Sulfasalazine, also marketed as Azulfidine, is an anti-inflammatory drug primarily prescribed to treat inflammatory bowel disease and rheumatoid arthritis, according to the American College of Rheumatology. Developed in the early 1940s, it is a combination of 5-aminosalicylic acid (5-ASA), which is an anti-inflammatory, and the antibiotic sulfapyridine. How it works remains uncertain despite its long history. The irony of its use to treat digestive diseases is that nausea, vomiting and general gastric distress are common side effects for up to a third of those taking it.
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Communicate with your physician. Tell your doctor about all other medications you take; some combinations can cause or worsen side effects. Dosages may need to be adjusted if sulfasalazine is prescribed along with certain cyclosporines or Digoxin. Share all other known medical issues with your doctor, including liver, kidney or urinary problems, which can increase the number and severity of side effects. According to the U.S. National Library of Medicine's Daily Med website, sulfasalazine is rated as Pregnancy Category B, which means it can be taken if needed during pregnancy; but always tell your doctor if you are pregnant or plan to conceive while on this medication.
Take medication as prescribed. Sulfasalazine comes in 500 mg tablets. The usual dosage is three to four grams daily, or up to eight pills, spread evenly throughout the day and taken no more than eight hours apart. If the dosage is four grams daily, for example, take two pills each at 6 a.m., noon, 6 p.m. and 10 p.m. The Mayo Foundation for Medical Education and Research recommends taking each dose with food and eight ounces of water. If you forget a dose, take it as soon as you can unless it is almost time for the second dose. Do not double doses. Do not stop taking the medication after you begin to feel better, unless directed to do so by your doctor.
Stay well hydrated. Drink six to eight (eight-ounce) glasses of water or other beverages while taking sulfasalazine. This helps minimise many of the medication's side effects.
Swallow tablets whole. Do not split, crush or chew sulfasalazine. This can create gastric distress.
Take enteric-coated tablets. Sulfasalazine can be prescribed in the form of a stomach-coated tablet. These pills have a coating or barrier that keeps it intact until it reaches the intestines; this minimises stomach upset and discomfort.
Build up your dosage. If nausea, vomiting, diarrhoea or loss of appetite persists, check with your doctor about starting with a lower dose, usually not more than two grams a day, and building up to the recommended amount over a period of several days. In some instances your doctor may direct you to stop sulfasalazine completely for up to seven days and then begin again at a reduced dosage.
Tips and warnings
- Baseline laboratory work, including blood tests and renal assessments, should be conducted when sulfasalazine is prescribed, and then periodically as directed by the physician for as long as you take the medication.
- Sulfasalazine should not be prescribed for anyone who has a urinary or intestinal blockage, porphyria or allergies to salicylates or any of the sulfa drugs.
- Sulfasalazine can cause low sperm count and infertility in males. Sperm count will return to normal when the drug is stopped.
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- MedlinePlus: Sulfasalazine
- MedlinePlus: Azulfidine (sulfasalazine) tablet
- American College of Rheumatology: Sulfasalazine (Azulfidine)
- Mayo Clinic: Sulfasalazine (Oral Route, Rectal Route)
- National Center for Biotechnology Information: Sulfasalazine reduces bile acid induced apoptosis in human hepatoma cells and perfused rat livers