Sulfazin

Indications

Sulfasalazine is used to treat ulcerative colitis and to keep it in remission, and for Crohn's disease affecting the large bowel. It is also used for rheumatoid arthritis and some other inflammatory joint diseases when simple painkillers are not enough.

How It Works

In the bowel, bacteria split it into two parts: Mesalazine, which calms inflammation in the gut lining, and Sulfapyridine, which helps calm the immune activity that causes joint inflammation. It is a disease-modifying medicine (DMARD), so in arthritis its full benefit takes about 6 to 12 weeks.

Dosage and Administration

• Ulcerative colitis, adults: during a flare the doctor commonly prescribes 2 to 4 g a day in divided doses, then usually 2 g a day to prevent relapse.
• Rheumatoid arthritis, adults: usually started at 500 mg a day and increased step by step each week to 2 to 3 g a day in divided doses, using enteric-coated tablets.
• Take after food with a full glass of water. Swallow enteric-coated tablets whole.
• Children: only as prescribed.

Interactions

It can reduce absorption of Digoxin and Folic Acid. Taking it with Methotrexate, Azathioprine or Mercaptopurine increases the risk of blood problems, so extra blood tests may be needed. Tell your doctor about all medicines you take.

Contraindications

• Allergy to sulfasalazine, sulfonamide ("sulfa") medicines or salicylates such as Aspirin.
• Acute porphyria.
• Children under 2 years.

Side Effects

Common: nausea, loss of appetite, headache, stomach upset and mild rash. Urine and sometimes skin and sweat may turn orange-yellow, which is harmless but can stain soft contact lenses. In men it can lower sperm count while it is taken; this recovers after stopping.

Get urgent medical help if you have a sore throat, fever, mouth ulcers or frequent infections, unexplained bruising or bleeding, a severe or blistering rash, yellow eyes or skin, or new breathlessness. These can be signs of a blood, skin, liver or lung reaction.

Pregnancy and Lactation

It can usually be continued in pregnancy if needed, with extra folic acid as the doctor advises. It is generally acceptable while breastfeeding a healthy full-term baby; ask the doctor first if the baby is premature, jaundiced or unwell, and report diarrhoea in the baby.

Precautions and Warnings

Regular blood tests (blood count and liver tests) are needed, most often in the first 3 months. Use with care in kidney or liver disease, asthma, and G6PD deficiency. Drink plenty of fluids. Do not stop without your doctor's advice.

Overdose

Too much may cause nausea, vomiting, stomach pain, drowsiness or fits. Seek medical help straight away.

Therapeutic Class

Aminosalicylate for inflammatory bowel disease; disease-modifying antirheumatic drug (DMARD).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.