Sulfasalazine [ Azulfadine ]
Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into two products: 5-aminosalicylic acid (5ASA), and sulfapyridine. There is some controversy as to which of these two products are responsible for the activity of azulfidine. Whereas it is known that 5ASA has therapeutic benefit, it is not clear whether sulfapyridine adds any further benefit. In the colon, the products created by the breakdown of sulfasalazine work as anti-inflammatory agents for treating inflammation of the colon. The beneficial effect of sulfasalazine is believed to be due to a local effect on the bowel, although there may also be a beneficial systemic immune-suppressant effect as well. Following oral administration, 33% of the sulfasalazine is absorbed, all of the sulfapyridine is absorbed, and about 33% of the 5ASA is absorbed. Sulfasalazine was approved by the FDA in 1950.
Sulfasalazine is used for the treatment of mild to moderate ulcerative colitis; as adjunctive therapy (i.e. with other medications) in the treatment of severe ulcerative colitis; for the treatment of Crohn's disease; for the treatment of rheumatoid arthritis or ankylosing spondylitis.
tell your doctor if you are allergic to sulfasalazine, sulfapyridine, aspirin, choline magnesium trisalicylate (Triosal, Trilisate), choline salicylate (Arthropan), mesalamine (Asacol, Pentasa, Rowasa), salsalate (Argesic-SA, Disalcid, Salgesic, others), sulfa drugs, trisalicylate (Tricosal, Trilisate),or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially digoxin (Lanoxin), folic acid, and vitamins.
tell your doctor if you have or have ever had asthma, kidney or liver disease, porphyria, blood problems, or blockage in your intestine or urinary tract.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking sulfasalazine, call your doctor.
plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen. Sulfasalazine may make your skin sensitive to sunlight.
Pregnancy
Sulfasalazine has not been studied in pregnant women. However, reports on women who took sulfasalazine during pregnancy have not shown that it causes birth defects or other problems. In addition, sulfasalazine has not been shown to cause birth defects in studies in rats and rabbits given doses of up to 6 times the human dose.
Breast-feeding
Sulfa medicines pass into the breast milk in small amounts and have been shown to cause unwanted effects in nursing babies with glucose-6-phosphate dehydrogenase (G6PD) deficiency. It may be necessary for you to take another medicine or to stop breast-feeding during treatment. Be sure you have discussed the risks and benefits of the medicine with your doctor.
Children
Sulfasalazine should not be used in children up to 2 years of age because it may cause brain problems. However, sulfasalazine has not been shown to cause different side effects or problems in children over the age of 2 years than it does in adults.
When you are taking sulfasalazine, it is especially important that your health care professional know if you are taking any of the following:
Acetaminophen (Tylenol)
Amiodarone (Cordarone)
Anabolic steroids (nandrolone [Anabolin], oxandrolone [ Anavar], oxymetholone [ Anadrol], stanozolol [ Winstrol])
Androgens (male hormones)
Carbamazepine (Tegretol)
Carmustine ( BiCNU)
Dantrolene ( Dantrium)
Daunorubicin ( Cerubidine)
Disulfiram ( Antabuse)
Divalproex ( Depakote)
Estrogens (female hormones)
Ethionamide ( Trecator-SC)
Etretinate ( Tegison)
Fat emulsions, intravenous ( Intralipid)
Fluconazole ( Diflucan)
Gold salts
Inflammation or pain medicine, except narcotics or
Iron
Labetalol ( Normodyne)
Lovastatin ( Mevacor)
Mercaptopurine ( Purinethol)
Methimazole ( Tapazole)
Naltrexone (ReVia) (with long-term, high-dose use)
Niacin (with high doses, sustained release, and antihyperlipidemic use)
Nitrofurans
Other anti-infectives by mouth or by injection (medicine for infection)
Phenothiazines (acetophenazine [ Tindal], chlorpromazine [ Thorazine], fluphenazine [ Prolixin], mesoridazine [ Serentil], perphenazine [ Trilafon], prochlorperazine [ Compazine], promazine [ Sparine], promethazine [ Phenergan], thioridazine [ Mellaril], trifluoperazine [ Stelazine], triflupromazine [ Vesprin], trimeprazine [ Temaril])
Plicamycin ( Mithracin)
Pravastatin ( Pravachol)
Propylthiouracil ( Propyl-Thyracil)
Simvastatin ( Zocor)
Troleandomycin
Valproic acid ( Depakene)
Vitamin A (with chronic overdose)—Use of sulfasalazine with these medicines may increase the chance of side effects affecting the liver
Acetohydroxamic acid ( Lithostat)
Dapsone
Furazolidone (Furoxone)
Menadiol ( Synkavite)
Nitrofurantoin ( Furadantin)
Primaquine
Procainamide ( Pronestyl)
Quinidine ( Quinidex)
Quinine ( Quinamm)
Sulfoxone ( Diasone)—Use of sulfasalazine with these medicines may increase the chance of side effects affecting the blood
Anticoagulants (blood thinners)
Ethotoin ( Peganone)
Mephenytoin ( Mesantoin)—Use of sulfasalazine with these medicines may increase the chance of side effects of these medicines
Antidiabetics, oral (diabetes medicine you take by mouth)—Use of oral antidiabetics with sulfasalazine may increase the chance of side effects affecting the blood and/or increase the side effects of oral antidiabetics
Methotrexate ( Mexate)—Use of methotrexate with sulfasalazine may increase the chance of side effects affecting the liver and/or increase the side effects of methotrexate
Methyldopa ( Aldomet)—Use of methyldopa with sulfasalazine may increase the chance of side effects affecting the liver and/or the blood
Phenytoin ( Dilantin)—Use of phenytoin with sulfasalazine may increase the chance of side effects affecting the liver and/or increase the side effects of phenytoin
Common Side Effects:
Check with your doctor if any of the following side effects continue or are bothersome:
abdominal or stomach pain or upset
diarrhea
loss of appetite
nausea or vomiting
Notify Doctor Immediately:
More common
aching of joints
headache (continuing)
itching
increased sensitivity of skin to sunlight
skin rash
Less Common or Rare
aching of joints and muscles
back, leg, or stomach pains
bloody diarrhea
bluish fingernails, lips, or skin; chest pain
cough
difficult breathing
difficulty in swallowing
fever, chills, or sore throat
general feeling of discomfort or illness
loss of appetite
pale skin
redness, blistering, peeling, or loosening of skin
unusual bleeding or bruising
unusual tiredness or weakness
yellow eyes or skin
In some patients this medicine may also cause the urine or skin to become orange-yellow. This side effect does not need medical attention.>P>
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. This information is meant only as a guideline - always consult a physician or pharmacist for complete information about prescription medications.
On behalf of learning, and use as teaching tools for those of us who need to
know about our disease, I have tried to supply you with as much information as
I could find on all of the drugs, treatments and disorders associated with
Inflammatory Bowel Diseases. I have tried to blend all facts supported by research
and also from personal experiences of other IBD sufferers into one readable webpage, and any and all information presented here is not entirely
from one source. Most information contained within these pages is found in the public domain.
At times you may find information used from another site, and as with all copyrighted materials you may find on these pages, I claim fair use under sections 107 through 118 of the Copyright Act (title 17, U.S. Code). Click here for more info
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