Sulfasalazine

From Anvita Health Wiki

Contents 1 Introduction 2 Indications 3 Dosage 4 Pharmacokinetics 5 Adverse-effects 6 Drug-interactions 7 Mechanism-of-action 8 More General Terms 9 Additional Terms 10 Internet Database 11 References

Introduction

• Tradename: Azulfidine.

Indications

• ulcerative colitis & Crohn's disease
• rheumatoid arthritis
• also see mesalamine Cautions:
• renal or hepatic impairment
• blood dyscrasias
• slow acetylators
• bronchial asthma
• glucose-6-phosphate dehydrogenase ( G6PD) deficiency

Dosage

• mild to moderate inflammatory bowel disease:

• 500-1000 mg PO QID
• do not exceed 8 hours between night time & morning dose

• maintenance 1-2 g/day in divided doses
• take plenty of water
• avoid direct sunlight
• pediatrics: 20-60 mg/kg/day

• Tabs: 500 mg.
• Liquid: 250 mg/5 mL.

Pharmacokinetics

• different with different formulations
• primary site of action is the colon
  

• elimination via kidney

Adverse-effects

• common (> 10%)

• fever, itching, rash, photosensitivity, dizziness, headache, anorexia, nausea/vomiting, diarrhea, reversible oligospermia

• less common (1-10%)

• granulocytopenia, leukopenia, thrombocytopenia, aplastic anemia, hemolytic anemia, hepatitis, Lyell's syndrome, Stevens-Johnson syndrome

• uncommon (< 1%)

• crystalluria, hematuria, thyroid dysturbance, interstitial nephritis, serum sickness-like reaction, jaundice, acute nephropathy

• other

• abdominal pain
• hypersensitivity reactions

• skin rash
• fever
• hepatotoxicity
• agranulocytosis
• aplastic anemia

• fatigue
• paradoxical exacerbations of colitis
• may cause orange & yellow discoloration of the skin & urine
• may precipitate porphyria

Drug-interactions

• folic acid: reduced absorption of folic acid; consider folate replacement with long-term therapy
• digoxin: reduced absorption of digoxin

Mechanism-of-action

• converted to sulfapyridine & mesalamine
• the sulfapyridine component is thought to be involved in the adverse events

More General Terms

• anti-inflammatory agent
• disease-modifying antirheumatic agent (DMARD)
• gastrointestinal agent

Additional Terms

• mesalamine (Asacol, Rowasa, Pentasa, Pentasacaps, Lialda, Apriso)
• sulfapyridine

Internet Database

PubChem: 5339

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 356
3. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
4. Kaiser Permanente Northern California Regional Drug Formulary, 1998

sulfasalazine (SSZ, Azulfidine, SAS)