Sulfasalazine
About Sulfasalazine
Sulfasalazine is used to treat bowel diseases (ulcerative colitis, Crohn's disease), skin-related problems (psoriasis), and chronic joint diseases (rheumatoid arthritis, ankylosing spondylitis) in children and adults.
Sulfasalazine contains sulfasalazine, which works by inhibiting the formation of a chemical known as prostaglandins, which control pain and inflammation.
In some cases, you may experience common side effects like a sore throat, a fever, unexplained bruising, or ringing in your ears (tinnitus). Most of these side effects do not require medical attention and gradually resolve over time. However, if the side effects are persistent, please reach out to your doctor.
Avoid taking Sulfasalazine if you are allergic to it. Sulfasalazine can lower your sperm count, leading to a temporary decrease in male fertility. In this case, you can speak to your doctor. Your doctor might arrange a blood test before you start taking Sulfasalazine. Inform your doctor if you are pregnant or are breastfeeding before taking Sulfasalazine.
Uses of Sulfasalazine
Medicinal Benefits
- Sulfasalazine works by reducing the inflammation in the colon.
- It inhibits the formation of a chemical, prostaglandin, which controls inflammation. Together, they help in reducing the inflammation at all the sites like joints, skin, and bowel (intestines),
- This medicine treats a wider range of joint, skin and bowel diseases, including ulcerative colitis, Crohn's disease, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis.
- Sulfasalazine is not a painkiller. Rather, it is an anti-inflammatory.
Directions for Use
- Sulfasalazine should be taken after meals.
- Follow your doctor's instructions on the dosage and timing of this medication.
- Swallow Sulfasalazine as a whole with a glass of water.
- Do not crush, break, or chew it.
Storage
Side Effects of Sulfasalazine
- Headache
- Indigestion
- Nausea
- Watery diarrhoea
Drug Warnings
- Do not use Sulfasalazine if you are allergic to any of its components.
- Sulfasalazine treatment is generally considered to be safe during pregnancy, but its usage in pregnant mothers should be discussed with the doctor if planning for pregnancy.
- This medication should be avoided in breastfeeding mothers, as it passes into the milk and causes jaundice and brain problems in infants less than 2 years of age.
- Tell your doctor if you have an allergy to any other sulfa drugs (sulfonamide antibiotics), as it may cause serious skin allergies like urticaria and Stevens-Johnson syndrome.
- In men, an intake of Sulfasalazine may lower the sperm count, which improves after stopping this medicine.
- Tell your doctor if you have asthma, wheezing, fever, breathing difficulties, a sudden severe skin rash, unusual bleeding, sore throat, fever, unexplained bruising, or any other symptoms of infection.
- Use of Sulfasalazine may change the colour of your urine, contact lenses, and tears to yellow/orange and even make your skin more sensitive to the sunlight. But, this is normal, harmless, and nothing to worry about.
- You may have low folic acid in pregnancy while taking Sulfasalazine, so your doctor might prescribe you iron or folic acid supplements.
Drug Interactions
Drug-Drug Interaction: Sulfasalazine may interact with blood thinner (warfarin), heart disease medicine (digoxin), iron supplements (folate), anti-diabetic medicine (glimepiride, glyburide, glipizide, antibiotics (methenamine), immune system affecting drug (azathioprine, mercaptopurine), anti-arthritis or anti-cancer drug (methotrexate) and anti TB drug (isoniazid).
Drug-Food Interaction: No relevant interaction be found.
Drug-Disease Interaction: Sulfasalazine should not be given to the people affected with colitis intestinal obstruction, urinary obstruction, hematologic toxicity, hypersensitivity or allergic reactions, liver disease, porphyria and kidney disease.
Drug-Drug Interactions Checker List:
Safety Advice
Alcohol
unsafeIt is not recommended to consume alcohol while taking Sulfasalazine to avoid unpleasant side-effects.
Pregnancy
consult your doctorSulfasalazine should be recommended in pregnancy only if required. In case, if prescribed to a pregnant woman, it is advised to increase the folate supplementation after consulting your doctor.
Breast Feeding
unsafeSulfasalazine is excreted in breastmilk and is not recommended especially if the baby is premature or is at the risk of jaundice. It might cause kernicterus (excessive levels of bilirubin in the blood) in the new-born.
Driving
safe if prescribedSulfasalazine does not affect the ability to drive. However, if you feel drowsy after taking Sulfasalazine, it is advised not to drive.
Liver
unsafeSulfasalazine is not recommended to use in patients with a history of liver diseases. In other people, rarely, it can cause hepatitis (inflammation of the liver).
