SULFASALAZINE (Salazopyrin®) INFORMATION SHEET

Developed by Andy Thompson MD FRCPC

What is Sulfasalazine?

Sulfasalazine is a Disease Modifying Anti-Rheumatic Drug (DMARD). It is used for the treatment of Rheumatoid arthritis, Psoriatic arthritis, and many other types of arthritis. It is also used for diseases other than arthritis (i.e. ulcerative colitis).

How does Sulfasalazine work?

Sulfasalazine is a combination of a salicylate (like Aspirin) and a sulfa antibiotic. It is believed that the sulfa portion of the medication is responsible for helping to control your arthritis.

Why am I taking Sulfasalazine?

Your doctor has prescribed this medicine to help with the following:

1. Reduce the pain and swelling (inflammation) in your joints.
2. Improve your day to day function.
3. Delay any long-term damage from the joint inflammation.

What is the usual dose of Sulfasalazine?

• Sulfasalazine is available in 500 mg tablets.
• Sulfasalazine is usually started slowly and increased as follows:

• The standard dose ranges from 2 tablets (1000 mg) twice a day to 3 tablets twice a day (1500 mg).

How often do I take Sulfasalazine?

• Sulfasalazine is taken TWICE A DAY, preferably with food.

Who should NOT take Sulfasalazine?

• Patients who have had a prior serious allergic reaction to Sulfasalazine.
• Patients who have an allergy to medications containing Sulfa.
• Patients who have an allergy to ASA (Aspirin).

When will I start to feel the effects of Sulfasalazine?

Sulfasalazine does not work right away. It will take about 6 to 12 weeks before you start feeling better. If your doctor changes the dose it can take another 6 to 8 weeks before you start feeling the effects.

What Medications are safe with Sulfasalazine?

Most medications can be given safely with Sulfasalazine. As an example, some of the medications which may be safely added to Sulfasalazine include: Acetaminophen (Tylenol), Prednisone, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Other DMARDs (i.e. Methotrexate, Hydroxychloroquine, and Gold), and Biologics (i.e. Etanercept, Infliximab, Anakinra).

What are the side-effects of Sulfasalazine?

MORE COMMON side-effects include:

• Nausea, diarrhea, and abdominal pain
• Headaches or slight dizziness
• Rash
• Urine may turn slightly orange

RARE side-effects include:

• Sensitivity to the sun
• Liver – Sulfasalazine may irritate the liver. This does not usually cause symptoms but may be found on blood tests. It is rare and usually reversible when regularly monitored with your monthly blood tests.
• Blood Counts – Sulfasalazine can cause a drop in the numbers of white blood cells (which are needed to fight infection), red blood cells (which carry oxygen), and platelets (which help to stop bleeding). Because we monitor the blood count closely, it is unusual for this to be a serious problem.
• Fertility – Sulfasalazine may cause a drop in the sperm count resulting in temporary infertility. This reverses when the medication is stopped.
• Kidneys – Sulfasalazine may rarely irritate the kidneys.

How can I help to minimize the side-effects of Sulfasalazine?

• Take your Sulfasalazine as prescribed by your doctor.
• Take your Sulfasalazine with food.
• When starting Sulfasalazine, start with a low dose (500 mg once or twice per day) and increase the dose slowly (as described).

Do I need to have regular blood tests while taking Sulfasalazine?

YES, your doctor will order BLOOD TESTS EVERY 2 WEEKS – 3 MONTHS. This is important to make sure the Sulfasalazine is having no harmful effects on your liver, blood counts, or kidneys.

How do I stop the Sulfasalazine?

You do not need to wean yourself off the Sulfasalazine. It can simply be stopped. However, your arthritis may “flare” after you stop the medicine.

What should I do if I miss a dose of Sulfasalazine?

• If you forget to take your Sulfasalazine in the morning but remember later on the same day, skip the dose and take your usual evening dose.
• If you forgot to take your Sulfasalazine in the evening, skip the dose and take your usual morning dose.

Is Sulfasalazine safe in Pregnancy?

• It is generally advisable to avoid all medications during pregnancy and while you are trying to become pregnant. However, Sulfasalazine is believed to be one of the safer medications used to treat arthritis during pregnancy.
• If you become pregnant while taking Sulfasalazine NOTIFY YOUR DOCTOR IMMEDIATELY.