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sulfasalazine (Oral route)

Pronunciation

sul-fa-SAL-a-zeen

Commonly used brand name(s)

In the U.S.

  • Azulfidine
  • Azulfidine Entabs
  • Sulfazine
  • Sulfazine EC

In Canada

  • Alti-Sulfasalazine
  • Salazopyrin

Available Dosage Forms:

  • Tablet
  • Tablet, Enteric Coated

Therapeutic Class: Gastrointestinal Agent

Chemical Class: Sulfonamide

Uses For sulfasalazine

Sulfasalazine is used to treat and prevent ulcerative colitis. It works inside the bowels by helping to reduce the inflammation and other symptoms of the disease.

Sulfasalazine enteric-coated tablets are used to treat adults and children with rheumatoid arthritis in patients who have not been helped by or who cannot tolerate other medicines (eg, salicylates or NSAIDs) for rheumatoid arthritis.

Slideshow: Drug Treatment for Rheumatoid Arthritis - What Are Your Options?

sulfasalazine is available only with your doctor's prescription.

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, sulfasalazine is used in certain patients with the following medical conditions:

  • Ankylosing spondylitis.

Before Using sulfasalazine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sulfasalazine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to sulfasalazine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of sulfasalazine tablets and enteric-coated tablets to treat ulcerative colitis in children younger than 2 years of age. Safety and efficacy have not been established in children younger than 2 years of age.

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of sulfasalazine enteric-coated tablets to treat juvenile rheumatoid arthritis in children. However, safety and efficacy have not been established in children younger than 6 years of age.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of sulfasalazine in the elderly.

Pregnancy

Pregnancy Category Explanation
All Trimesters B Animal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking sulfasalazine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using sulfasalazine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Methenamine

Using sulfasalazine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Riluzole

Using sulfasalazine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Cyclosporine
  • Digoxin
  • Warfarin

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of sulfasalazine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Allergy to sulfa drugs or salicylates or
  • Bowel blockage or
  • Porphyria (enzyme problem) or
  • Urinary bladder blockage—Should not be used in patients with these conditions.
  • Asthma, bronchial—Use with caution. May increase risk of having an allergic reaction.
  • Blood or bone marrow problems (eg, agranulocytosis, aplastic anemia) or
  • Kidney disease or
  • Liver disease—Use with caution. May make these conditions worse.
  • Glucose-6-phosphate dehydrogenase (G6PD) deficiency (a hereditary metabolic disorder affecting red blood cells)—May cause hemolytic anemia (blood disorder) in patients with this condition.
  • Infection—May decrease your body's ability to fight infection.

Proper Use of sulfasalazine

Take sulfasalazine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

It is best to take sulfasalazine right after meals, at evenly spaced times throughout the day and night. Try not to let more than 8 hours go by between doses, even at night.

Swallow the enteric-coated tablet whole. Do not crush, break, or chew it.

Drink extra fluids so you will pass more urine while you are using sulfasalazine. This may help prevent kidney problems.

Keep using sulfasalazine for the full time of treatment, even if you begin to feel better after a few days. Do not miss any doses.

While using sulfasalazine, part of the enteric-coated tablet may pass into your stools. This is normal and is nothing to worry about.

Dosing

The dose of sulfasalazine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of sulfasalazine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For treatment of ulcerative colitis:
    • For oral dosage form (enteric-coated tablets):
      • Adults—At first, 500 to 1000 milligrams (mg) every 6 to 8 hours per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 4000 mg per day.
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 40 to 60 milligrams (mg) per kilogram (kg) of body weight per day, divided into 3 to 6 doses.
      • Children 2 to 5 years of age—Dose must be determined by your doctor.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (tablets):
      • Adults—At first, 500 to 1000 milligrams (mg) every 6 to 8 hours per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 4000 mg per day.
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 40 to 60 milligrams (mg) per kilogram (kg) of body weight per day, divided into 3 to 6 doses.
      • Children 2 to 5 years of age—Dose must be determined by your doctor.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
  • For maintenance treatment of ulcerative colitis:
    • For oral dosage form (enteric-coated tablets):
      • Adults—2000 milligrams (mg) per day.
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 30 milligrams (mg) per kilogram (kg) of body weight per day, divided into 4 doses.
      • Children 2 to 5 years of age—Dose must be determined by your doctor.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
    • For oral dosage form (tablets):
      • Adults—2000 milligrams (mg) per day.
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 30 milligrams (mg) per kilogram (kg) of body weight per day, divided into 4 doses.
      • Children 2 to 5 years of age—Dose must be determined by your doctor.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
  • For treatment of rheumatoid arthritis:
    • For oral dosage form (enteric-coated tablets):
      • Adults—At first, 500 mg to 1000 milligrams (mg) per day, divided into 2 doses. Your doctor may increase your dose as needed. However, the dose is usually not more than 3000 mg per day.
      • Children 6 years of age and older—Dose is based on body weight and must be determined by your doctor. The dose is usually 30 to 50 milligrams (mg) per kilogram (kg) of body weight per day, divided into 2 doses. Your doctor may increase your dose as needed. However, the dose is usually not more than 2000 mg per day.
      • Children younger than 6 years of age—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of sulfasalazine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using sulfasalazine

It is very important that your doctor check your or your child's progress at regular visits. This will allow your doctor to check if the medicine is working properly. Blood and urine tests will be needed to check for unwanted effects.

Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin. These could be symptoms of a serious liver problem.

Check with your doctor right away if you or your child have a fever and sore throat, pale skin, unusual bruising or bleeding, or unusual tiredness or weakness. These may be symptoms of a blood problem.

sulfasalazine may decrease the amount of sperm men make and affect their ability to have children. If you plan to have children, talk with your doctor before using sulfasalazine.

sulfasalazine may increase your risk of developing infections. Avoid being near people who are sick or have infections while you are using sulfasalazine. Wash your hands often. Tell your doctor if you have any kind of infection before you start using sulfasalazine. Also tell your doctor if you have ever had an infection that would not go away or an infection that kept coming back.

Call your doctor right away if you start to have a cough that won't go away, weight loss, night sweats, fever, chills, or flu-like symptoms, such as a runny or stuffy nose, headache, blurred vision, or feeling generally ill. These may be signs that you have an infection.

Serious skin reactions can occur with sulfasalazine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while you are using sulfasalazine.

Sulfasalazine may cause blood problems. These problems may result in a greater chance of certain infections, slow healing, and bleeding of the gums. Therefore, you should be careful when using regular toothbrushes, dental floss, and toothpicks. Dental work should be delayed until your blood counts have returned to normal. Check with your medical doctor or dentist if you have any questions about proper oral hygiene (mouth care) during treatment.

Sulfasalazine may cause your skin to be more sensitive to sunlight than it is normally. Exposure to sunlight, even for brief periods of time, may cause a skin rash, itching, redness or other discoloration of the skin, or a severe sunburn. When you begin taking sulfasalazine:

  • Stay out of direct sunlight, especially between the hours of 10:00 a.m. and 3:00 p.m., if possible.
  • Wear protective clothing, including a hat. Also, wear sunglasses.
  • Apply a sun block product that has a skin protection factor (SPF) of at least 15. Some patients may require a product with a higher SPF number, especially if they have a fair complexion. If you have any questions about this, check with your health care professional.
  • Apply a sun block lipstick that has an SPF of at least 15 to protect your lips.
  • Do not use a sunlamp or tanning bed or booth.

If you have a severe reaction from the sun, check with your doctor.

Your skin or urine may turn an orange or yellow color while you or your child are using sulfasalazine. This is normal and nothing to worry about.

sulfasalazine Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Aching of joints
  • fever
  • headache (continuing)
  • increased sensitivity of the skin to sunlight
  • skin rash or itching
  • vomiting
Less common
  • Back, leg, or stomach pains
  • bleeding gums
  • bluish color of the fingernails, lips, skin, palms, or nail beds
  • chills
  • dark urine
  • difficulty breathing
  • fever
  • general body swelling
  • headache
  • loss of appetite
  • nausea
  • nosebleeds
  • pale skin
  • sore throat
  • troubled breathing with exertion
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • yellowing of the eyes or skin
Less common or rare
  • Aching of muscles
  • black, tarry stools
  • blistering, peeling, or loosening of the skin
  • bloating
  • blood in the urine or stools
  • bloody diarrhea
  • bluish fingernails, lips, or skin
  • chest pain
  • constipation
  • cough
  • difficulty with swallowing
  • dizziness
  • fainting spells
  • fast heartbeat
  • general feeling of discomfort or illness
  • general tiredness and weakness
  • hives
  • indigestion
  • inflammation of the joints
  • irregular heartbeat
  • light-colored stools
  • muscle aches
  • muscle cramps or spasms
  • muscle pain or stiffness
  • painful or difficult urination
  • pains in the stomach, side, or abdomen, possibly radiating to the back
  • pinpoint red spots on the skin
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rash
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • redness, blistering, peeling, or loosening of the skin
  • sores, ulcers, or white spots in the mouth or on the lips
  • swollen or painful glands
  • tightness in the chest
  • upper right abdominal or stomach pain
Incidence not known
  • Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Abdominal or stomach pain or upset
  • decreased weight
Less common
  • Welts
Less common or rare
  • Discoloration of the skin or urine
  • hair loss or thinning of the hair
  • swelling or inflammation of the mouth

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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