Pharm
Sulfasalazine
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Sulfasalazine
, Azulfidine, Olsalazine, Dipentum
Mechanism
5-Aminosalicylic Acid Derivative
which is metabolized into sulfapyridine and
Mesalamine
Indications
Inflammatory Bowel Disease
(e.g.
Ulcerative Colitis
)
Early
Rheumatoid Arthritis
(especially seronegative)
Psoriatic Arthritis
Arthritis
in
Reiter's Syndrome
Contraindications
Sulfa Allergy
Consider
Mesalamine
(
Asacol
,
Pentasa
) as alternative
Consider slowly tapering to dose if unclear allergy
Start: 250 grams per day
Increase: 250 grams per week
Dosing
Sulfasalazine
Ulcerative Colitis
dosing target
Active disease: Sulfasalazine 4-6 grams/day divided four times daily
Maintenanance: Sulfasalazine 2-4 grams/day divided four times daily
Gene
ral
Increase slowly to lowest effective dose
Co-administer
Folic Acid
1 mg/day
Increase Protocol
Start: 500 mg per day
Increase: 500 mg per week up to 2 grams per day
Increase: 3 grams per day after 3 months
Maximum: 4 grams per day (2 grams twice daily) after 6 months
Maintenance Doses
Adult: 500-1000 mg PO qid with food
Pediatric: 20-60 mg/kg/day divided qid with food
Dosing
Olsalazine (Dipentum)
Olsalazine (Dipentum) 500 mg orally twice daily (as of 2022, >$1500/month)
Adverse effects
Gene
ral
Prevent adverse effects with
Folic Acid
1-2 mg/day
Nausea
and other Gastrointestinal Intolerance (30%)
Consider enteric coated Azulfidine EN-tablets
Neurologic adverse effects
Headache
(20%)
Dizziness
or lightheaded (<20%)
Hematologic adverse effects
Folate
-inhibition
Anemia
Hemolytic Anemia
Granulocytopenia
Skin rash associated with
Sulfa Allergy
Requires discontinuing medication immediately
Renal adverse effects: Micro-
Crystalluria
Risk of
Interstitial Nephritis
Avoid
Dehydration
Avoid high doses
Monitoring
Complete Blood Count
(CBC) every 4-6 months
Aspartate Aminotransferase
(AST,
SGOT
) at 2 months
References
Adams (2013) Am Fam Physician 87(10): 699-705 [PubMed]
Adams (2022) Am Fam Physician 105(4): 406-11 [PubMed]
Kornbluth (2010) Am J Gastroenterol 105(3): 501-23 [PubMed]
Matteson (2000) Mayo Clin Proc 75:669-74 [PubMed]
Pincus (1999) Clin Rheumatol 17(6 Suppl 18):S2-S124 [PubMed]
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