Sulfasalazine

Administration

• Type: Salicylate
• Dosage Forms: Tab: 500mg; DR Tab: 500mg
• Routes of Administration: Oral
• Common Trade Names: Azulfidine, Azulfidine EN-tabs, Sulfazine

Adult Dosing

Ulcerative Colitis

• 500 mg PO q6h
  • Max: 6 g/day

Rheumatoid arthritis

• 1 g PO q12h
  • Max 4 g/day

Crohn's disease

• 500 mg PO q6h
  • Max 6 g/day

Pediatric Dosing

Ulcerative Colitis

• 6+ years old
  • 30-70 mg/kg/day PO divided q12h
    • Max: 2 g/day

Juvenile idiopathic arthritis

• 6+ years old
  • 30-50 mg/kg/day PO divided q12h
    • Max: 2 g/day

Special Populations

• Pregnancy Rating: Category B, benefits outweigh risk during pregnancy; low risk
• Lactation risk: Caution advised; risk of infant diarrhea

Renal Dosing

• Adult: Not defined
• Pediatric: Not defined

Hepatic Dosing

• Adult: Not defined
• Pediatric: Not defined

Contraindications

• Allergy to class/drug
• Hypersensitivity to salicylates
• Hypersensitivity to sulfonamides
• Porphyria
• GI Obstruction, GU obstruction
• Febrile viral infection (pts <20 yo)

Adverse Reactions

Serious

• Hypersensitivity reaction, anaphylaxis
• Erythema multiforme
• Stevens-Johnson syndrome, Toxic epidermal necrolysis
• Pulmonary toxicity, hepatotoxicity, nephrotoxicity
• Pancreatitis
• Seizure
• Meningitis
• Agranulocytosis, Aplastic anemia, hemolytic anemia
• Infertility, Oligospermia
• Reye syndrome
• Hypoglycemia

Common

• Anorexia
• Headache, Nausea, Vomiting, Dizziness
• Dyspepsia, stomatitis
• Oligospermia
• Rash, Pruritus, Urticaria
• Abdominal pain
• Fever
• Leukopenia, hemolytic anemia
• Cyanosis
• Crystalluria, Hematuria
• Photosensitivity

Pharmacology

• Half-life: 7.6 h (Active metabolites 10.4-14.8h)
• Metabolism: GI tract, liver
• Excretion: Urine 37% (15% unchanged), feces

Mechanism of Action

• Blocks cyclooxygenase and inhibits prostaglandin production, producing anti-inflammatory effects