Sulfasalazine

By Dr. Brian Bressler

What is it?

Sulfasalazine is under a class of medications called 5-aminosalicylates (5-ASA). It works as an anti-inflammatory by limiting the production of certain chemical products that are toxic to cells in the GI tract that promote diarrhea.

Why do I need this medication?

This medication is used to treat ulcerative colitis and Crohn’s disease. It can also be helpful in alleviating the symptoms of joint pains.

How long do I have to take this medication?

Sulfasalazine is used to induce remission and then is continued to maintain remission. If this medication is taken regularly, it will reduce the chances of flaring.

When will I start to feel better?

Some people may notice some improvement in their symptoms within 2 weeks. However, the full benefits may take approximately 8 weeks.

How do I take it?

This medication comes in pill form (500mg capsules) and a typical dose consists of 2 capsules taken 3 times a day. To avoid side effects, it is recommended to start with a smaller dose and to slowly increase to the prescribed dose if tolerated well.

Example:
Day 1-3
Start by taking 1 capsule with breakfast for 3 days.

Day 4-6
Try increasing your dose by taking 1 capsule with breakfast and 1 capsule with dinner for the next 3 days.

Day 7-9
Increase your dose by adding another capsule at lunchtime for another 3 days. You will be taking 1 capsule at breakfast, lunch, and dinner.

Day 10-12
Try adding another capsule at mealtime, ie 2 capsules at breakfast, 1 capsule at lunch, 1 capsule at dinner. Every 3 days, you can add another capsule at meal time until you are tolerating your prescribed dose.

What happens when I want to get pregnant?

Sulfasalazine is safe to take during pregnancy. However, there may be specific implications if you are trying to conceive while taking this medication. Whether you are male or female, speak to your doctor before you start family planning for more information.

Read more: Pregnancy and Crohn's Disease or Ulcerative Colitis

Can I drink alcohol while on this medication?

Yes

Check out other treatments for ulcerative colitis and other treatments for Crohn's disease

What are the side effects/risks?

  • Nausea: The most common side effects of Sulfasalazine are gastrointestinal. This can sometimes be avoided by starting with a small dose and slowly titrating up to the prescribed dosage. It may also be helpful if taken with food.

  • Allergic Reactions: Swelling or hives may appear on the hands and/or face. This reaction typically occurs 14-21 days after starting on therapy.

  • Folic Acid Deficiency: Sulfasalazine can reduce the ability of the intestine to absorb folic acid. Therefore, it is important to take a folic acid supplement daily. This can be bought over the counter.

  • Decreased Blood Count: Sulfasalazine can cause a decrease in red and white blood cells. Therefore, it is recommended to go for bloodwork every 3 months while on this therapy.

  • Steven-Johnson Syndrome: In very rare cases, Sulfasalazine has been associated with a rare, serious skin disorder. Please notify the doctor immeidately if you develop flu-like symptoms or a rash.

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