Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: sulfasalazine
BRAND NAME: Azulfidine
DRUG CLASS AND MECHANISM: Sulfasalazine is a drug that is used primarily for treating ulcerative colitis. It is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into 5-aminosalicylic acid (5-ASA), and sulfapyridine. (5-ASA is also marketed as mesalamine (Lialda, Rowasa, Pentasa, Canasa Apriso, and Asacol.) The 5-ASA has therapeutic benefit, but it is not clear if sulfapyridine adds any additional therapeutic benefit. The inflammation of ulcerative colitis and other inflammatory diseases is caused, in part, by excessive production of chemicals (for example, prostaglandins) that produce inflammation. Prostaglandins are produced by two enzymes, cyclooxygenase and lipoxygenase, and these enzymes are over-active in individuals with ulcerative colitis. 5-ASA may reduce inflammation by blocking the activity of cyclooxygenase and lipoxygenase thereby reducing the production of prostaglandins. Sulfasalazine was approved by the FDA in 1950.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 500 mg.
STORAGE: The tablets should be kept at room temperature, 15-30 C (59-86 F).
PRESCRIBED FOR: Sulfasalazine is used for the treatment of mild to severe ulcerative colitis, and treatment of rheumatoid arthritis. It has also been used "off label" (unapproved by the FDA) for Crohn's disease and ankylosing spondylitis.
DOSING: Adult doses range from 1000 mg to 4000 mg daily. Sulfasalazine is administered 2 to 4 times daily depending on the disease for which it is used. Sulfasalazine should be taken with a full glass of water after meals or with food to minimize upset stomach. Patients with kidney diseases may need to use lower doses of sulfasalazine.
DRUG INTERACTIONS: Sulfasalazine may cause reduced absorption of folic acid and digoxin (Lanoxin). Reduced folic acid absorption may cause folic acid deficiency and result in anemia. Reduced digoxin absorption may reduce the effectiveness of digoxin. Sulfapyridine (a byproduct of sulfasalazine) is a sulfonamide, and sulfonamides increase blood levels of methotrexate (Rheumatrex, Trexall), resulting in increased methotrexate toxicity. Conversely, methotrexate can increase the occurrence of the anemia caused by sulfonamides because methotrexate also causes folic acid deficiency. Sulfonamides can increase the risk of kidney damage from cyclosporine by an unknown mechanism. They also may increase the blood glucose lowering effect of oral anti-diabetic drugs and potentially cause excessive reductions in blood sugar (hypoglycemia) by decreasing elimination of anti-diabetic drugs by the liver and elevating the levels of the anti-diabetic drugs in the blood.
Combining 5-ASA with drugs that affect kidney function such as nonsteroidal antiinflammatory drugs, for example, ibuprofen (Advil), may increase the likelihood of kidney dysfunction. Concurrent use of 5-ASA and 6-mercaptopurine or azathioprine (Imuran) may increase the likelihood of blood disorders. 5-ASA may increase the blood thinning effect of warfarin (Coumadin).
PREGNANCY: In hundreds of pregnant women with ulcerative colitis or Crohn's disease treated with sulfasalazine, there has been no increase in the risk of fetal malformations relative to other women with these illnesses who have not been treated with sulfasalazine. Additionally, there have not been ill effects on pregnant animals given high doses of sulfasalazine. Thus, sulfasalazine may be used during pregnancy if the physician feels the benefit outweighs the possible risk.
It should also be noted, however, that sulfasalazine may reduce sperm count and sperm function in men. These effects are reversible upon stopping the drug.
NURSING MOTHERS: Caution should be exercised by women who are nursing their infants. Sulfasalazine and its constituents are secreted into breast milk. There is a small risk that sulfapyridine (a byproduct of sulfasalazine) may displace bilirubin from albumen in the blood of infants and cause jaundice.
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