Sulfasalazine

(brand name Azulfidine in the U.S.,

 Speak with your doctor about what precautions you might take against traveler’s diarrhea. Some doctors will provide a prescription for a supply of antibiotics to be taken if you develop diarrhea, rectal bleeding, and fever. However, the best treatment is prevention by being careful.

Salazopyrin and Sulazine in Europe and Hong Kong) was developed over 70 years ago specifically to treat . It was believed at the time that bacterial infections were the cause of . Sulfasalazine is a sulfa drug, (a derivative of mesalazine) and is formed by combining sulfapyridine and salicylate with an azo bond. It may be abbreviated SSZ.

Sulfasalazine

Sulfasalazine

Indications

Sulfasalazine is used in the , including and Crohn’s disease. It is also indicated for use in rheumatoid arthritis and used in other types of (e.g. psoriatic arthritis) where it has a beneficial effect. It is often well tolerated compared to other DMARDS.

In recent British research involving animal studies, and more recently, human trials for the treatment of chronic alcoholics, sulfasalazine has been found to reverse the scarring associated with cirrhosis of the liver. Cells called myofibroblasts, which contribute to scar tissue in a diseased liver, also appear to secrete proteins that prevent the breakdown of the scar tissue. Sulfasalazine appears to retard this secretion.

A study at found that the drug may also act to aid the healing of cirrhosis of the liver.
It is usually not given to children under 2 years of age.

The use of sulfasalazine in has declined due mainly to the fact that it yields the metabolite sulfapyridine which gives rise to side-effects such as agranulocytosis and hypospermia. However, the other metabolite of sulfasalazine, 5-aminosalicylic acid (5-ASA) is attributed to the drug’s therapeutic effect. Therefore, 5-ASA and other derivatives of 5-ASA, are now usually preferred and given alone (as mesalazine), despite their increased cost, due to their more favourable side-effect profile.
Sulfasalazine has also been used successfully to treat cases of idiopathic urticaria that do not respond to antihistamines.

Mode of action

Sulfasalazine, and its metabolite 5-ASA, are poorly absorbed from the gut. Its main mode of action is therefore believed to be inside the intestine.

Bowel disease

In Crohn’s disease and ulcerative colitis, it is thought to be an antinflammatory drug that is essentially providing topical relief inside the intestine. It does this via a number of mechanisms such as reducing the synthesis of inflammatory mediators known as eicosanoids and . However, unlike glucocorticoids (another class of drug used in the treatment in inflammatory bowel disease), sulfasalazine has no immunosuppressant action.

Arthritis

When treatment for arthritis is successful, pain, joint swelling and stiffness will be reduced and this may slow down or stop the development of joint damage. The precise reasons why sulfasalazine are effective in various forms of arthritis is not clearly understood.

Because sulfasalazine and its metabolite 5-ASA are poorly absorbed into the bloodstream, it is surprising that the drug is effective against symptoms outside of the intestine. One possible explanation is that, given that ulcerative colitis produces arthritic symptoms, the arthritic symptoms are actually a product of unrecognized ulcerative colitis, which is effectively treated with sulfazalazine.
The other metabolite, sulfapyridine, is absorbed into the blood, and is believed to be the source of the side-effects discussed below. It is possible that the sulfapyridine is responsible for some of the anti-arthritic effects of sulfasalazine.

Side effects

Refer to external links for a full listing of known side effects.

In rare cases, Sulfasalazine can cause severe depression in young males. It can also cause temporary infertility.
Sulfsalazine metabolizes to sulfapyridine. Serum levels should be monitored every three months, and more frequently at the outset. Serum levels above 50 μg/l are associated with side effects.

Immune thrombocytopenia has been reported.

Sulfasalazine inhibits dihydrofolate reductase, and cause folate deficiency, .
Sulfasalazine can cause hemolytic anemia in people with .

About Robert Hill

I founded IDEAS Intestinal Disease Education and Awareness Society, from my home base in Vancouver, British Columbia. Intestinal Disease Education and Awareness Society IDEAS is established to raise public awareness of intestinal diseases in order to help remove the stigmas associated with these illnesses. The programs of IDEAS help children, youth and young adults learn to live full lives, find acceptance and gain confidence.

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