Sulfasalazine (Oral)

Sulfasalazine reduces inflammation in the bowels as a preventative measure against, and a treatment of, ulcerative colitis. It is also affective against rheumatoid arthritis.

Overview

Sulfasalazine is used for both the prevention, and the treatment, of ulcerative colitis. It is also used in the treatment of rheumatoid arthritis.

Ulcerative colitis is a long-term condition in which the colon and rectum become inflamed. The bowel and rectum develop ulcers, which will bleed and produce pus, creating significant discomfort in the patient. Sulfasalazine helps to reduce inflammation in the bowels and rectum and can also relieve other symptoms of the disease.

The medication is also administered with an enteric coating in the treatment of adults and children with rheumatoid arthritis in cases where patients are unable to take or continue taking other medications for treatment of rheumatoid arthritis. The enteric coating enables the tablet to pass into the small intestines before it breaks down and the treatment is released.

This medication is available as a tablet, which is prescribed for ulcerative colitis, and as an enteric-coated tablet, which is prescribed for rheumatoid arthritis and ulcerative colitis.

Condition treated

  • Ulcerative colitis
  • Rheumatoid arthritis

Type of medicine

  • Sulfa medication

Side Effects

In addition to the desired affects caused by this medication, it will also cause unwanted side effects in the body. Some of these side effects will require medical attention to be taken, while others will not necessitate this.

If you experience any of the following then you should contact your doctor immediately:

Occurring more commonly:

  • Aches and pains in the joints
  • Feverishness
  • Headaches that continue for long periods
  • Increased sensitivity of the skin to sunlight and quickly occurring sunburn.
  • Skin rash, redness or itchiness
  • Vomiting

Occurring less commonly:

  • Pains experienced in the back, legs or stomach
  • Bleeding from the gums
  • Bluish appearance of the fingernails, lips, palms, or nail beds
  • Chills
  • Darker than usual urine
  • Difficulty taking breath
  • Feverishness
  • General swelling experienced around the body
  • Headaches
  • Loss of hunger
  • Nausea
  • Nosebleeds or nasal soreness
  • Paleness of the skin
  • Sore throat or hoarseness
  • Troubled breathing when exerting oneself
  • Unusual bleeding
  • Unusual bruising
  • Unusual tiredness
  • Unusual weakness
  • Yellowing of the eyes
  • Yellowing of the skin

Occurring less commonly or rarely

  • Aches in the muscles
  • Black stools with an appearance of tar
  • Blistering or loosening of the skin
  • Bloating or increased win
  • Blood in the urine
  • Blood in the stools
  • Bloody diarrhea
  • Bluish appearance of fingernails, lips, or skin
  • Chest pains
  • Constipation or difficulty passing stools
  • Coughing
  • Difficulty with swallowing
  • Dizziness or disorientation
  • Fainting spells or faintness
  • Faster than usual heartbeat
  • General feeling of illness
  • General tiredness
  • General weakness
  • Hives
  • Indigestion
  • Inflammation or swelling of the joints
  • Irregular heartrate
  • Lightly-colored stools
  • Muscle cramps or spasming
  • Muscle stiffness or pains
  • Painful or uncomfortable urination
  • Pains in the stomach, side, or abdomen and possibly the back
  • Pinpoint red spots appearing on the skin
  • Puffiness or swelling of the eyelids, face, lips, or tongue
  • Rash
  • Red skin lesions. Will sometimes have a purple spot in the middle.
  • Red or irritated eyes
  • Redness, blistering or loosening of the skin
  • Sores or ulcers in the mouth.
  • Swelling or pain in the glands
  • Tightness in the chest
  • Upper right abdominal pains
  • White spots around the mouth

Frequency of occurrence unknown:

Swellings appearing like hives affecting the:

  • Face
  • Eyelids
  • Lips
  • Tongue
  • Throat
  • Hands
  • Legs
  • Feet
  • Sexual organs

Other side effects may occur that would not normally require you to seek medical attention. These side effects can, however, become bothersome and should be reported to your doctor if they are ongoing. Your healthcare professional may be able to help you alleviate the side effects to make your day-to-day life more comfortable.

