Sulfasalazine

Sulfasalazine is a type of drug known as a disease-modifying anti-rheumatic drug, or DMARD. These drugs have the effect of dampening down the underlying disease process, rather than simply treating symptoms. Sulfasalazine is generally prescribed as Salazopyrin EN-Tabs. This is the brand name for sulfasalazine that is specially coated so that it does not dissolve quickly in the stomach.

 

Why is sulfasalazine prescribed?

Sulfasalazine can reduce the symptoms and slow the progress of rheumatoid arthritis and other types of arthritis, such as psoriatic arthritis. It may reduce the inflammation in your joints and decrease pain, swelling and stiffness.

When and how do I take sulfasalazine?

Sulfasalazine is taken in tablet form. The tablets should be taken with a glass of water. They should be swallowed whole and not crushed or chewed.

Your doctor will advise you about the correct dose. Usually you will start on a low dose, e.g. 500 mg (one tablet) daily, and your doctor will tell you how to increase the dose gradually. This is usually over a period of about 4 weeks. A typical dose would be 1 g (two tablets) twice daily. The dose may be adjusted according to the severity of your symptoms.

How long does sulfasalazine take to work?

Sulfasalazine does not work immediately. It may be at least 12 weeks before you notice any benefit.

What are the possible risks or side-effects?

The commonest side-effects of sulfasalazine are nausea (feeling sick), diarrhoea, stomach pain, dizziness, headache and rashes. These side-effects usually occur during the first 3 months of treatment.

Sulfasalazine can affect the blood count (one of the effects is that fewer blood cells are made). You should tell your doctor or rheumatology nurse specialist straight away if you develop any of the following after starting sulfasalazine:

• a sore throat
• a fever
• any other symptoms of infection
• unexplained bruising
• any other new symptoms or anything else that concerns you.

You should stop sulfasalazine and see your doctor immediately if any of the symptoms listed above are severe.

Your urine may change colour (to orange) with sulfasalazine but this is nothing to worry about. Also sulfasalazine may stain soft contact lenses (and tears) yellow.

You should not take sulfasalazine if you are known to have a sulphonamide allergy.

Side-effects caused by sulfasalazine may clear up if the dose is reduced.

What other treatments could be used instead of sulfasalazine?

A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions. Your doctor will discuss these other options with you.

Will I need any special checks while on sulfasalazine?

Side-effects of sulfasalazine on the blood or liver may be picked up at an early stage by regular checks on your blood. Your doctor will arrange for you to have a blood test before you start treatment and then regular checks while on sulfasalazine. You may be asked to keep a record booklet with your blood test results, and you should bring this with you when you visit your GP or the hospital. You must not take sulfasalazine unless you are having regular checks.

Can I take other medicines along with sulfasalazine?

You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking sulfasalazine.

Sulfasalazine is not a painkiller. If you are already on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can carry on taking these as well as sulfasalazine, unless your doctor advises otherwise.

Do not take over-the-counter preparations or herbal remedies without discussing this first with your doctor, rheumatology nurse or pharmacist.

What about immunisations?

You can have immunisations while on sulfasalazine.

Can I drink alcohol while on sulfasalazine?

There is no particular reason to avoid alcohol while on sulfasalazine.

Does sulfasalazine affect fertility or pregnancy?

Sulfasalazine can cause a fall in sperm count, and so can lead to a temporary decrease in male fertility, but this is reversible on stopping the drug.

The risks to the unborn child of taking sulfasalazine seem to be very small. Sometimes it is recommended that sulfasalazine is continued through pregnancy to prevent a flare of disease. If you are planning a family you should seek advice from your doctor. If you become pregnant while taking sulfasalazine, you should discuss this with your doctor as soon as possible.

What about breastfeeding?

You should not breastfeed if you are on sulfasalazine. The drug may pass into the breast milk and could be harmful to your baby.

Where can I obtain further information?

If you would like any further information about sulfasalazine, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.

 

Remember to keep all medicines out of reach of children.

PLEASE NOTE: We have made every effort to ensure that this content is correct at time of publication, but remember that information about drugs may change. This page is for general education only and does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet that comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects that may be relevant in your particular case.

Our drug information is revised annually and published at the start of the year.