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Sulphasalazine / Sulfasalazine

What is Sulphasalazine?
Sulphasalazine is a drug used for treating Rheumatoid arthritis, Ankylosing spondylitis, Inflammatory bowel disease related arthritis and psoriatic arthritis. It is not an analgesic, but a disease modifying agent.
How long will it take to work?
Sulphasalazine usually takes 1 to 3 months to start working in arthritis. Evidence suggests that there is significant improvement in the number of swollen, tender joints, decrease in the morning stiffness in rheumatoid arthritis patients with Sulfasalazine *.
What dose of Sulfasalazine will I have to take?
Sulphasalzine is available as a 500 mg & 1000 mg tablet. It is usually started in a dose of 500mg tablet daily. It is slowly increased over a period of 3-4 weeks. Though the exact dose depends on the severity of your arthritis, usual dose of 2 gms/day is used.
What should I discuss with my Rheumatologist before
starting Sulphasalzine?
Before starting Sulphasalazine, tell your Rheumatologist if you have any of the following --
  • Any allergy to sulpha drugs.
  • Any hematological problems you have.
  • If pregnant or planning to conceive.
  • Any fertility related problems.
Can Sulphasalzine be taken in pregnancy?
Sulphasalzine is generally considered to be safe during pregnancy **. However you should always discuss with your Rheumatologist before planning pregnancy.
Can Sulphasalzine be taken while breast feeding?
Sulphasalazine increases the risk of jaundice, especially in the newborn. You should always discuss with your Rheumatologist if you are breastfeeding the baby.
Can I take alcohol when I am on Sulfasalazine?
There is no specific reason to avoid alcohol while on sulphasalazine.
What are the side effects of Sulphasalazine?
The most common side effects of Sulphasalazine are nausea & abdominal discomfort. Other side effects include rash, leucopenia (decrease in the white cells in the body), increase in the liver enzyme levels.
Does Sulfasalazine affect fertility?
Sulfasalazine may decrease the sperm count & motility in males. However, it is reversible & may take upto 2 months after discontinuation of the drug ***.
Will I require blood tests while on Sulfasalazine?
Yes. Your Rheumatologist would like to follow up your response to sulphasalazine closely. You will be asked to do blood counts & liver enzymes (SGPT, SGOT) regularly.
What is sulpha allergy? what symptoms can I get if I have sulpha allergy?
Sulpha allergy is allergy to sulpha drugs like Sulphasalazine. This can manifest in the form of rash, oral & genital blisters. You should contact your Rheumatologist immediately if you develop any of these.

* ME Winblatt et al. Sulfasalazine treatment for rheumatoid arthritis: a metaanalysis of 15 randomized trials. Journal of Rheumatology 1999 26: 2123-2130.
** Antirheumatic Drugs in Pregnancy and Lactation. Seminars in Arthritis and Rheumatism, Volume 35, Issue 2, Pages 112-121 K. Temprano, R. Bandlamudi, T. Moore
*** Toovey S, Hudson E, Hendry WF, Levi AJ. Sulphasalazine and male infertility: reversibility and possible mechanism. Gut 1981;22:445–51.
Freeman JG, Reece VAC, Venables CW. Sulphasalazine and spermatogenesis. Digestion 1982;23:68–71.

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Created on: April 2007
Last updated on: Feb 2015
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