnancy or breastfeeding: Tell your doctor if you are pregnant or plan to become pregnant. A study suggests that treatment with sulfasalazine is not associated with fetal malformation. However, neural tube defects have been reported in some infants born to mothers taking sulfasalazine during pregnancy. This may be linked to the drug’s ability to inhibit the absorption and metabolism of folic acid. Sulfasalazine and sulfpyridine pass through the placenta. It is recommended that sulfasalazine is only used during pregnancy if clearly needed. Tell your doctor if you are breastfeeding or planning to breastfeed. Sulfasalazine and its metabolite pass into breast milk and can lead to a type of brain damage called kernicterus in newborns. Limited data also suggests it may cause infants to develop bloody stools or diarrhea. Sulfasalazine should be used with caution in people who are breastfeeding. Talk to your doctor about the best way to feed your baby while