Sulfasalazine
A DRUG Information Sheet
Why am I being prescribed sulfasalazine?
Sulfasalazine can reduce the symptoms and slow the progress of rheumatoid arthritis and other types of arthritis, such as psoriatic arthritis. It may reduce the inflammation in your joints and decrease pain, swelling and stiffness. It is generally prescribed as Salazopyrin EN-Tabs. This is the brand name for sulfasalazine which is specially coated so that it does not dissolve quickly in the stomach.
How do I take sulfasalazine?
Sulfasalazine tablets should be taken with a glass of water. Do not crush or chew the tablets. They should be swallowed whole.
What dose do I take?
Your doctor will advise you. Usually you will start on a low dose, e.g. 500 mg (one tablet) daily, and your doctor will tell you how to increase the dose gradually. This is usually over a period of around 4 weeks. A typical dose would be 1 g (two tablets) twice daily. The dose may be adjusted according to the severity of your symptoms.
How long will sulfasalazine take to work?
Sulfasalazine does not work immediately. It may be at least 12 weeks before you notice any benefit.
What are the possible risks or side-effects?
The commonest side-effects are feeling sick (nausea), diarrhoea, abdominal pain, dizziness, headache and rashes. These side-effects usually occur during the first 3 months of treatment. Occasionally sulfasalazine can affect the blood count (which means fewer blood cells are made). If you develop a sore throat or other infection, a fever, unexplained bruising or any other new symptoms, then you should report to your doctor or rheumatology nurse specialist as soon as possible. If any of these symptoms are severe, you should stop sulfasalazine as well as seeing your doctor immediately. Side-effects caused by sulfasalazine may clear up if the dose is reduced.
Your urine may change colour (to orange) with sulfasalazine but this is nothing to worry about. Also sulfasalazine may stain soft contact lenses (and tears) yellow.
Rarely, people may be allergic to sulfasalazine. It this is the case with you, the drug will have to be stopped. You should not take sulfasalazine if you are known to have a sulphonamide allergy.
What other treatments could be used instead of sulfasalazine?
A number of other drugs are used in the treatment of rheumatoid arthritis and related conditions (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
Do I need any special checks while on sulfasalazine?
Side-effects of sulfasalazine on the blood or liver may be picked up at an early stage by regular checks on your blood. Your doctor will arrange for you to have a blood test before you start treatment and then regular checks while on sulfasalazine. You may be asked to keep a record booklet with your blood test results. Bring this with you when you visit your general practitioner or the hospital. You must not take sulfasalazine unless you are having regular checks.
May I take other medicines along with sulfasalazine?
You should discuss any new medications with your doctor before starting them, and you should always tell any other doctor treating you that you are taking sulfasalazine.
Sulfasalazine is not a painkiller. So if you are on a non-steroidal anti-inflammatory drug (NSAID) or painkillers you can continue to take these as well, unless your doctor advises otherwise.
Do not take over-the-counter preparations without discussing this first with your doctor, rheumatology nurse or pharmacist.
Can I have immunisations while on sulfasalazine?
Yes, you can have immunisations while being treated with sulfasalazine.
May I drink alcohol while taking sulfasalazine?
There is no particular reason for you to avoid alcohol while taking sulfasalazine.
Does sulfasalazine affect fertility or pregnancy?
Sulfasalazine can cause a fall in sperm count, and so can lead to a temporary decrease in male fertility, but this is reversible on stopping the drug.
As almost all drugs carry some risk when used in pregnancy, it is best not to take sulfasalazine during pregnancy. If you are planning a family or you become pregnant while taking sulfasalazine, you should discuss this with your doctor as soon as possible.
What about breastfeeding?
If you wish to breastfeed, you should ask your doctor for advice.
Where can I obtain further information?
If you would like any further information about sulfasalazine, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of children.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