Kidney
unsafeSulfasalazine is not recommended to use in patients with a history of kidney diseases. In other people, rarely it can cause inflammation of the kidneys.
Children
consult your doctorSulfasalazine should be advised in children only if prescribed by a child specialist.
Habit Forming
Diet & Lifestyle Advise
- It is advised to drink plenty of water to prevent the occurrence of kidney stones.
- Take low fibre foods such as white rice, white pasta, bread, egg, fish, tofu, butter, etc. to avoid triggering ulcerative colitis.
- Exercise regularly to suppress inflammation in the body.
- Manage stress by doing meditation and deep breathing exercises.
- Eat smaller meals to avoid pain in the stomach.
- Avoid foods that can increase or worsen ulcerative colitis such as milk, milk products, raw fruits and vegetables, beans, spicy foods, popcorn, artificial sweeteners, nuts, seeds, and fatty foods.
Special Advise
It is advised to drink plenty of water to prevent the occurrence of kidney stones or crystalloids.
Patients Concern
Disease/Condition Glossary
Ulcerative colitis: It is an inflammatory disease of the bowels that causes irritation, inflammation, and ulcers in the lining of the large intestine (colon).
Crohn’s disease: It is an inflammatory bowel disease (IBD) characterized by inflammation of the digestive tract.
Psoriasis: It is a skin disease in which our skin cells start multiplying faster, building up bumpy red patches covered with white scales.
Rheumatoid arthritis and Ankylosing spondylitis: They are the most common rheumatic diseases affecting joints and the spine, leading to chronic inflammation and painful conditions, ultimately leading to disability.
FAQs
Sulfasalazine is used to treat bowel diseases (ulcerative colitis, Crohn's disease), skin-related problems (psoriasis), and chronic joint diseases (rheumatoid arthritis, ankylosing spondylitis).
Yes, Sulfasalazine is contraindicated in patients with intestinal or urinary obstruction, patients with porphyria (liver disorders), and patients hypersensitive to sulfasalazine, its metabolites, sulfonamides, or salicylates.
Yes, Sulfasalazine is said to affect fertility in males as it can cause a fall in sperm count. However, it is only affected by the time this medicine is taken.
Yes, Sulfasalazine is safe to use in breastfeeding. However, please inform your doctor if the baby is premature or is at risk of jaundice as this medicine might not be advised in such cases.
Yes, Sulfasalazine can affect the blood count but it is rare. There is a decrease in the number of white blood cells (infection-fighting cells). In some cases, the bone marrow might completely stop producing a specific type of white blood cell, this condition is known as agranulocytosis. It occurs within two months of starting this medicine and might be accompanied by symptoms such as fever and rash. This condition resolves within one or two weeks after this medicine is discontinued.
No, Sulfasalazine is a disease-modifying anti-rheumatic drug’ (DMARD) and not a painkiller. So, if you are taking a painkiller before starting this medicine, you can continue taking it along with Sulfasalazine.
No, Sulfasalazine should be taken in the dose and duration as advised by the doctor. If you take it in more than the recommended dose, it might cause unpleasant side-effects. If you think your symptoms are not improving, please consult your doctor.
Sulfasalazine in rare cases may cause blood disorders so your doctor may ask you to have blood count, electrolytes, urea, creatinine, and liver function tests every 3 months for the first year and every 6 months next year onwards.
If well tolerated you should take a prescribed dose of Sulfasalazine while the disease remains in remission. Do not stop taking your medicine unless your doctor tells you to do so.
Sulfasalazine may cause central nervous system adverse effects such as serious psychiatric problems including mania, depression, and psychosis, and these symptoms have been reported to occur only infrequently.
The side effects of Sulfasalazine include headache, nausea, indigestion and watery diaarhoea. If these side effects persist or worsen, please consult your doctor.
Sulfasalazine takes about 6 to 12 weeks to show the full effect. After using Sulfasalazine, you might feel better in 4 weeks, although this can vary from person to person and some patients may notice improvement after 3 months. Do not stop taking Sulfasalazine without first consulting your doctor.
Sulfasalazine may affect the kidney function, although it is rare. Therefore, before using Sulfasalazine, it is important that your kidney function remains normal. If your kidney functions become abnormal during treatment with Sulfasalazine, please consult your doctor.
You are recommended to avoid using azathioprine along with Sulfasalazine as it may decrease blood cell count, which can be a serious side effect. However, please consult your doctor before taking other medicines with Sulfasalazine to avoid drug interactions.
