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Sulfasalazine

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Sulfasalazine

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Sulfasalazine

Salazopyrin En-Tabs 500 mg tablets also comes with Enteric coating to reduce GI SEs Typical regimen may start with 500 mg / day ↑ ed at intervals of 1 week by one 500 mg tablet a day to a max of 2-3 gm in divided doses

Ulcerative Colitis -induction and maintenance of remission Crohn’s disease – treatment Rheumatoid arthritis Sero negative spondylo-arthopathy ( including psoriatic arthritis and Psoriasis ) Can be used as monotherapy or in combination

Is a prodrug Structurally related to both salicylates ( for eg aspirin ) and sulphonamides Split by bacterial in colon into Sulfapyridine ( SP ) & Mesalazine MP ) Precise mechanism of action not know Local actions of mesalamine in colon – likely reason for effectiveness in inflammatory bowel dis RA- may be related to anti-inflammatory and immunomodulatory properties In rheumatoid arthritis a disease-modifying effect is seen in 1-3 months ( reduction in inflammatory markers ) Renal/Faecal- primary excretion routes

Adverse effects

Adverse reactions are possible to either Suphonamide or Salicylate Most commonly encountered are nausea , headache , rash , loss of appetite and raised temperature

Few other points
 May discolour contact lenses ( yellow/ orange ) Can cause a fall in sperm count- leading to a reversible temporary decrease in male fertility Pregnancy- can be used not teratogenic Breast feeding – small amounts in milk ( risk neonatal haemolysis ) Patients with known ANA→ can induce lupus like illness G6PD ( glucose -6-phosphate dehydrogenase ) risk haemolytic anaemia

Digoxin- reduced absorption Hypoglycaemia risk ( if on hypoglycaemic agents ) Increased GI adverse effects -particularly nausea if used with Methotrexate Azathioprine / Mercaptopurine →bone marrow suppression and leucopenia

Monitoring- FBC or CBC Fortnightly for the 1st 3 months Monthly for 2nd 3 months 3 monthly or as clinically indicated after that WBC < 3.5 x 109 / L Neutrophils < 2 x 109 / L
( threshold may vary locally from
1.5 to 2 check with local team ) Platelets < 150 x 109 / L

 MCV > 105 fL 
○ check Vit B12 and TSH
○ If abnormal treat underlying abnormality
○ If normal discuss with specialist team Withhold treatment until discussed with specialist team

LFT Fortnightly for the 1st 3 months Monthly for 2nd 3 months 3 monthly or as clinically indicated after that AST , ALT → twice upper limit of normal Withold treatment until discussed with specialist team

us and Es Renal function test Urinalysis Monthly for 1st 3 months As clinically indicated after that Excreted in urine and accumlation is associated with ↑risk of toxicity 

Check for presence of rash or oral ulceration
( each visit )
 Nausea / dizziness / headache


 Abnormal bruising , pallor , severe sore throat , fever malaise

 Unexplained acute widespread rash

 Oral ulceration

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