Sulfasalazine

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Category: Aminosalicylates

Sulfasalazine is a combination of 5-aminosalicylic acid (‘5-ASA') and sulfapyridine; sulfapyridine acts only as a carrier to the colonic site of action but still causes side-effects. In the newer aminosalicylates, mesalazine (5-aminosalicylic acid), balsalazide (a prodrug of 5-aminosalicylic acid) and olsalazine (a dimer of 5-aminosalicylic acid which cleaves in the lower bowel), the sulphonamide-related side-effects of sulfasalazine are avoided, but 5-aminosalicylic acid alone can still cause side-effects including blood disorders (see recommendation below) and lupus-like syndrome also seen with sulfasalazine.
Cautions

  • Aminosalicylates should be used with caution in renal impairment, during pregnancy and breast-feeding; blood disorders can occur.
  • Blood disorders: Patients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.

Side-effects
Side-effects of the aminosalicylates include diarrhoea, nausea, vomiting, abdominal pain, exacerbation of symptoms of colitis, headache, hypersensitivity reactions (including rash and urticaria); side-effects that occur rarely include acute pancreatitis, hepatitis, myocarditis, pericarditis, lung disorders (including eosinophilia and fibrosing alveolitis), peripheral neuropathy, blood disorders (including agranulocytosis, aplastic anaemia, leucopenia, methaemoglobinaemia, neutropenia, and thrombocytopenia—see also recommendation above), renal dysfunction (interstitial nephritis, nephrotic syndrome), myalgia, arthralgia, skin reactions (including lupus erythematosus-like syndrome, Stevens-Johnson syndrome), alopecia.

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