sulfasalazine (SSZ, Azulfidine, SAS)
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Introduction
Tradename: Azulfidine.
Indications
- rheumatoid arthritis
- spondyloarthritis[6]
- scleroderma[5]
- microsopic colitis[5]
Contraindications
Cautions:
- renal or hepatic impairment
- blood dyscrasias
- slow acetylators
- bronchial asthma
- glucose-6-phosphate dehydrogenase (G6PD) deficiency
Dosage
- mild to moderate inflammatory bowel disease:
- maintenance 1-2 g/day in divided doses
- take plenty of water
- avoid direct sunlight
- pediatrics: 20-60 mg/kg/day
Tabs: 500 mg.
Liquid: 250 mg/5 mL.
Pharmacokinetics
- different with different formulations
- primary site of action is the colon
elimination via kidney
Monitor
- CBC, LFTs, serum creatinine baseline & every 3-6 months thereafter[6]
Adverse effects
- common (> 10%)
- less common (1-10%)
- uncommon (< 1%)
- crystalluria, hematuria, thyroid dysturbance, interstitial nephritis, serum sickness-like reaction, jaundice, acute nephropathy
- other
- abdominal pain
- hypersensitivity reactions
- fatigue
- paradoxical exacerbations of colitis
- may cause orange & yellow discoloration of the skin & urine
- may precipitate porphyria
Drug interactions
- folic acid: reduced absorption of folic acid; consider folate replacement with long-term therapy
- digoxin: reduced absorption of digoxin
- drug interaction(s) of direct oral anticoagulants (DOAC) with NSAIDs
- drug interaction(s) of cholinesterase inhibitors with NSAIDs
- drug interaction(s) of lithium carbonate with NSAIDs
- drug interaction(s) of beta-adrenergic receptor antagonists with salicylate
- drug interaction(s) of salicylates with sulfonylureas
- drug interaction(s) of NSAIDs with oral contraceptive
- drug interaction(s) of NSAIDs with SSRIs
- drug interaction(s) of NSAIDs with antidepressants
- drug interaction(s) of aspirin with NSAIDs
- drug interaction(s) of apixaban with NSAIDs
- drug interaction(s) of warfarin with NSAIDs
- drug interaction(s) of NSAIDs with beta blockers
- drug interaction(s) of NSAIDs with ARBs
- drug interaction(s) of NSAIDs with aldosterone antagonis
- drug interaction(s) of NSAIDs with glucocorticoid
- drug interaction(s) of NSAIDs, diuretics & angiotensin II receptor antagonists
- drug interaction(s) of NSAIDs, diuretics & ACE inhibitors
- drug interaction(s) of NSAIDs with ACE inhibitors
- drug interaction(s) of NSAIDs & antihypertensives
- drug interaction(s) of NSAIDs & loop diuretics
- drug interaction(s) of NSAIDs & aspirin
Mechanism of action
- converted to sulfapyridine & mesalamine
- mesalamine is active component in GI tract
- sulfapyridine component exerts systemic effects
More general terms
Additional terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 356
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 5.0 5.1 5.2 5.3 Deprecated Reference
- ↑ 6.0 6.1 6.2 Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ 7.0 7.1 NEJM Knowledge+ Gastroenterology