SULFASALAZINE (Azulfidine) |
Description
Sulfasalazine (Azulfidine) is an anti-inflammatory medication
that belongs to a class of drugs called sulfa drugs. The active ingredients
in sulfasalazine consist of salicylate (the main ingredient in aspirin)
combined with a sulfa antibiotic. Sulfasalazine is also known as a disease
modifying antirheumatic drug (DMARD) because it not only decreases the
pain and swelling of arthritis but also may prevent damage to joints and
reduce the risk of long term disability.
Uses
Sulfasalazine was first used to treat rheumatoid
arthritis, once thought
to develop after an infection and thus responsive to antibiotics. Today
sulfasalazine is often given for mild symptoms or used in combination
with other drugs for more severe symptoms or rheumatoid arthritis. It
is also used to treat other conditions, including juvenile
rheumatoid arthritis, ankylosing spondylitis, psoriatic
arthritis and ulcerative
colitis.
How it works
Sulfasalazine counters inflammation; however, it is not entirely clear
why this medication is effective in treating arthritis.
Dosing
Sulfasalazine comes in a 500 milligram tablet. This medication is often
started at low doses to prevent side effects. A typical starting dose
for rheumatoid arthritis may be one to two tablets of sulfasalazine a
day. After the first week, the dose may be increased slowly to the usual
dose of 2 tablets (1 gram) taken twice a day. This dose can be increased
to up to 6 pills (3 grams) a day in some situations. The dose for other
conditions, such as ulcerative colitis, may be different. Take this medication
with food and a full glass of water to prevent stomach upset.
Time to effect
It usually takes between 1 and 3 months to notice any improvement in
rheumatoid arthritis symptoms after starting sulfasalazine
Side Effects
In general, most patients tolerate sulfasalazine without many side effects.
The most common side effects are nausea and abdominal discomfort, which
tend to occur early in the course of treatment. These occur in up to a
third of patients taking sulfasalazine. However, serious side effects
such as stomach ulcers are actually less common with sulfasalazine than
with non-steroidal anti-inflammatory drugs such as ibuprofen. What abdominal
side effects do occur with sulfasalazine usually subside with time and
are often improved by starting with a low dose and gradually increasing
it. Sulfasalazine also is available in an enteric-coated preparation that
helps prevent nausea and abdominal discomfort.
In some cases, sulfasalazine may reduce the number of disease-fighting
white blood cells in the body. This often does not cause symptoms, but
can be detected by regular blood tests performed by your doctor.
Other common side effects include a skin rash or headache, both of which
occur in about 10 percent of patients on this medication. Less common
side effects include mouth sores, itching, or abnormalities in blood tests
of liver function that occur in a small proportion of people taking this
medication for rheumatoid arthritis. Sulfasalazine also increases the
risk of reduced blood counts in people born without an enzyme called Glucose-6-phosphate
dehydrogenase.
Sulfasalazine can increase sensitivity to sunlight. It is therefore recommended
that you use sunscreen (SPF 15 or higher) when outdoors and avoid prolonged
exposure to sunlight while taking this medication. Some people taking sulfasalazine
develop an orange discoloration of their urine, and occasionally of their
skin. This is usually harmless and should not cause alarm. The discoloration
is temporary and goes away after stopping the medication.
Points to remember
Sulfasalazine treatment is generally considered to be safe to use during
pregnancy but should be discussed with your physician if you are planning
to become pregnant. This medication should not be taken by mothers who
are breastfeeding, as it increases the risk for a type of jaundice, known
as kernicterus, in the newborn. This can cause brain problems in infants
who are younger than two years old. In men, sulfasalazine may lower sperm
count, although this should improve after stopping the medication.
If you develop a rash while taking sulfasalazine you should contact your
doctor for instructions. Most rashes are not serious, but occasionally
patients taking sulfasalazine develop a more severe rash and should be
evaluated by their doctor to determine if the medication should be discontinued.
Tell your doctor if you have ever had any unusual or allergic reaction
to any other sulfa medicines as well as medicines that are chemically
related to sulfa drugs. Your doctor will then determine whether you should
take sulfasalazine. Sulfa drugs and those related to them include:
- furosemide (Lasix)
- thiazide diuretics (water pills,
such as hydrochlorothiazide)
- some diabetes medications
- some glaucoma medications
such as acetazolamide (Diamox), dichlorphenamide (Daranide), and
methazolamide (Neptazane)
- salicylates such as aspirin
Sulfasalazine may interfere with warfarin
(Coumadin), so
dose adjustments may be needed if these two medications are taken together.
For more information
The American College of Rheumatology has compiled this list to give you
a starting point for your own additional research. The ACR does not endorse
or maintain these Web sites, and is not responsible for any information
or claims provided on them. It is always best to talk with your rheumatologist
for more information and before making any decisions about your care.
National Institutes of Health
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202537.html
Official Sulfasalazine Website
http://www.sulfasalazine.com/
Updated April 2004.
Written by Michael Cannon, MD, and reviewed by the American
College of Rheumatology Communications and Marketing Committee.
