Sulfasalazine: A Comprehensive Medication Guide

Summary or Key Points

Sulfasalazine is a medication primarily used to treat rheumatoid arthritis and ulcerative colitis. It helps reduce inflammation and alleviate symptoms. Though generally safe and effective, sulfasalazine can have side effects, and proper dosing is critical. As always, consult with a healthcare provider, ideally one of ours through our convenient telemedicine services, before starting or adjusting any medication.

Names of Medication

US Brand Name: Azulfidine (Sulfasalazine).

The term ‘generic name’ refers to the official medical name for the active ingredient in the medicine, which is listed here in parenthesis. In this case, sulfasalazine is the generic name for Azulfidine.

Pharmacologic Category

Sulfasalazine belongs to a class of drugs known as disease-modifying antirheumatic drugs (DMARDs). Other medications in this category include methotrexate, hydroxychloroquine, and leflunomide.

Dosing

• Rheumatoid Arthritis: The typical adult dose is 500-1000 mg daily to start, increasing as directed by your healthcare provider up to 3000 mg daily. Treatment duration is long-term and will be adjusted according to patient response and tolerance.
• Ulcerative Colitis: The usual adult dose is 3000-4000 mg daily, in divided doses. This medication is generally used long-term for maintenance of remission. As always, dosage and duration should be individualized under the guidance of your healthcare provider.

Always consult your healthcare provider before adjusting your dosage. If you don’t have a provider or can’t reach yours, one of our telemedicine professionals is available for consultation.

Dosage Forms and Strengths

Sulfasalazine is available in the following forms and strengths:

• Tablets: 500 mg
• Delayed-release tablets (Azulfidine EN-tabs): 500 mg

Administration Instructions

Sulfasalazine should be taken with food and a full glass of water to minimize potential gastrointestinal discomfort. The medication should be swallowed whole—do not crush or chew it. If you miss a dose, take it as soon as you remember unless it’s close to the time for your next dose. In this case, skip the missed dose and continue with your regular schedule. Do not double up on doses to make up for a missed one. If you have any questions about how to take this medication, one of our telemedicine providers can help.

Adverse Reactions and Side Effects

Like all medications, sulfasalazine may cause side effects. Common side effects, occurring in up to 1 in 10 people, include:

• Nausea or vomiting
• Headache
• Stomach pain
• Diarrhea
• Decreased appetite

Some side effects are less common, but potentially more serious. If you experience any side effects or have concerns about your medication, please reach out to your healthcare provider immediately or schedule a visit with one of our telemedicine professionals. Always remember that your healthcare team is your best source for any concerns or questions about your health.

Contraindications

A contraindication is a specific situation or condition in which a particular medication should not be used because it may be harmful to the patient. Sulfasalazine should not be taken in the following situations:

• If you have a known allergy to sulfasalazine, its components, or sulfonamides and salicylates. Using this medication when allergic could cause a severe and potentially life-threatening allergic reaction.
• If you have a urinary or intestinal blockage, as sulfasalazine could worsen these conditions.
• If you have porphyria, a group of rare genetic disorders affecting the nervous system or skin, as sulfasalazine may trigger a porphyria attack.

If you have any of these conditions, discuss alternative treatments with your healthcare provider, or one of our telemedicine providers.

Drug to Drug Interactions

Sulfasalazine may interact with the following medications:

• Warfarin (Coumadin, Jantoven) – Sulfasalazine may increase the risk of bleeding.
• Digoxin (Lanoxin) – Sulfasalazine can decrease the absorption of digoxin.
• Methotrexate (Trexall) – Sulfasalazine can increase the toxicity of methotrexate.

Sulfasalazine in Pregnancy

While Sulfasalazine can be taken during pregnancy, it should be used under the guidance of a healthcare provider. Although it doesn’t appear to pose significant risk to an unborn baby, it’s important to discuss any concerns with your healthcare provider or with one of our telemedicine professionals.

Sulfasalazine while Breastfeeding

Sulfasalazine can pass into breast milk. Although it is generally considered safe to use during breastfeeding, any potential risks should be discussed with your healthcare provider.

Estimated Cost of Medication

Based on the data from GoodRx, the estimated cost of a 30-day supply of Sulfasalazine without insurance, using a GoodRx coupon, is approximately $30-$60. Costs can vary based on location and pharmacy.

Possible Alternatives

• Rheumatoid Arthritis: Alternatives may include other DMARDs, such as methotrexate or leflunomide, biologic agents, and non-pharmacologic interventions like physical therapy. Lifestyle changes, such as a balanced diet and regular exercise, may also help manage symptoms.
• Ulcerative Colitis: Other treatments may include aminosalicylates, corticosteroids, immunosuppressive agents, or biologic therapies. Lifestyle changes, like a healthy diet and stress management techniques, can also support overall health.

Always discuss potential alternatives with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are here to help with this discussion.

Recent Updates on Sulfasalazine Research

Research on Sulfasalazine continues to evolve. Recent studies indicate that sulfasalazine may help in managing other immune-mediated inflammatory diseases, beyond its approved indications of rheumatoid arthritis and ulcerative colitis. Further studies are needed to confirm these findings and to fully understand the potential benefits and risks.

Brief Legal Disclaimer

This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.
Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.