What is Azulfidine?
Sulfasalazine is a drug that is used primarily for treating ulcerative colitis.
Why is Azulfidine prescribed to patients?
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.
Is Azulfidine available as a generic drug?
Do I need a prescription for Azulfidine?
What are the side effects of Azulfidine?
Gastrointestinal disturbances frequently occur in patients taking sulfasalazine that may include:
- gastric distress, and
- loss of appetite.
Headache, allergic reactions, and photosensitivity (development of a rash when exposed to sunlight) may develop during sulfasalazine therapy and require medical attention. Some of the allergic reactions may progress from a rash to difficulty in swallowing, blistering, peeling, or loosening of the skin, aching joints and muscles, and unusual tiredness or weakness. It may be accompanied by fever. The more severe allergic reactions are rare.
Sulfasalazine may cause the skin or the urine to change color.
Development of an orange-yellow discoloration of the urine is no cause for concern.
Several potentially dangerous side effects have been reported rarely with sulfasalazine. A drop in white blood cell count or a type of anemia in which red blood cells are disrupted (hemolyzed) may occur. These effects are characterized by fever, pale skin, sore throat, fatigue, and unusual bleeding and bruising, and require discontinuation of the drug. Liver failure, pancreatitis, and kidney failure also have been associated with sulfasalazine.
What is the dosage for Azulfidine?
- For treating ulcerative colitis, adult doses range from 3000 mg to 4000 mg daily. Treatment may be started at 1000 to 2000 mg daily to reduce stomach upset.
- Rheumatoid arthritis is treated with 2000 to 3000 mg daily. Treatment may be started with 500 to 1000 mg daily.
- Sulfasalazine is administered 3 to 4 times daily. It 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.
Which drugs or supplements interact with Azulfidine?
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).
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Is Azulfidine safe to use during pregnancy or while breastfeeding?
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.
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.
What else should I know about Azulfidine?
What preparations of Azulfidine are available?
Tablets: 500 mg. Suspension: 250 mg/5 ml.
How should I keep Azulfidine stored?
The tablets should be stored at room temperature, 15 C -30 C (59 F- 86 F).
How does Azulfidine work?
Sulfasalazine is a prodrug, that is, it is not active in its ingested form. It is broken down by bacteria in the colon into its two components, 5-aminosalicylic acid (5-ASA), and sulfapyridine. (5-ASA also is marketed as mesalamine (Lialda, Rowasa, Pentasa, Canasa Apriso, and Asacol.) The 5-ASA has a 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.
When was Azulfidine approved by the FDA?
Sulfasalazine was approved by the FDA in 1950.
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Sulfasalazine (Azulfidine) is a drug prescribed for the treatment of mild to severe ulcerative colitis and the treatment of rheumatoid arthritis. Sulfasalazine (Azulfidine) has also been prescribed "off label" for Crohn's disease and ankylosing spondylitis. Side effects, warnings and precautions, drug interactions, and safety during pregnancy should be reviewed prior to taking this medication.
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Related Disease Conditions
Colitis refers to inflammation of the inner lining of the colon. 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, infectious colitis like C. difficile, or microscopic colitis). Treatment depends on the cause of the colitis.
Rheumatoid Arthritis (RA)
Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Early RA signs and symptoms include anemia, both sides of the body affected (symmetric), depression, fatigue, fever, joint deformity, joint pain, joint redness, joint stiffness, joint swelling, joint tenderness, joint warmth, limping, loss of joint function, loss of joint range of motion, and polyarthritis.
Ulcerative colitis is a chronic inflammation of the colon. Symptoms and signs 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. Treatment incorporates medications, physical therapy, and exercise.
Psoriatic arthritis is a disease that causes skin and joint inflammation. Symptoms and signs include painful, stiff, and swollen joints, tendinitis, and organ inflammation. Treatment involves anti-inflammatory medications and exercise.
Crohn's Disease vs. Ulcerative Colitis
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or ulcerative colitis only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease or IBD. Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example, nausea, loss of appetite, fatigue, weight loss, episodic and/or persistent diarrhea, fever, abdominal pain and cramping, rectal bleeding, bloody stools, joint pain and soreness, eye redness, or pain. Symptoms unique to Crohn’s disease include anemia and skin changes. Symptoms of unique to ulcerative colitis include certain rashes, and an urgency to defecate (have a bowel movement). Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or ulcerative colitis with medication, diet, nutritional supplements, and/or surgery.
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 and signs.
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 anti-inflammatory medications.
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 anti-inflammatory drugs (NSAIDs), and cortisone medications.
Juvenile Rheumatoid Arthritis (JRA)
Juvenile rheumatoid arthritis (JRA) annually affects one child in every thousand. There are six types of JRA. Treatment of juvenile arthritis depends upon the type the child has and should focus on treating the symptoms that manifest.
Osteoarthritis vs. Rheumatoid Arthritis
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic joint disorders. RA is also an autoimmune disease. OA and RA symptoms and signs include joint pain, warmth, and tenderness. Over-the-counter pain relievers treat both diseases. There are several prescription medications that treat RA.
What Triggers Ankylosing Spondylitis?
Ankylosing spondylitis (AS), also called Bechterew disease, is a chronic inflammatory disease. Ankylosing spondylitis affects the joints of the body, especially the small joints of the spine and the pelvic (hip) bone. It can also affect multiple organ systems in rare conditions. Prolonged inflammation of the joints eventually leads to the fusion of the joints leading to deformities.
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