Sulfasalazine: what it is for and how to take it

Sulfasalazine is an anti-inflammatory and antirheumatic agent indicated for the treatment of chronic inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, as well as rheumatological diseases, such as rheumatoid arthritis and ankylosing spondylitis, for example.

This medicine can be found in the form of 500 mg coated tablets, and works by reducing the production of inflammatory substances in the body, such as prostaglandins, cytokines and leukotrienes, in addition to having an immunosuppressive action, helping to alleviate the symptoms of these diseases.

Sulfasalazine must be used with the advice of a gastroenterologist, rheumatologist or general practitioner, and can be offered free of charge by the SUS, as long as there is a medical indication, or be purchased in pharmacies or drugstores upon presentation of a medical prescription, under the trade name Azulfin.

What is it for

Sulfasalazine is indicated for the treatment of:

• Nonspecific ulcerative colitis;
• Ulcerative colitis of moderate severity;
• Severe ulcerative colitis;
• Crohn’s disease;
• Rheumatoid arthritis;
• Ankylosing spondylitis.

This medicine helps to alleviate the symptoms of these diseases by reducing the production of inflammatory substances in the body and the action of the immune system.

How to drink

Sulfasalazine should be taken orally, with a glass of water, preferably after a meal, at times established by the doctor. The tablets should not be broken or chewed.

The doses of sulfasalazine normally recommended for adults are:

• Initial treatment: initial doses may vary, with 3 to 4 g per day being recommended, in equally divided doses, or smaller doses of 1 to 2 g per day, to reduce the risk of gastrointestinal side effects;
• Maintenance treatment: The maintenance doses normally indicated are 2 g per day, in equally divided doses. This dose can be changed by the doctor according to tolerance to the treatment and the appearance of gastrointestinal side effects.

Treatment with sulfasalazine must be regularly evaluated by the doctor, who must request tests to make the necessary dose adjustments.

Possible side effects

The most common side effects during treatment with sulfasalazine are headache, reduction or loss of appetite, nausea, vomiting, pain or discomfort in the stomach, or a decrease in the number of sperm in the semen, in the case of men.

In addition, although they are less frequent, redness, itching or hives on the skin, anemia, fever, abdominal pain, stomatitis, blue or purplish discoloration of the skin, nails or lips, or changes in liver tests, or blood tests with decrease in leukocytes and neutrophils.

Who shouldn’t use

Sulfasalazine should not be used by children under 2 years of age, pregnant or breastfeeding women, or people with intestinal obstruction or porphyria.

Furthermore, this medicine should not be used by people who are allergic to sulfasalazine, its metabolites, such as 5-aminosalicylic acid and sulfapyridine, or medicines from the sulfonamide or salicylate class.