Advise to report rash, sore throat, purport, bleeding, etc.
- Previously Sulphasalazine it is a combination of 5 ASA and Sulphapyridine
Mode of action
- Contains 5-aminosalicylate joined by an azo bond to the antibiotic sulphapyridine
- 5 ASA has anti-inflammatory properties in colitis
- Sulfapyridine is a carrier to the colon and is the active moiety against RA
- It is poorly absorbed by the bowel
Indication/Dose
- Rheumatoid Arthritis: Sulfasalazine 500 mg daily increasing to 2 g daily in divided doses over weeks
- Acute Ulcerative Colitis/Active Crohn's Colitis: Sulfasalazine 1-2 g 6 hourly reducing to 500 mg qds maintenance
- Acute Ulcerative Colitis/Active Crohn's Colitis: Oral Medications+/- Sulfasalazine Suppositories 0.5-1 g bd or Sulfasalazine Enemas at night 3 g on
Interactions
- Cautions with other potential bone marrow suppressants
Contraindications
- Cautions in renal and hepatic failure
- Acute Porphyrias, G6PDH deficiency, Allergy, Asthma
- Has been used in pregnancy - ensure folate supplements
Side effects
- Diarrhoea, nausea, vomiting, gallstones, Azoopspermia - male infertility
- Hypersensitivity - rashes, Stevens-Johnson syndrome, interstitial nephritis, Drug-induced lupus-like syndrome
- Blood disorders - agranulocytosis, aplastic anaemia, neutropenia, thrombocytopenia - check FBC if any concerns e.g. anaemia, bleeding, infection
- Fibrosing alveolitis and eosinophilia, Depression, peripheral neuropathy
- Orange tears and urine
Cautions
- Measure FBC fortnightly for the first 12 weeks
- Measure LFTs monthly for 12 weeks
References