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SulfasalazineAka: Azulfidine
- Mechanism
- 5-Aminosalicylic Acid Derivative
- Indications
- Inflammatory Bowel Disease
- Early Rheumatoid Arthritis (especially seronegative)
- Psoriatic Arthritis
- Arthritis in Reiter's Syndrome
- Contraindications: Sulfa allergy
- Consider Mesalamine (Asacol, Pentasa) as alternative
- Consider slowly tapering to dose if unclear allergy
- Start: 250 grams per day
- Increase: 250 grams per week
- Dosing
- General
- Increase slowly to lowest effective dose
- Co-administer Folic Acid 1 mg/day
- Increase Protocol
- Start: 500 mg per day
- Increase: 500 mg per week up to 2 grams per day
- Increase: 3 grams per day after 3 months
- Maximum: 4 grams per day (2 grams bid) after 6 months
- Maintenance Doses
- Adult: 500-1000 mg PO qid with food
- Pediatric: 20-60 mg/kg/day divided qid with food
- Adverse effects
- General
- Prevent adverse effects with Folic Acid 1-2 mg/day
- Nausea and other Gastrointestinal Intolerance (30%)
- Consider enteric coated Azulfidine EN-tablets
- Neurologic adverse effects
- Headache (20%)
- Dizziness or lightheaded (<20%)
- Hematologic adverse effects
- Folate-inhibition Anemia
- Hemolytic Anemia
- Granulocytopenia
- Skin rash associated with sulfa allergy
- Requires discontinuing medication immediately
- Renal adverse effects: Micro-crystalluria
- Avoid dehydration
- Avoid high doses
- Monitoring
- Complete Blood Count (CBC) every 4-6 months
- Aspartate Aminotransferase (AST, SGOT) at 2 months
- References
- Matteson (2000) Mayo Clin Proc 75:669
- Pincus (1999) Clin Rheumatol 17(6 Suppl 18):S2
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| Definition (MSH) | A drug that is used in the management of inflammatory bowel diseases. Its activity is generally considered to lie in its metabolic breakdown product, 5-aminosalicylic acid (see MESALAMINE) released in the colon. (From Martindale, The Extra Pharmacopoeia, 30th ed, p907) |
| Definition (NCI) | A synthetic salicylic acid derivative with affinity for connective tissues containing elastin and formulated as a prodrug, antiinflammatory Sulfasalazine acts locally in the intestine through its active metabolites, sulfamide 5-aminosalicylic acid and salicylic acid, by a mechanism that is not clear. It appears inhibit cyclooxygenase and prostaglandin production and is used in the management of inflammatory bowel diseases. (NCI04) |
| Concepts | Organic Chemical (T109)
, Pharmacologic Substance (T121)
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| English | Salazosulfapyridine, Salazosulphapyridine, Salicylazosulfapyridine, Salicylazosulphapyridine, Sulfasalazine, SULFASALAZINE PREPARATION, Sulfasalazine product, Sulphasalazine, Sulphasalazine product |
| Spanish | salazosulfapiridina, salicilazosulfapiridina, sulfasalazina |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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| Concepts | Organic Chemical (T109)
, Pharmacologic Substance (T121)
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| English | Asulfidine, Azulfadine, Azulfidine, Pharmacia Brand 1 of Sulfasalazine |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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