Sulfasalazine Clinical Medication Guide

Sulfasalazine is used forTreatment of ulcerative colitis

The drug has also been used for the treatment of inflammatory bowel disease and rheumatoid arthritis for more than 40 years

Indications

ulcerative colitis

Rheumatoid Arthritis

 psoriatic arthritis

Precautions for medication

Ø In order to prevent adverse drug reactions, it is recommended to start with a low dose, 0.

Ø Before use, find out whether there is a history of allergy to sulfonamide drugs.

Ø Those who are allergic can be changed to mesalazine; if the gastrointestinal reaction is severe, it can be changed to anal suppository

Ø Drink plenty of water, can be taken with sodium bicarbonate: the metabolite of sulfasalazine, acesulfame, has low solubility in partial acid urine, easy to precipitate crystals, mechanical stimulation to the kidneys, low back pain and hematuria, and even occur Urinary closure, etc.

ØDo not take with acidic drugs: such as vitamin C and pepsin mixture, etc.

ØCan be used for pregnant women, but the dose should not exceed 2 g/d, folic acid should be supplemented at the same time (to reduce the risk of cleft lip), those who give birth to full-term neonates (without glucose-6-phosphate dehydrogenase deficiency), and mothers who are breastfeeding.

ØMen should stop the drug for 3 months before giving birth (it can lead to male spermatopenia, but it is generally reversible and can be recovered after a few months of drug withdrawal)

Ø It takes 2-3 months or even longer to take effect, so it is necessary to continue to use it, and regularly review liver and kidney function and blood routine to evaluate side effects

ØPay attention to the discharge of complete pills: the quality of medicines from different manufacturers varies greatly, and some patients report that complete pills are discharged with the feces, and the medicine loses its therapeutic effect at this time

When Dosage Adjustment Is Required

ØIf there are symptoms of gastrointestinal irritation, you can take the medicine after meals or take it in small doses multiple times to relieve symptoms

Ø The interval of drug withdrawal at night shall not exceed 8h

ØAccording to the patient's response and drug resistance, the dose can be adjusted at any time.

Ø Patients with renal impairment should reduce the dose

ØWhen the symptoms of diarrhea do not improve, the dose can be increased
.

adverse drug reaction

Ø Fever and rash may occur, and in severe cases, skin necrosis (Lyell syndrome) may occur
.

Ø Respiratory system: Adverse reactions of the respiratory system are rare
.
Fibrous alveolitis has been reported, but should be distinguished from symptoms of ulcerative colitis such as fever, dyspnea, eosinophilia, and pulmonary infiltrates
.
Such adverse reactions generally appear within 1 to 6 months after taking the drug, and can be recovered after stopping the drug, but there are also reports of death
.
For such patients, azosalicylic acids can be used instead
.
 

ØBlood system : The most important adverse reaction of sulfasalazine is the inhibition of hematopoietic system
.

• Thrombocytopenia (in severe cases, bleeding tendency) and leukopenia (in severe cases, infection ) can occur;
• Sulfasalazine can also reduce the absorption of folic acid, causing megaloblastic anemia;

• The tendency for hemolysis is more severe in patients with a deficiency of glucose-6-phosphate dehydrogenase;

• There are also reports of death due to damage to the hematopoietic system
  .
  

The tendency for hemolysis is more severe in patients with a deficiency of glucose-6-phosphate dehydrogenase;

There are also reports of death due to damage to the hematopoietic system
.

Ø Digestive system : common nausea, vomiting, abdominal discomfort, sore throat, dysphagia, rare pancreatitis, toxic hepatitis and colitis exacerbation
.
For patients with slow acetylation metabolism, the incidence of digestive system
.

ØReproductive system: Sulfasalazine can cause decreased sperm count, decreased motility, and increased deformity ratio in males, resulting in decreased fertility or infertility
.

Ø Psycho-neurological system : For some patients with abnormal allergies, taking sulfasalazine may experience psycho-neurological symptoms
.
Severe depression has been reported
.

ØUrinary system: The sulfapyridine contained in sulfasalazine can cause dysuria, crystalluria and hematuria after absorption
.

Ø Drug resistance: Studies have found that sulfasalazine can induce bacterial drug resistance
.

o Other: Rare goiter

references:

1.
Yang Baofeng, editor-in-chief.
Pharmacology (8th Edition) [M].
People's Health Publishing House.
P: 402.

2.
Instructions for sulfasalazine enteric-coated tablets.