Occurring commonly:

  • Stomach upset or abdominal discomfort.
  • Decrease in weight

Occurring less commonly:

  • Welts

Occurring only rarely

  • Discoloration of the skin
  • Change in coloration of the urine
  • Hair loss or hair thinning
  • Swelling in or around the mouth

Other side effects that are not listed herein may occur. If you experience other side effects then you should inform your doctor at your next checkup. If you are concerned about a side effect then seek advice immediately.

Dosage

This medication should be taken only as directed by your doctor. You should never take more than you have been prescribed, nor take the medication more often than it was prescribed to you. Doing so can increase the chances of side effects occurring and can increase the severity of the side effects too.

This medication should be taken on a full stomach straight after meals whenever it is possible to do so. If you are prescribed the enteric coated tablet then do not crunch, break, chew or dissolve this medication. It should be swallowed as a tablet to enable it to pass into the small intestines before releasing.

Increase your fluid intake when you are using this medication. This will ensure that you pass more urine and will reduce the risk of developing kidney problems from use.

This medication should be used for the full course. If you start feeling better then you should still finish the full course of treatment. Do not skip any doses. Ensure that you talk to your doctor before making any changes in your use of this medication.

You may find parts of the enteric-coated tablet in your stools. This is because the body cannot break them down properly and this is normal to experience.

This medication will be issued in different doses for each patient. The medication can be used in the treatment of disparate conditions and as such doses will be different. The dose will also depend on the strength of the medication, the size of the patient and on other factors. Only take the dose prescribed by your doctor. The following dosage information is a guideline only:

For treatment of ulcerative colitis only:

Enteric-coated tablets

  • Adults - Between 500-1000 mg at 6-8 hour intervals. This initial dose may be increased if required up to a maximum of 4000mg per day.
  • Children aged 6+ - Dose to be determined in relation to body weight by the doctor. The usual dose will be 40-60 mg/kg. This dose would be split into 3-6 doses.
  • Children aged 2-5 - Dose must be determined by the doctor.
  • Children below the age of 2 - Not recommended for use. To be determined by the doctor.

Tablets

  • Adults - Between 500-1000 mg at 6-8 hour intervals. This dose may be adjusted up to a maximum of 4000 mg per day.
  • Children aged 6+ - Dose to be determined in relation to body weight by the doctor. The usual dose will be 40-60 mg/kg. This dose would be split into 3-6 doses.
  • Children aged 2-5 - Dose must be determined by the doctor.
  • Children below the age of 2 - Not recommended for use. To be determined by the doctor.

For maintenance treatment of ulcerative colitis only:

Enteric-coated tablets

  • Adults - 2000 mg per day.
  • Children aged 6+ - Dose to be determined in relation to body weight by the doctor. The usual dose will be 30 mg/kg. This dose would be split into 4 doses.
  • Children aged 2-5 - Dose must be determined by the doctor.
  • Children below the age of 2 - Not recommended for use. To be determined by the doctor.

Tablets

  • Adults - Between 2000 mg per day.
  • Children aged 6+ - Dose to be determined in relation to body weight by the doctor. The usual dose will be 30 mg/kg. This dose would be split into 4 doses.
  • Children aged 2-5 - Dose must be determined by the doctor.
  • Children below the age of 2 - Not recommended for use. To be determined by the doctor.

For treatment of rheumatoid arthritis only:

Enteric-coated tablets

  • Adults - Between 500 - 1000 mg per day split over 2 doses. This can be increased by your doctor up to a maximum of 3000mg per day.
  • Children aged 6+ - Dose to be determined in relation to body weight by the doctor. The usual dose will be 30-50 mg/kg. This dose would be split into 2 doses. This dose may be increased up to a maximum of 2000 mg per day.
  • Children aged 5 or younger - Not recommended. Dose to be determined by the doctor.

If a dose of the medication is missed then it should be taken as soon as possible. If it is almost time for your next dose, however, then you should skip the dose that was missed and return to the usual schedule of medication. Do not take double doses.

