Understanding Sulfasalazine: An Essential Guide

Names of Medication

The medication commonly known as Sulfasalazine is marketed in the United States under the brand name Azulfidine.

Pharmacologic Category

Sulfasalazine belongs to a class of drugs known as anti-inflammatory drugs. Similar medications in this category include Mesalamine (Asacol, Pentasa), Balsalazide (Colazal), and Olsalazine (Dipentum).

Dosing

The dosing of Sulfasalazine varies based on the disease it is being used to treat:

Ulcerative Colitis

The typical dose for adults is 3 to 4 grams daily in divided doses. Your doctor may start you at a lower dose and gradually increase your dose to reduce the risk of side effects.

Rheumatoid Arthritis

The standard dose is 2 grams per day in divided doses. Your doctor may increase this dose based on your response to the medication.

Crohn’s Disease

Typically, adults are prescribed 3 to 6 grams daily in divided doses.

Psoriatic Arthritis

Standard treatment involves 2 grams daily in divided doses.

Ankylosing Spondylitis

The usual dosage is 2 to 3 grams daily in divided doses.

Juvenile Rheumatoid Arthritis

For children, the dosing is typically 30 to 50 mg/kg daily in divided doses.
These are typical dosages, but your personal dosage may vary. Always consult your doctor before adjusting your dose.

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 tablets should be taken with a full glass of water after meals or with food to minimize stomach upset. If taking the delayed-release tablets, swallow them whole. Do not crush, chew, or break them.

Adverse Reactions and Side Effects

Like all medications, Sulfasalazine can cause side effects. Some of the more common ones include:

Upset Stomach (Common)

Upset stomach is a common side effect of Sulfasalazine. This is because Sulfasalazine can irritate the lining of the stomach. Taking the medication with food or milk can help to minimize this side effect.

Headache (Common)

Headaches can occur in response to changes in your body’s levels of inflammation as Sulfasalazine works to control your symptoms.

Rash (Uncommon)

A rash is a less common side effect of Sulfasalazine. This could be an allergic reaction to the medication, and if you experience a rash, you should contact your doctor immediately.

Changes in Blood Counts (Rare)

Sulfasalazine can sometimes cause changes in your blood counts, including reduced white blood cells or platelets. This is a rare side effect, but if it occurs, it can increase your risk of infection or bleeding.

Contraindications to taking Sulfasalazine

A contraindication is a situation in which a drug should not be used because it may be harmful to the patient. For indication for Sulfasalazine includes:

Allergy to Sulfa Drugs or Salicylates (Absolute Contraindication)

If you have a known allergy to sulfa drugs or salicylates, you should not take Sulfasalazine. Sulfasalazine is a sulfa drug, which means it contains a type of substance that some people are allergic to. An allergic reaction can cause symptoms such as rash, itching, swelling, severe dizziness, or trouble breathing.

Severe Kidney Disease (Relative Contraindication)

If you have severe kidney disease, your doctor may advise against using Sulfasalazine. The medication is partially eliminated by the kidneys, and if your kidneys aren’t functioning well, the drug could build up in your body, potentially leading to side effects.

Severe Liver Disease (Relative Contraindication)

Sulfasalazine is metabolized in the liver, and if you have severe liver disease, this process may be impaired. Your doctor may decide that the risks of using Sulfasalazine outweigh the benefits in this case.

Drug to Drug Interactions

Sulfasalazine can interact with several other medications, including:
Methotrexate (Trexall): Combined use can increase the risk of liver problems.
Warfarin (Coumadin): Sulfasalazine can increase the effects of warfarin, increasing the risk of bleeding.
Digoxin (Lanoxin): Sulfasalazine can decrease the absorption of digoxin, potentially making it less effective.

Sulfasalazine in Pregnancy

Sulfasalazine is generally considered safe to use during pregnancy. However, it’s important to discuss the potential risks and benefits with your healthcare provider.

Sulfasalazine while Breastfeeding

Sulfasalazine does pass into breast milk, but it is generally considered safe for use while breastfeeding. Again, this is something you should discuss with your healthcare provider.

Estimated Cost of Medication

The estimated cost for a 30-day supply of Sulfasalazine (500mg tablets) is around $30-$40 with a GoodRx coupon, but this can vary depending on the pharmacy and location. Remember, these are just estimates, and actual costs may vary.

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.