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Sulfadiazine Side Effects

Medically reviewed by Last updated on Nov 19, 2023.

Applies to sulfadiazine: oral tablet.

Serious side effects of Sulfadiazine

Along with its needed effects, sulfadiazine 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 while taking sulfadiazine:


Incidence not known

Other side effects of Sulfadiazine

Some side effects of sulfadiazine 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:

Incidence not known

For Healthcare Professionals

Applies to sulfadiazine: compounding powder, oral tablet.


Hypersensitivity side effects have included urticarial rash (most common), allergic myocarditis, anaphylactoid reactions, anaphylaxis, arthralgia, conjunctival and scleral injection, drug fever and chills, epidermal necrolysis, erythema multiforme, exfoliative dermatitis, generalized skin eruptions, periorbital edema, photosensitization, serum sickness, Stevens-Johnson syndrome, and urticaria.[Ref]

The use of sulfonamide antibiotics, including sulfadiazine, is associated with large increases in the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis, although these phenomena are rare as a whole.[Ref]


Hemolytic anemia occurs less often with sulfadiazine than with other sulfonamides. Aplastic anemia may be more likely in patients with poor bone marrow reserves.[Ref]

Hematologic side effects have included agranulocytosis (0.1%), aplastic anemia, hemolytic anemia (0.05%), hypoprothrombinemia, leukopenia, methemoglobinemia, and purpura.[Ref]


Gastrointestinal side effects have included nausea, vomiting, abdominal pain, diarrhea, anorexia, pancreatitis, and stomatitis.[Ref]


Hepatic side effects are rare but can be serious. Isolated cases of hepatitis and jaundice due to cholestasis have been associated with sulfadiazine. Elevated liver function tests (with a negative hepatitis panel) have been reported in at least one case associated with psychosis.[Ref]


Psychosis associated with sulfadiazine and pyrimethamine therapy in patients with AIDS and CNS toxoplasmosis has been described in two separate case reports. In each case, tremulousness and disorientation developed within three days to two weeks after starting therapy, despite partial resolution of the size of the intracranial T gondii lesions. No other obvious cause for mental status changes was found. The delirium resolved upon discontinuation of therapy in each case, and was reproducible upon rechallenge. In one case, the patient had elevated liver function tests (hepatitis panel was negative), which were reversible upon discontinuation of therapy.[Ref]

Psychiatric side effects have rarely included frank psychosis in patients with AIDS and CNS toxoplasmosis. Tremulousness, disorientation, and delirium have been reported.[Ref]

Nervous system

Nervous system side effects have included ataxia, convulsions, hallucinations, headache, insomnia, mental depression, peripheral neuritis, tinnitus, and vertigo.[Ref]


Renal side effects have included crystalluria, lupus erythematosus, periarteritis nodosa, toxic nephrosis with oliguria and anuria, and acute renal failure secondary to crystalluria or tubulointerstitial nephritis.[Ref]


In one case, analysis of the stone fragments showed a composition of 100% acetylated 2-sulfanilamidopyrimidine, a metabolite of sulfadiazine.[Ref]

Genitourinary side effects have included urolithiasis.[Ref]


Metabolic side effects have included hypoglycemia.[Ref]


Endocrine side effects associated with sulfonamides have rarely included diuresis, goiter production, and sialadenitis.[Ref]


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11. Iaccheri B, Fiore T, Papadaki T, et al. Adverse drug reactions to treatments for ocular toxoplasmosis: A retrospective chart review. Clin Ther. 2008;30:2069-74.

12. Kounis GN, Kouni SA, Chiladakis JA, Kounis NG. Comment: Mesalamine-Associated Hypersensitivity Myocarditis in Ulcerative Colitis and the Kounis Syndrome (February). Ann Pharmacother. 2009;43:393-4.

13. Puckett J, Cooper M, Stuart J, Wu WC, Sterchi JM. Pyrimethamine, sulfadiazine, and villous atrophy of the jejunum. Ann Intern Med. 1982;96:380.

14. Reboli AC, Mandler HD. Encephalopathy and psychoses associated with sulfadiazine in two patients with AIDS and CNS toxoplasmosis. Clin Infect Dis. 1992;15:556-7.

15. Young C. Acute encephalopathy associated with sulfadiazine in a patient with AIDS-related complex. J Infect Dis. 1989;160:163-4.

16. Marques LPJ, Madeira EPQ, Santos OR. Renal alterations induced by sulfadiazine therapy in an AIDS patients. Clin Nephrol. 1994;42:68-9.

17. Crespo M, Quereda C, Pascual J, Rivera M, Clemente L, Cano T. Patterns of sulfadiazine acute nephrotoxicity. Clin Nephrol. 2000;54:68-72.

18. Perazella MA. Drug-induced renal failure: update on new medications and unique mechanisms of nephrotoxicity. Am J Med Sci. 2003;325:349-62.

19. Schuler AK, Talor Z. The case: 69 year old man with sand in the urine. N-acetylsulfadiazine crystals. Kidney Int. 2007;72:769-70.

20. Dusseault BN, Croce KJ, Pais VM Jr. Radiographic characteristics of sulfadiazine urolithiasis. Urology. 2009;73:928.e5-6.

21. Anibarro B, Fontela JL. Sulfadiazine-induced sialadenitis. Ann Pharmacother. 1997;31:59-60.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.