Sulfasalazine

Sulfasalazine (or Sulphasalazine) is a medicine that is used to treat conditions such as rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease.

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What is this Medication used for

  • Sulfasalazine (or Sulphasalazine) is a medicine that is used to treat conditions such as rheumatoid arthritis, psoriatic arthritis and inflammatory bowel disease.

  • It is a disease-modifying anti-rheumatic drug (DMARD) which helps to reduce pain and inflammation in the joints, hence preventing joint and cartilage destruction in the long term.

Dosage and How to Use

  • Sulfasalazine doses typically range from 500mg - 3g a day (given in 1 to 3 divided doses). Dosage may vary depending on your disease activity and response to medication.

  • Take Sulfasalazine with or after food to prevent stomach upset. Swallow the tablets whole with a full glass of water. Do not chew or crush the enteric-coated tablets unless you are told to do so. The medication may upset the stomach at the start of therapy, but your body will usually get used to it when dosage is increased slowly.

  • It may take between 1 to 3 months for the beneficial effects of Sulfasalazine to occur. Thus, it is important that you take your medication regularly or you may not benefit at all.

  • If you miss a dose, take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dose. Do not double the dosage to make up for the missed dose.

Side Effects, Precautions, Contraindication

Can Sulfasalazine be taken with other medications?

  • You will need to continue your other arthritis and anti-inflammatory tablets unless advised otherwise by your doctor. If you need to take Sulfasalazine with antacids, space them at least 2 hours apart.

  • Please inform your doctor, pharmacist or rheumatology nurse clinician if you are taking other medications including over-the-counter medicines, supplements and traditional/herbal remedies as they may interact with Sulfasalazine.

What are the important side effects of Sulfasalazine?

  • Sulfasalazine is generally well-tolerated but there may be some side effects. Always discuss with your doctor if you experience any side effects.

Side Effect

Management

Nausea, vomiting or loss of appetite

Take medication after food to minimise the side effects. Sucking hard, sugar-free candy may reduce nausea and vomiting. Inform your doctor if symptoms are severe or if you experience loss of appetite.

Headache or dizziness

Improves as you get used to the medication or with dose reduction.

Orange-yellow staining of skin and body fluid e.g. urine, tears

This is harmless. However staining of soft contact lenses can occur and you may opt to wear spectacles instead.

Photosensitivity

(Warning signs: Skin rashes, redness or other discolouration of the skin, severe sunburn)

Avoid prolonged sun exposure (especially between 10am – 3pm). Wear protective clothing or apply sunblock when necessary and do not use a sunlamp.

Allergic reactions

(Warning signs: Generalized skin rashes, skin peeling or blistering, itching, wheezing, chest/throat tightness or swelling of the eyes)

Consult your doctor immediately as the medication may need to be stopped. Inform your doctor if you have any unusual or allergic reaction(s) to any sulfa medicines, aspirin or tartrazine dye before starting treatment.

Liver disorder (rare side effect)

(Warning signs: Yellowing of eye whites or skin, dark or tea-coloured urine, or constant abdominal pain)

Consult your doctor immediately. Avoid alcohol.

Blood disorder (rare side effect)

(Warning signs: May be asymptomatic; unusual bleeding or bruising, lip or mouth ulcers with “flu-like” symptoms may occur)

Consult your doctor immediately. Monitoring the effects of your new treatment is important, particularly during the first month of treatment, as well as when the dose is increased. For your safety, you need to do regular blood tests for monitoring.

Inform your doctor if you have G6PD deficiency.

If you develop rashes, facial swelling or shortness of breath after taking the medication, you could be allergic to the medication. Please seek medical attention immediately.

Are theres any special precautions that I need to take?

  • Sulfasalazine is generally safe for use during pregnancy. However, as with all medications, it is important to inform your doctor if you intend to conceive while taking this medication.

  • Sulfasalazine can reduce sperm count and motility, but this is usually reversible once the medication is stopped. Inform your doctor if you intend to start a family.

Do I need to be monitored while taking Sulfasalazine?

  • While on Sulfasalazine, regular blood tests are essential for early detection of side effects such as liver inflammation or blood disorders.

I think I am allergic to sulfa drugs. Can I take Sulfasalazine?

  • Your doctor will verify your sulfa drug allergy with you as not all sulfa-containing drugs cross react. Please discuss with your doctor.

Handling and Storage

  • Store your medication in a cool, dry place away from heat, moisture and direct sunlight.

If you have any problem with your treatment, please contact your doctor, pharmacist or rheumatology nurse clinician.

Please keep all medications out of reach of children.


© Tan Tock Seng Hospital, Singapore 2017. All rights reserved. All information correct as of August 2017. No part of this document may be reproduced, copied, reverse compiled, adapted, distributed, commercially exploited, displayed or stored in a database, retrieval system or transmitted in any form without prior permission of Tan Tock Seng Hospital. All information and material found in this document are for purposes of information only and are not meant to substitute any advice provided by your own physician or other medical professionals.

PECC-PHA-ED-2017-027-v1


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