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sulfasalazine

A07EC01

Forms & Strengths

Oral tablet: 500 mg
Oral tablet, delayed-release (enteric-coated): 500 mg

Adult Dosing

Ulcerative Colitis (Remission/Acute): Initial 1 to 2 g daily in divided doses up to 8 g daily for acute attacks; maintenance 2 g daily
Rheumatoid Arthritis: Initial 500 mg daily or BID, increase by 500 mg weekly to maintenance of 2 g daily in divided doses (max 3 g/daily)

Pediatric Dosing

Ulcerative Colitis (Children > 6 years): 40 to 60 mg/kg/day in divided doses acute; maintenance 20 to 30 mg/kg/day
Juvenile Idiopathic Arthritis (Children ≥ 6 years): 30 to 50 mg/kg/day in 2 divided doses (max 2 g/day)

Indications

Management of inflammatory bowel disease (ulcerative colitis, Crohn's disease)
Treatment of rheumatoid arthritis unresponsive to salicylates or NSAIDs
Treatment of juvenile idiopathic arthritis

Mechanism of Action

Cleaved by intestinal bacteria into 5-aminosalicylic acid (mesalamine) and sulfapyridine
5-ASA exerts local anti-inflammatory effects in the colon via inhibition of prostaglandin and leukotriene synthesis
Sulfapyridine modulates systemic immune and inflammatory responses in rheumatoid arthritis

Contraindications

Hypersensitivity to sulfasalazine, sulfonamides, or salicylates
Intestinal or urinary tract obstruction
Porphyria
Infants under 2 years of age due to risk of kernicterus

Adverse Reactions

Common: Headache, nausea, vomiting, dyspepsia, anorexia, rash, reversible oligospermia
Serious: Severe hypersensitivity reactions (DRESS, Stevens-Johnson syndrome), agranulocytosis, aplastic anemia, hepatitis, pneumonitis

Drug Interactions

Decreases absorption of folic acid, potentially leading to deficiency
May decrease digoxin absorption and serum levels
Increases myelosuppression risk when used with bone marrow suppressants (e.g., azathioprine, mercaptopurine)
Enhances anticoagulant effect of warfarin

Curated Content: Needs Vetting Before Put to Clinical Use