Drug Interaction Report

MONITOR: Coadministration with turmeric may increase the plasma concentrations of sulfasalazine. The proposed mechanism involves enhanced bioavailability of sulfasalazine due to inhibition of breast cancer resistance protein (BCRP)-mediated intestinal efflux by curcumin, an active constituent of turmeric. When a single 2 gm dose of sulfasalazine was administered orally to 8 healthy male volunteers 30 minutes following a 2 gm dose of curcumin, mean sulfasalazine peak plasma concentration (Cmax) and systemic exposure (AUC) increased by 3.7- and 3.2-fold, respectively, compared to administration of the sulfasalazine dose alone.

MANAGEMENT: Caution is advised when sulfasalazine is used with turmeric-containing products. Patients should be monitored for serious adverse effects of sulfasalazine such as blood dyscrasias, myelosuppression, infections, hepatotoxicity, and renal impairment.