Azulfidine (sulfasalazine) is a prescription, oral, anti-inflammatory medication used to treat inflammatory conditions likerheumatoid arthritis (RA)and ulcerative colitis.Tetra Images / Getty ImagesDrug ClassSulfasalazine belongs to a class of drugs referred to as sulfa drugs. It containssalicylateand the sulfa antibiotic.Sulfasalazine treats the disease process, not just the symptoms of RA, and thus it is classified as adisease-modifying anti-rheumatic drug (DMARD).Indications for Use of SulfasalazineSulfasalazine is prescribed for treating RA, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis.This medication helps reduce pain, swelling, and stiffness associated with arthritis. It is most effective for treating mild to moderate symptoms. Sulfasalazine also may prevent joint damage and decrease the risk of reduced joint function. Typically, symptom improvement is noticeable within 12 weeks of starting treatment.Dosing Information and AvailabilitySulfasalazine is available as a 500 milligram (mg) tablet. It is recommended that you take it with food and a full glass of water.Treatment for rheumatoid arthritis typically starts at a low dose, which is then increased. For the first week, your healthcare provider may prescribe one or two sulfasalazine tablets per day. Your dose will likely be gradually increased to two tablets twice a day. The maximum dose is six tablets per day.Enteric-coated tablets are available and may help prevent stomach upset.Common Side EffectsThe most common side effects of sulfasalazine are nausea or abdominal discomfort. Abdominal issues usually resolve over time, especially when the drug is started at a low dose.Less common side effects may include skin rash, headache, mouth sores, itching, problems with liver function, and sun sensitivity.Possible Severe Adverse ReactionsWhile severe adverse reactions are not considered common, they do tend to increase when the daily dose of sulfasalazine equals or exceeds 4 grams.Adverse reactions associated with sulfonamides (sulfa drugs) that can occur with sulfasalazine include blood disorders, hypersensitivity reactions, central nervous system reactions, renal reactions, and urine and skin discoloration.Severe adverse reactions affect about one-third of patients treated with sulfasalazine.Severe reactions include:AnorexiaSevere headacheSevere gastric distressVomitingLow sperm countThe low sperm count may be reversible with discontinuation of the drug.Adverse reactions that affect no more than 1 in 30 patients taking sulfasalazine include itching, hives, fever, Heinz body anemia, hemolytic anemia, and cyanosis (low oxygen and bluish discoloration).Contraindications (Who Should Not Take the Drug)Sulfasalazine is not an appropriate treatment option for patients with intestinal or urinary obstruction, porphyria, or in patients with known hypersensitivity to sulfasalazine, sulfonamides, or salicylates.Warnings and PrecautionsTo minimize the risk of side effects or adverse reactions. you should be aware of the following warnings and precautions while taking sulfasalazine.Regular blood tests should be performed to monitor blood counts, kidney function, and liver function.If you are planning to become pregnant, you should discuss your sulfasalazine usage with your healthcare provider.This medication can increase the risk of kidney stones, so it is important to stay hydrated.Women who are breastfeeding should not take sulfasalazine.Folic acid supplementation may be necessary if you are being treated with sulfasalazine.Sulfasalazine can interact with warfarin, cyclosporine, and digoxin.The drug may increase the risk of liver injury in patients who take isoniazid for tuberculosis.Sulfasalazine may also increase the risk of low blood sugar among patients who take certain diabetes medications.
Azulfidine (sulfasalazine) is a prescription, oral, anti-inflammatory medication used to treat inflammatory conditions likerheumatoid arthritis (RA)and ulcerative colitis.
Tetra Images / Getty Images
Drug Class
Sulfasalazine belongs to a class of drugs referred to as sulfa drugs. It containssalicylateand the sulfa antibiotic.
Sulfasalazine treats the disease process, not just the symptoms of RA, and thus it is classified as adisease-modifying anti-rheumatic drug (DMARD).
Indications for Use of Sulfasalazine
Sulfasalazine is prescribed for treating RA, juvenile arthritis, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis.
This medication helps reduce pain, swelling, and stiffness associated with arthritis. It is most effective for treating mild to moderate symptoms. Sulfasalazine also may prevent joint damage and decrease the risk of reduced joint function. Typically, symptom improvement is noticeable within 12 weeks of starting treatment.
Dosing Information and Availability
Sulfasalazine is available as a 500 milligram (mg) tablet. It is recommended that you take it with food and a full glass of water.
Treatment for rheumatoid arthritis typically starts at a low dose, which is then increased. For the first week, your healthcare provider may prescribe one or two sulfasalazine tablets per day. Your dose will likely be gradually increased to two tablets twice a day. The maximum dose is six tablets per day.
Enteric-coated tablets are available and may help prevent stomach upset.
Common Side Effects
The most common side effects of sulfasalazine are nausea or abdominal discomfort. Abdominal issues usually resolve over time, especially when the drug is started at a low dose.
Less common side effects may include skin rash, headache, mouth sores, itching, problems with liver function, and sun sensitivity.
Possible Severe Adverse Reactions
While severe adverse reactions are not considered common, they do tend to increase when the daily dose of sulfasalazine equals or exceeds 4 grams.
Adverse reactions associated with sulfonamides (sulfa drugs) that can occur with sulfasalazine include blood disorders, hypersensitivity reactions, central nervous system reactions, renal reactions, and urine and skin discoloration.
Severe adverse reactions affect about one-third of patients treated with sulfasalazine.
Severe reactions include:
The low sperm count may be reversible with discontinuation of the drug.
Adverse reactions that affect no more than 1 in 30 patients taking sulfasalazine include itching, hives, fever, Heinz body anemia, hemolytic anemia, and cyanosis (low oxygen and bluish discoloration).
Contraindications (Who Should Not Take the Drug)
Sulfasalazine is not an appropriate treatment option for patients with intestinal or urinary obstruction, porphyria, or in patients with known hypersensitivity to sulfasalazine, sulfonamides, or salicylates.
Warnings and Precautions
To minimize the risk of side effects or adverse reactions. you should be aware of the following warnings and precautions while taking sulfasalazine.
SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sulfasalazine (Azulfidine). American College of Rheumatology. March 2015.Rheumatoid Arthritis: Early Diagnosis and Treatment. Cush JJ M.D., Weinblatt ME M.D., Kavanaugh A M.D. Professional Communications, Inc. Third Edition. Copyright 2010.
Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Sulfasalazine (Azulfidine). American College of Rheumatology. March 2015.Rheumatoid Arthritis: Early Diagnosis and Treatment. Cush JJ M.D., Weinblatt ME M.D., Kavanaugh A M.D. Professional Communications, Inc. Third Edition. Copyright 2010.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Sulfasalazine (Azulfidine). American College of Rheumatology. March 2015.Rheumatoid Arthritis: Early Diagnosis and Treatment. Cush JJ M.D., Weinblatt ME M.D., Kavanaugh A M.D. Professional Communications, Inc. Third Edition. Copyright 2010.
Sulfasalazine (Azulfidine). American College of Rheumatology. March 2015.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
