Gastroenterology Book

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SulfasalazineAka: 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
    2. Pincus (1999) Clin Rheumatol 17(6 Suppl 18):S2

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)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishSalazosulfapyridine, Salazosulphapyridine, Salicylazosulfapyridine, Salicylazosulphapyridine, Sulfasalazine, SULFASALAZINE PREPARATION, Sulfasalazine product, Sulphasalazine, Sulphasalazine product
Spanishsalazosulfapiridina, salicilazosulfapiridina, sulfasalazina
CreditsDerived from the NIH UMLS (Unified Medical Language System)


Azulfidine (C0699547)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
EnglishAsulfidine, Azulfadine, Azulfidine, Pharmacia Brand 1 of Sulfasalazine
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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