Interactions

Certain medications should never be taken together. In some cases, they can react with one another to prevent each other from working. In other cases they can react violently with one another, causing serious side effects in the patient. Before taking any Sulfasalazine it is very important that you inform your doctor of any medications that you are taking. This includes all herbal remedies, vitamin supplements and over the counter treatments that you are taking. It is especially important that you inform your doctor if you are taking any of the medications listed below:

Using Sulfasalazine with any of the following medications is not recommended and your doctor may wish to change a prescription that you are receiving:

  • Ketorolac
  • Methenamine

The use of Sulfasalazine with the following medications would not normally be recommended but your doctor may still prescribe both. In such cases he may wish to amend the doses prescribed or the frequency at which you take them:

  • Aceclofenac
  • Acemetacin
  • Amtolmetin Guacil
  • Azathioprine
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Clonixin
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Dipyrone
  • Droxicam
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Flurbiprofen
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Mercaptopurine
  • Morniflumate
  • Nabumetone
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Phenylbutazone
  • Piketoprofen
  • Piroxicam
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Riluzole
  • Rofecoxib
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tolfenamic Acid
  • Tolmetin
  • Valdecoxib

Use of Sulfasalazine alongside the following medications should be avoided where it is possible to do so. The use of both will increase the risks of certain side effects. However, use of both may still be the best option for your treatment. Your doctor may wish to change the doses you take of the frequency at which you take the following medications:

  • Cyclosporine
  • Digoxin
  • Warfarin

Existing medical problems from which you suffer can also impact the prescribing of this medication. You should inform your doctor of any medical conditions that you have or have had in the past before you take this medicine. This is especially important if you suffer from any of the following:

Patients with the following conditions should not receive Sulfasalazine:

  • Any allergies to sulfa medications or salicylates
  • Bowel blockages
  • Problems producing enzymes in the body.
  • Urinary bladder blockage

The following conditions may be worsened by the use of Sulfasalazine:

Patients suffering from the following will have an increased risk of complications when taking Sulfasalazine:

  • Deficiency in Glucose-6-phosphate dehydrongenase (G6PD)
  • Infection

Warnings

Before agreeing to begin treatment with Sulfasalazine it is important that you consider the risks and benefits of taking it with your doctor. For this to be properly considered you should ensure that you discuss the following factors with your doctor:

Allergies - If you have had any allergic reactions or unusual reactions to any medications then it is very important to inform your doctor. This is especially important with sulfa medications. You should also inform your doctor of any allergies to dyes, preservatives, animals and other substances that you are aware of.

Pediatric - Tests for safety and efficiency have not be performed on children below the age of 2. The use of enteric-coated tablets has been shown to be effective in the treatment of children over the age of 6 who are suffering from rheumatoid arthritis.

Geriatric - No problems have been identified with geriatric use that would limit the effectiveness of treatment. Age-related medical conditions should be considered before use.

Pregnancy - Discuss the use of this medication in relation to pregnancy with your doctor before beginning treatment. While animal studies have shown no risk of harm to the fetus, appropriate tests have not been carried out on pregnant women.

Breastfeeding - Studies have shown that this medication can interact with the composition of milk. If you are taking this treatment and breastfeeding then the infant should be monitored for any side effects.

Other interactions - Medications can also interact with food, drink, alcohol and tobacco. You should discuss your use of these consumables before beginning treatment with this medication.

During use of Sulfasalazine, a doctor should regularly review your progress or the progress of your child. The doctor may need to take blood and urine samples to determine the effect and check for any unwanted side effects of the treatment.

This medication may reduce the amount of sperm that males are able to produce. This can impact the chances of parenting a child. This should be discussed with your doctor before use.

If you or your child experiences symptoms of liver problems during treatment then you should seek emergency medical attention. These symptoms include:

  • Pain in the stomach
  • Pale stools
  • Dark or cloudy urine
  • Loss of hunger
  • Vomiting
  • Yellow skin
  • Yellow eyes
  • Nausea

If you or your child experience any symptoms of blood problems during treatment then you should seek emergency medical attention. These symptoms include:

  • Fever
  • Sore throat
  • Paleness of the skin
  • Unexplained or unusual bruising or bleeding
  • Unusual tiredness
  • Unusual weakness

Use of this medication can increase your risk of infections developing in the body. When using this treatment you should avoid contact with people who have infections. If you do need to be exposed to these people then consider wearing face protection to prevent contraction of the infection. If you experience infection then you should inform your doctor.

