Sulfasalazine (Salazopyrin®)

How does it work?

• Sulfasalazine is a disease modifying anti-rheumatic drug (DMARD). It contains both an antibiotic (sulpha) & and an anti-inflammatory (salicylate) medicine.

• Sulfasalazine is used to treat inflammatory arthritis and

inflammatory bowel disease. It works by modifying the body’s immune system. In these conditions, the body’s immune system which normally helps to protect you from germs & viruses, starts to attack the good cells in your body, causing inflammation (swelling, warmth, pain and stiffness). Untreated inflammation can cause damage to joints and other tissues that cannot be repaired.

Why am I taking it?

• Sulfasalazine has been ordered by your doctor to help manage your arthritis. It is used alone or often in combination with other medicines to help − reduce swelling and pain in your joints & other tissues − reduce morning stiffness & how tired you feel − increase ability to move your body & do daily activities − slow or even prevent damage to your joints or tissues

How quickly does it work?

• Most people find their arthritis symptoms start to feel better within 6 to 12 weeks.

• If you still have symptoms of inflammation at 12 weeks, your doctor may increase the dosage.

How do I take it? • Each plain or enteric-coated tablet is 500 mg.

• It is best taken two times a day, with breakfast and supper, to lessen stomach upset.

1

• Each dose should be taken with a full glass (8 oz) of water. Each day you should drink 1.5 litres (six 8 oz of water) while taking sulfasalazine to prevent unwanted side effects.

• Take one tablet daily at supper for one week then gradually

increase by one tablet each week to a maximum of 4 tablets per day.

Week 1 Week 2 Week 3 Week 4 morning • • • • evening • • • • • •

• Take you medication as advised by your doctor.

Work with your doctor to determine how much medicine you need. Medications are started a low dosages and increased slowly to decrease the risk of side effects. Skipping doses will reduce how well it is working in your body to control your condition.

What if I forget to take it?

• If taking sulfasalazine more than once a day, skip the dose that you missed, and wait until your next dose is due.

What tests are needed?

Blood tests: • Complete Blood Count (WBC, hemoglobin, platelet count)

and liver enzymes (AST, ALT) are done every 2 weeks for 2 months, then every 3 months.

• Inflammatory markers (CRP/ESR) is done initially and then every 3 months.

• Your doctor will monitor the results of your blood tests to

ensure you are getting benefit from taking sulfasalazine and that there are no harmful changes occurring in your blood, liver or kidneys.

What are the possible side effects?

Possible side effects to watch for are: • nausea, upset stomach or stomach pain • loss of appetite • headache or slight dizziness

2

• skin rash • yellow-orange colour to urine (normal - does not require

medical attention) Less common side effects: • increase sensitivity of skin to sunlight • increase in liver enzymes (AST, ALT) due to irritation of

the liver. • low blood-cell count (drop in white blood cells, red blood

cells and/or platelets) • unusual bleeding or bruising

What if I have a side effect?

Contact your doctor or nurse if you develop any of the above symptoms. • Side effects are often related to the amount of medicine that

you are taking. A decrease or temporary stopping of sulfasalazine or an increase in blood testing may be required.

Stomach/Bowel Problems: • Take your medicine with meals • Drink lots of water throughout the day.

Sun Sensitivity: • Use protective eyewear and clothing • Use sunscreen with an SPF of 15 or higher

Are there any precautions?

Previous Allergic Reactions: • Before taking, ensure you inform your doctor if you have

had a previous reaction to any sulfa medications, including sulfonamides (sulpha antibiotics, glyburide), furosemide or thiazide diuretics (water pills) or aspirin.

Pregnancy: • Inform your doctor if you are pregnant or intending to

become pregnant, planning to father a child or breastfeeding. • Sulfasalazine is known to reduce sperm counts in men. This

effect is reversed when the medication is discontinued.

3

What about other medications?

• Sulfasalazine may interact with other medications. Discuss other prescription and non-prescription medications you are taking with your doctor prior to starting sulfasalazine.

• It is safe to take with other DMARDs (Gold, Methotrexate & Hydroxychloroquine), biologics, non-steroidal anti-inflammatories (NSAIDs) tylenol & prednisone.

What if I get sick?

If illness occurs while taking sulfasalazine, stop the medication if unable to tolerate the medication & fluid requirements. Continue taking when you feel better.

What if I need surgery?

• Sulfasalazine may be stopped the week of your surgery. • Develop a plan with your doctor about medications &

vitamin/mineral or herbal supplements when having upcoming surgery, dental work or other procedures.

How do I store it?

• Keep the tablets in their original container & tightly closed. • Store at room temperature, away from heat, moisture and

direct light.

How often will I see my doctor?

• See your rheumatologist every 3 to 6 months after starting Sulfasalazine. These visits allow you & your doctor to decide how well it is working to help your condition, & if any changes to your medicines are needed.

• Keep a diary and a medicine list in your wallet. Record all medications, vitamin/mineral & herbal supplements you are taking & any allergies you may have. Record when you take your medicine, any side effects and reasons for changes or stopping of medicine. Bring these with you to all appointments with your health care provider.

What if I travel?

• Always take extra medicine & a prescription in your purse or carry-on bag.

Disclaimer: This handout is to help you make an informed choice in your medical care. Specific questions about medications should be discussed with your doctor, nurse or pharmacist.

Developed: December 2004. Last revised: January 2017- Jane Prince RN, BScN,

Mary Pack Arthritis Program, Vancouver Coastal Health Authority. 4