Sulfasalazine

Sulfasalazine is a sulfa drug used primarily in the treatment of inflammatory bowel disease. It is a 5-aminosalicylic acid derivative. It is sold as Azulfidine in the United States. It is also used for rheumatoid arthritis (see Disease-modifying antirheumatic drugs). It is usually not given to children under 2 years of age. more...

Side effects

1. diarrhea
2. headache

Brand Names

• Azulfidine ®
• Salazopyrin ®
• Pyralin ®

MIMS Guide to Sulfasalazine

Section: 1(d) Antidiarrhoeals Pregnancy Category: A

Sport Category: Permitted in sport

Uses/Indications: Ulcerative colitis; Inflammatory Bowel Syndrome; Crohn's disease; rheumatoid arthritis unresponsive to NSAIDs

Contraindications: Haematological, renal or hepatic dysfunction; hypersensitivity to salicylates or sulfonamide derivatives; GI or urinary tract obstruction; porphyria; children < 2 yrs

Precautions: Perform blood counts, urinalysis before and during treatment; maintain fluid intake; G-6-PD deficiency; atopy; slow acetylators; lactation

Adverse Reactions: Hypersensitivity; GI upset; fever; rash; headache; oligospermia; folate deficiency; others, see full PI

Drug Interactions: Oral anticoagulants; methotrexate; sulfonylurea hypoglycaemics; urinary acidifiers; phenylbutazone; indomethacin; sulfinpyrazone; salicylates; antacids, ferrous sulfate (concurrent); penicillins, oxacillin; some local anaesthetics; digoxin

PYRALIN EN (Tablets) Prescription required. S4 Sulfasalazine; yellow e-c tab; Dose: Should be taken with food. GI disease. Initial dosage. Adults: 1-2 g 4 times daily; children: 40-60 mg/kg daily in 3-6 divided doses. Maintenance. Adults: 2 g daily in 4 divided doses; children: 40 mg/kg daily in 4 divided doses. Rheumatoid arthritis. Adults: 1 g 2-3 times daily Pack: 500 mg x2 Brand substitution is permitted. : PBS/RPBS (Rp 5) PBS: $58.15

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Pharmacodynamics.

Sulfasalazine has, among others, an immunosuppressive effect and has shown affinity to connective tissue. It has also been shown to have a wide range of effects in other biological systems. It is, however, difficult to judge the clinical relevance of its various pharmacological actions since the aetiology of rheumatoid arthritis is largely unknown. Moreover, the mode of action of sulfasalazine in the treatment of ulcerative colitis is also not known. A metabolite of the drug may have an inhibitory effect on an antigen-antibody process occurring in the intestinal wall and the salicylate component may act as an anti-inflammatory agent. The drug does not appear to have any long-term antibacterial effect on the stool flora of patients with ulcerative colitis (see Antibacterial effect, below).

The following effects have been found in vitro: inhibition of bacterial growth; inhibition of prostaglandin synthesis; increased intestinal cytoprotection due to inhibition of prostaglandin degradation; reduction of leukotriene formation; modulation of polymorphonuclear leucocyte function; inhibition of proteolytic enzymes; inhibition of DNA synthesis; and impairment of folate absorption and metabolism.

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