Sulfasalazine

Brand names of sulfasalazine

  • Alti-Sulfasalazine
  • Azaline
  • Azulfidine
  • Azulfidine EN-Tabs
  • PMS-Sulfasalazine
  • PMS-Sulfasalazine EC
  • Salazopyrin
  • Salazopyrin EN
  • S.A.S
  • S.A.S-Enema
  • S.A.S-500

Sulfasalazine is a pro-drug (a medication not active in its ingested form) and is mainly used to treat ulcerative colitis (chronic ulceration in the large intestine). Following ingestion, bacteria break this pro-drug down in the colon to form 5-aminosalicylic acid or 5-ASA and sulfapyridine. The chemical substance 5-ASA possesses remedial advantages, but it is still uncertain if sulfapyridine contributes any supplementary therapeutic gain. It may be noted that the inflammation of ulcerative colitis or, for that matter, any other inflammatory disease is partially caused by disproportionate production of certain chemicals, for instance, prostaglandins, which cause swelling and tenderness. Two enzymes - lipoxygenase and cyclooxygenase, are responsible for the production of prostaglandins and these enzymes have been found to be overcharged in people suffering from ulcerative colitis. In effect, 5-ASA is able to lessen the inflammation by means of obstructing the actions of cyclooxygenase and lipoxygenase. This action of 5-ASA, in turn, decreases prostaglandin production. The Food and Drug Administration approved the sale and use of sulfasalazine in 1950.

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Things you need to tell your physician before taking sulfasalazine

Like in the case of using any drug for the first time, you should adopt a number of cautions prior to beginning treatment with sulfasalazine. Prior to using this medication, tell your doctor or pharmacist if you have any allergic reactions to sulfasalazine, any other sulfa medications, aspirin or any related drug - for instance, salicylates, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or mesalamine or if you have any other allergies. Sulfasalazine is likely to enclose a number of inactive ingredients that may result in allergic reactions as well as other medical problems. It is advisable that you consult your doctor for further details.

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Individuals suffering from certain medical conditions should not use sulfasalazine. Before starting treatment with this medication, talk to your doctor or pharmacist if you have any urinary blockage, intestinal blockage and/ or any particular blood disorder, such as porphyria (an anomaly of blood pigment metabolism wherein excessive porphyrins are produced). In addition, it is essential to tell your doctor or pharmacist regarding your entire medical history before you start taking sulfasalazine. You should especially inform your doctor if you have or have had any kidney ailment, liver problems, blood disorders (for instance, aplastic anemia -severe anemia due to damage or depressed working of the bone marrow), asthma, a particular genetic condition (such as G6PD deficiency) and/ or severe allergies.

Taking sulfasalazine may make you feel lightheaded and, hence, it is advisable that you should not undertake any task that requires alertness, for instance, driving a vehicle or operating a machine till you are sure about the impact of the drug on you and also you are certain that you can perform these jobs safely. People taking sulfasalazine ought to restrict their consumption of alcoholic beverages. Since sulfasalazine may make the patient more susceptible to the sun, they should avoid long-term exposure to the sun, keep away from tanning booths as well as sunlamps. When it is absolutely necessary for such individuals to go out in the sun, they should wear protective clothing, wear sunglasses and use sunscreen. As this medication is akin to aspirin, children as well as teenagers ought not take aspirin or medications related to aspirin, such as salicylates, if they are enduring chickenpox, flu or any other ailment that has not be diagnosed. In addition, they should also avoid aspirin and related medications if they have recently been given live virus vaccine, for instance varicella vaccine, without consulting a doctor regarding Reye's syndrome - an exceptional, but grave ailment.

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Sulfasalazine should strictly be given to pregnant women only when it is absolutely necessary for their medical condition and when all other similar medications have failed to respond. Additional caution needs to be exercised if this medication is given to a pregnant woman close to the expected delivery date, as it may harm the fetus or even the newborn. Prior to taking sulfasalazine, pregnant women should talk to their doctor regarding the benefits and risks involved in using the medication during pregnancy. In case any woman becomes pregnant while taking sulfasalazine, she should immediately contact her doctor and seek advice regarding what needs to be done next. It has been found that sulfasalazine has the aptitude to reduce the folic acid levels in your body, thereby augmenting the risks of defects of the spinal cord. Hence, it is important to check with your doctor to ensure that you are taking sufficient folic acid. It may be noted that parental care ought to include examinations for spinal cord defects. Sulfasalazine passes onto breast milk and may be detrimental for the health of the nursing infant. Hence, new mothers taking this medication should consult their doctor before breast feeding.

