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.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
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.
PRESCRIPTION: Yes
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.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Ankylosing spondylitis is a type of arthritis that causes chronic inflammation of the spine. The tendency to develop ankylosing spondylitis is genetically inherited.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves antiinflammatory medications and exercise.
Inflammation of the inner lining of the colon is referred to as colitis. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, Ulcerative colitis, or microscopic colitis). Treatment depends on the cause of the colitis.
Reactive arthritis is a chronic, systemic rheumatic disease characterized by three conditions, including conjunctivitis, joint inflammation, and genital, urinary or gastrointestinal system inflammation. Inflammation leads to pain, swelling, warmth, redness, and stiffness of the affected joints. Non-joint areas may experience irritation and pain. Treatment for reactive arthritis depends on which area of the body is affected. Joint inflammation is treated with antiinflammatory medications.
Juvenile arthritis (juvenile rheumatoid arthritis or JRA) annually affects one child in every thousand. There are three types of JRA: pauciarticular (less than four joints affected), polyarticular (more than four joints affected), and systemic-onset (inflamed joints with high fevers and rash). Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
SAPHO syndrome is a chronic disorder that involves the skin, bone, and joints. SAPHO syndrome is an eponym for the combination of synovitis, acne, pustulosis, hyperostosis, and osteitis. SAPHO syndrome is related to arthritic conditions such as ankylosing spondylitis and reactive arthritis. Treatment is directed toward the individual symptoms that are present, and includes medications such as nonsteroidal antiinflammatory drugs (NSAIDs), and cortisone medications.
Crohn's disease (also spelled Crohn disease) is a chronic inflammatory disease of the intestines. It
primarily causes ulcerations (breaks in the lining) of the small and large
intestines, but can affect the digestive system anywhere from the mouth to the
anus. It is named after the physician who described the disease in 1932. It also
is called granulomatous enteritis or colitis, regional enteritis, ileitis, or
terminal ileitis.
Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called
ulcerative colitis. Together, Crohn's disease and ulcerative colitis are frequently referred to as
inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's disease have no medical cure. Once the diseases begin, they tend to fluctuate between periods of inactivity (remission) and activity (relapse).
Inflammatory bowel disease affects approximately 500,000 to two million peop...
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