Uses of Sulfazin: - Rheumatoid arthritis - Ulcerative colitis - Crohn’s disease - Ankylosing spondylitis Inflammatory bowel disease, Rheumatoid arthritis Hypersensitivity to sulphonamides or salicylates, porphyria, <2 yr of age, intestinal or urinary obstruction, blood dycrasias, history of leucopenia with gold therapy.

Drugs for Irritable Bowel Syndrome, Drugs used for Rheumatoid Arthritis, Ulcerative Colitis

The mode of action of Sulfasalazine is still under investigation, but may be related to the anti inflammatory and/or immunomodulatory properties that have been observed in animal and in vitro models, to its affinity for connective tissue, and/or to the relatively high concentration it reaches in serous fluids, the liver and intestinal walls, as demonstrated in autoradiographic studies in animals. In ulcerative colitis, clinical studies utilizing rectal administration of Sulfasalazine, Sulfapyridine and 5-Aminosalyclic Acid have indicated that the major therapeutic action may reside in the 5-Aminosalyclic Acid moiety. The relative contribution of the parent drug and the major metabolites in rheumatoid arthritis is unknown.

How to use Sulfasalazine: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Sulfasalazine is to be taken with food. Administration: Should be taken with food. Take after meals. Ensure adequate fluid intake. Adult Dose: Oral Inflammatory bowel disease Adult: Initially, 1-2 g 4 times daily until remission occurs. Maintenance: 2 g/day in divided doses. Rheumatoid arthritis Adult: As enteric-coated tablet: Initially, 500 mg daily for the 1st wk increased by 500 mg every wk. Max: 3 g daily in 2-4 divided doses. Rectal Inflammatory bowel disease Adult: As suppository: 0.5-1 g in the morning and night, either alone or as an adjunct to oral treatment. Hepatic impairment: Avoid use. Child Dose: Oral Inflammatory bowel disease Child: >2 yr: 40-60 mg/kg/day in divided doses. Maintenance: 20-30 mg/kg/day in divided doses. Rheumatoid arthritis Child: For polyarticular juvenile rheumatoid arthritis: >6 yr: As enteric-coated tablet: 30-50 mg/kg/day in 2 divided doses. Begin treatment with 1/4 to 2/3 of expected maintenance dose and increase wkly to reach maintenance dose in 1 mth. Max: 2 g daily. Rectal Inflammatory bowel disease Child: As suppository (may be given as divided doses): 5-8 yr: 500 mg bid; 8-12 yr: 500 mg in the morning and 1 g at night; 12-18 yr: 1 g bid. Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30ml/min Admin twice daily. <10ml/min Admin once daily.

Plasma levels reduced by rifampicin and ethambutol. Interferes with absorption of folic acid. Additive leucopaenia with gold therapy for rheumatoid arthritis. Increased haematological toxicity with azathioprine. Reduced serum levels of digoxin.

Hypersensitivity to sulphonamides or salicylates, porphyria, <2 yr of age, intestinal or urinary obstruction, blood dycrasias, history of leucopenia with gold therapy.

Common - Diarrhea - Gastrointestinal discomfort - Headache - Loss of appetite - Nausea - Oligospermia (low sperm count) - Vomiting - Weight loss >10% Anorexia (~33%),Headache (~33%),Nausea (~33%),Vomiting (~33%),Gastric distress (~33%),Apparently reversible oligospermia (~33%) <1% Skin rash,Pruritus,Urticaria,Fever,Heinz body anemia,Hemolytic anemia,Cyanosis Potentially Fatal: Severe hypersensitivity reactions, blood dyscrasias, renal and hepatic toxicity, fibrosing alveolitis.

Use in pregnancy: Pregnancy category B. This drug should be used during pregnancy only if clearly needed.Use in lactation: Caution should be exercised when sulfasalazine is administered to a nursing mother.

Precaution: Hepatic/renal impairment, G6PD deficiency, allergic bronchial asthma, lactation. Lactation: Excreted into human breast milk; caution with breastfeeding, some reports of bloody stools or diarrhea in human milk fed infants of mothers taking sulfasalazine

Store in a cool and dry place, protected from light.

Drugs for Irritable Bowel Syndrome, Drugs used for Rheumatoid Arthritis, Ulcerative Colitis

Actual mechanism not determined. Sulphasalazine may have direct anti-inflammatory action in the colon. It also systemically interferes with secretion by prostaglandin synthesis inhibition.

Pregnancy category: B; D if used for prolonged periods or near term; increased potential for kernicterus in the newborn