If you experience signs of infection then you should inform your doctor. These symptoms of infection can include:

  • Weight loss
  • Night sweats
  • Chills
  • Fever
  • Flu-like symptoms
  • Runny nose
  • Blocked nose
  • Headaches
  • Blurry vision
  • General feeling of illness

This medication can cause serious conditions of the skin. You should inform your doctor if you experience any of the following skin conditions:

  • Blistering
  • Peeling
  • Loose skin
  • Red lesions
  • Rash
  • Sores
  • Ulcers
  • Acne
  • Fever
  • Chills

Sulfasalazine can cause problems with the blood in the patient. To minimise the increased risks that this poses you should take extra care in everyday life. No surgery, eye surgery or dental surgery should be performed while treatment is being used. You should also be careful with sharp objects and when brushing the teeth or using dental products. Consult your dentist for alternative methods of cleaning your teeth while using Sulfasalazine.

Sulfasalazine can also make you more sensitive to light. You should avoid exposure to light and be wary of redness, discoloration and severe sunburn. To stay safe consider the following:

  • Stay out of the sun when possible and avoid it particularly between the hours of 10am and 3pm.
  • Wear protective clothing including hat and sunglasses.
  • Apply suncream regularly.
  • Apply sun-blocking lip protection.
  • Do not use sunbeds or sunlamps.

Urine may change to an orange color when using this medication. This is a normal effect.

Storage

This medication should always be stored in a sealed container at room temperature. Keep it away from heat, moisture and direct sunlight. Keep the medication from freezing.

Dispose of any unwanted or outdated medication appropriately. Your healthcare professional will be able to inform you as to how best to do this.

Always keep medication out of the reach of children.

Summary

Sulfasalazine is delivered orally as a tablet or as an enteric coated tablet. It is used for the treatment of two different conditions in patients.

Sulfasalazine can be used to prevent and treat ulcerative colitis. This is an ulceration of the bowels and rectum that causes them to bleed and release pus.

Sulfasalazine is also used to treat rheumatoid arthritis. This medication should only be used to treat this condition in cases in which the patient is unable to take other medications for the condition. This can occur due to a bad reaction to other medicines or to an ineffectiveness of other medicines.

Sulfasalazine is prescribed as an enteric coated tablet for both conditions. This coating prevents the tablet from being absorbed until it has reached the small intestine where the coating is then broken down.

The tablet can be prescribed without this coating for use in the treatment of ulcerative colitis.

This medication can cause a wide range of significant side effects that should be seriously considered before opting to use this treatment. Of particular note is the effect that it has on the blood, exposing the patient to a higher risk of infection. When taking this medication the patient will be more vulnerable to colds and infections, meaning that steps will need to be taken to avoid people carrying infections wherever it is possible to do so.

Patients using this medication will also become more sensitive to sunlight and will need to take precautions to keep out of direct light where possible. Severe burns may occur where the patient is exposed to the sun or to sunbeds.

This medication should be taken straight after meals wherever it is possible to do so. The dose for each patient will be different and will be different depending on the condition treated too.

This medication can be used as an ongoing treatment or can be used over the short-term to clear an infection. You should always be sure to finish any course of medication that is prescribed to you, even if you think the problem has gone away. Failure to do so could cause the condition to come back and will make the treatment ineffective for a second course.

This medication should not be used in patients who have had an allergic reaction to sulfa medications and should not be used in patients with certain medical conditions. Other medications can also interact with this medication so be sure to inform your doctor of all of your medical history and any other treatments you are undergoing.

This medication can affect the production of sperm in male patients. If you are concerned about your fertility and the ability to father a child in the future, you should discuss this with your doctor.

This medication may cause your urine to turn an orange color when you are using it. This is normal and is not a cause for concern. You may also find parts of the enteric coating in your stools. This is normal and is not a cause for concern.

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Last Reviewed:
December 24, 2017
Last Updated:
April 05, 2018