Gastroenterology Book

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Sulfasalazine

Aka: Sulfasalazine, Azulfidine
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  1. Mechanism
    1. 5-Aminosalicylic Acid Derivative
  2. Indications
    1. Inflammatory Bowel Disease
    2. Early Rheumatoid Arthritis (especially seronegative)
    3. Psoriatic Arthritis
    4. Arthritis in Reiter's Syndrome
  3. Contraindications: Sulfa allergy
    1. Consider Mesalamine (Asacol, Pentasa) as alternative
    2. Consider slowly tapering to dose if unclear allergy
      1. Start: 250 grams per day
      2. Increase: 250 grams per week
  4. Dosing
    1. General
      1. Increase slowly to lowest effective dose
      2. Co-administer Folic Acid 1 mg/day
    2. Increase Protocol
      1. Start: 500 mg per day
      2. Increase: 500 mg per week up to 2 grams per day
      3. Increase: 3 grams per day after 3 months
      4. Maximum: 4 grams per day (2 grams bid) after 6 months
    3. Maintenance Doses
      1. Adult: 500-1000 mg PO qid with food
      2. Pediatric: 20-60 mg/kg/day divided qid with food
  5. Adverse effects
    1. General
      1. Prevent adverse effects with Folic Acid 1-2 mg/day
    2. Nausea and other Gastrointestinal Intolerance (30%)
      1. Consider enteric coated Azulfidine EN-tablets
    3. Neurologic adverse effects
      1. Headache (20%)
      2. Dizziness or lightheaded (<20%)
    4. Hematologic adverse effects
      1. Folate-inhibition Anemia
      2. Hemolytic Anemia
      3. Granulocytopenia
    5. Skin rash associated with sulfa allergy
      1. Requires discontinuing medication immediately
    6. Renal adverse effects: Micro-crystalluria
      1. Avoid dehydration
      2. Avoid high doses
  6. Monitoring
    1. Complete Blood Count (CBC) every 4-6 months
    2. Aspartate Aminotransferase (AST, SGOT) at 2 months
  7. References
    1. Matteson (2000) Mayo Clin Proc 75:669-74
    2. Pincus (1999) Clin Rheumatol 17(6 Suppl 18):S2-S124
Medication Costs
Sulfasalazine (on 2/9/2012 at DrugStore.com)
Sulfasalazine 500mg Enteric Coated Tabs #100 for $37.99 ($0.38/unit)
Sulfasalazine 500mg Tablets #100 for $29.99 ($0.30/unit)
Azulfidine (on 2/9/2012 at DrugStore.com)
Azulfidine 500mg Tablets #100 for $68.99 ($0.69/unit)
Azulfidine EN-tabs (on 2/9/2012 at DrugStore.com)
Azulfidine EN-tabs 500mg Enteric Coated Tabs #100 for $85.99 ($0.86/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Sulfasalazine (C0036078)

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)
MSH D012460
SnomedCT 330038003, 317422008, 387248006, 45844004, 363635007
English Salazosulfapyridine, Salicylazosulfapyridine, Sulfasalazine, Sulphasalazine, sulfasalazine, Benzoic acid, 2-hydroxy-5-((4-((2-pyridinylamino)sulfonyl)phenyl)azo)-, Sulfasalazine [gastro-intest], Sulfasalazine [musc-skel], Sulphasalazine [gastro-intest], Sulphasalazine [musc-skel], 2-Hydroxy-5-[[4-[(2-pyridinylamino)sulfonyl]phenyl]azo]benzoic Acid, salazosulfapyridine, salicylazosulfapyridine, Sulfasalazine [gastro-intestinal use], Sulphasalazine [gastro-intestinal use], Sulfasalazine [musculoskeletal use], Sulphasalazine [musculoskeletal use], Sulfasalazine [musculoskeletal use] (product), Sulfasalazine [gastro-intestinal use] (product), sulfasalazine (medication), SULFASALAZINE, Sulfasalazine [Chemical/Ingredient], sulphasalazine, sulfaSALAzine, Salazosulphapyridine, Salicylazosulphapyridine, Sulfasalazine (product), Sulfasalazine (substance), Sulfasalazine [gastro-intestinal use] (substance), Sulfasalazine [musculoskeletal use] (substance), Sulfasalazine product (substance), Sulfasalazine product, Sulphasalazine product
Swedish Sulfasalazin
Czech sulfasalazin
Spanish Sulphasalazine product, Sulfasalazine product (substance), Sulfasalazine product, sulfasalazina [uso gastrointestinal], sulfasalazina [uso musculoesquelético] (producto), sulfasalazina [uso gastrointestinal] (producto), sulfasalazina [uso musculoesquelético], salazosulfapiridina, salicilazosulfapiridina, sulfasalazina (producto), sulfasalazina (sustancia), sulfasalazina, Salicilazosulfapiridina, Sulfasalazina
Finnish Salatsosulfapyridiini
Russian SALITSILAZOSUL'FAPIRIDIN, SUL'FASALAZIN, SALAZOSUL'FAPIRIDIN, САЛАЗОСУЛЬФАПИРИДИН, САЛИЦИЛАЗОСУЛЬФАПИРИДИН, СУЛЬФАСАЛАЗИН
Japanese エミナピリン, スルファサラジン, ラノフェン, アザルフィジンEN, サリチルアゾサルファピリジン, サラゾピリン, スラマ錠, スラマ, サフィルジンEN, Slama錠, サラゾスルファピリジン
French Sulfasalazine, Salicylazosulfapyridine
Croatian SULFASALAZIN
Polish Salazosulfapirydyna, Sulfasalazyna
German Salicylazosulfapyridin, Sulfasalazin
Italian Sulfasalazina
Portuguese Salicilazossulfapiridina, Sulfassalazina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Azulfidine (C0699547)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D012460
English Azulfidine EN-tabs, Pyralin EN, Salazopyrin, EN, Azulfidine, Azulfidine EN, Sulfasalazine Pfizer Brand, Pfizer Brand of Sulfasalazine, salazopyrin, azulfidine, azulfadine, Azulfidine, Azulfadine, Asulfidine
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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