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Usage

The pro-drug sulfasalazine is indicated for treating a specific type of bowel ailment known as ulcerative colitis. It must be noted that this medication does not cure this medical condition, but facilitates in lessening the symptoms, such as diarrhea, stomach pain, rectal bleeding and fever. Once one attack is treated, this medication is also given to spread out the time between further attacks.

Sulfasalazine works by lessening inflammation in the large intestines. Sulfasalazine is also available in the form of delayed-release tablets that are used to treat rheumatoid arthritis. In addition, this medication also facilitates in diminishing joint pains, swellings as well as rigidity of the joints. It is important to note that treating rheumatoid arthritis with sulfasalazine in the early stages of the medical condition helps to lessen or even avoid further damage of the joints enabling you to carry on with your routine activities normally. Patients who have not responded to other medications, such as salicylates and non-steroidal anti-inflammatory drugs (NSAIDs), are give sulfasalazine in combination with other drugs, relaxation and physical therapy. Some doctors also prescribe sulfasalazine to treat another type of bowel ailment known as the Crohn's disease.

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How to use sulfasalazine

Sulfasalazine in an oral medication, available in the form of tablets, and should be taken after a meal with a full glass of water (approximately 8 ounces) or as per the instructions of your doctor. While starting treatment with this medication, your doctor may initially prescribe a lower dose with a view to avoid stomach disorders. The dosage of sulfasalazine is totally dependent on the patient's medical condition and his/ her response to the treatment. When treating children, the dosage also depends on their body weight. If you are taking the delayed-release form of the tablets, do not crush, break or chew them, but swallow them as a whole. This will help you to avoid getting stomach upsets.

Unless directed otherwise by the doctor, patients taking sulfasalazine ought to drink plenty of fluids during therapy, as this will help to prevent stones. Sulfasalazine should be taken on a regular basis with a view to obtain the utmost benefit from taking this medication. Take this medication around the same time every day as it would help you to remember the time of taking the drug. In case your condition does not improve, or it worsens, immediately contact your doctor and seek advice on what needs to be done. Individuals taking sulfasalazine for treating rheumatoid arthritis should not expect immediate results after taking this medication. In effect, it may take around one to three months before they can expect any improvement of their symptoms.

In the event of missing a dose of this medication, take it immediately when you remember. However, if it is almost time for the next dose, skip the missed dose and continue with your normal dosing schedule. Never take a double dose to make up for a missed dose. Remember, taking this medication in excess or too frequently will not alleviate your symptoms sooner, but it may increase the risks of the side effects.

How sulfasalazine works

Precisely speaking, the correct manner in which the pro-drug sulfasalazine works is yet to be ascertained. However, there is one elucidation that says that this medication works as an anti-inflammatory agent in the bowel. In addition, sulfasalazine also possesses antibiotic attributes that may be significant in altering the bacteria in the bowel.

Side effects

Serious
  • aching joints and muscles
  • bloody diarrhea
  • chest pain
  • swallowing difficulty
  • sore throat
  • loss of appetite
  • unusual bleeding or bruising
  • yellow discoloration of eyes or skin
  • pain in back, legs or stomach
  • blue fingernails, lips, or skin
  • increased sensitivity to sunlight
  • cough; breathing difficulty
  • unusual fatigue
  • paleness of skin or redness, peeling, blistering, or loosening of skin
  • general discomfort
  • fever
Common
Less common

Possible interactions

As is the case with most drugs, even sulfasalazine is known to interact with certain medications, especially herbal products and/ or minerals and, hence, they should not be taken concurrently. In addition, this medication or any sulfonamide drugs result in adverse after-effects when people consume alcoholic beverages during the treatment. In effect, consumption of alcoholic drinks while taking this medication may augment the inebriating effects of the drinks.

Using the herb St. John's wort concurrently with sulfasalazine may enhance susceptibility to the sun. Hence, it is advisable to avoid exposure to sunlight while taking this medication. In addition, it may be noted that certain herbs and herbal products, such as peppermint oil, flaxseed and psyllium husk carry Commission E monograph indications for irritable bowel syndrome (IBS). It is important to remember that people who are enduring ulcerative colitis should avoid herbs like aloe, cascara sagrada bark, rhubarb, buckthorn berry or bark as well as senna.

As aforementioned, people who are taking this medication or any other sulfonamide drugs should avoid exposure to direct sunlight as it may result in photosensitivity.

Storage instructions

Sulfasalazine should always be kept in the container it came in. The container should be closed firmly and kept in a place that is beyond the reach of children and pets. In addition, it is important to note that this medication should be stored at room temperature and in a place that is away from extreme heat and moisture. Never store sulfasalazine in your bathroom, which is mostly damp or moist. Any medication that has become outdated or is needed no longer should be discarded in a safe and proper manner. If necessary, talk to your pharmacist regarding the safe and appropriate way to discard this medication.

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