|Trade names||Azulfidine, Salazopyrin, Sulazine, others|
|Defined daily dose||2 grams (by mouth)|
2 grams (rectal)
|Elimination half-life||5-10 hours|
|Chemical and physical data|
|Molar mass||398.39 g·mol−1|
|3D model (JSmol)|
|Melting point||240 to 245 °C (464 to 473 °F) (dec.)|
|(what is this?)|
Sulfasalazine (SSZ), sold under the trade name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease. It is considered by some to be a first line treatment in rheumatoid arthritis. It is taken by mouth.
Significant side effects occur in about 25% of people. Commonly these include loss of appetite, nausea, headache, and rash. Severe side effects include bone marrow suppression, liver problems, Stevens–Johnson syndrome, and kidney problems. It should not be used in people allergic to aspirin or sulfonamide. Use during pregnancy appears to be safe for the baby.
Sulfasalazine is in the disease-modifying antirheumatic drugs (DMARDs) family of medications. It is unclear exactly how it works. One proposed mechanism is the inhibition of prostaglandins, resulting in local anti-inflammatory effects in the colon. The medication is broken down by intestinal bacteria into sulfapyridine and 5-aminosalicylic acid. That which is absorbed is excreted by the kidneys and in the bile.
Sulfasalazine was approved for medical use in the United States in 1950. It is on the World Health Organization's List of Essential Medicines. Sulfasalazine is available as a generic medication and is cost effective with respect to inflammatory bowel disease as of 2017.
Sulfasalazine is used in the treatment of inflammatory bowel disease, including ulcerative colitis and Crohn's disease. It is also indicated for use in rheumatoid arthritis and used in other types of inflammatory arthritis (e.g. psoriatic arthritis and reactive arthritis).
Sulfasalazine metabolizes to sulfapyridine. Serum levels should be monitored every three months, and more frequently at the outset. Serum levels above 50 μg/l are associated with side effects. In rare cases, sulfasalazine can cause severe depression in young males. It can also cause oligospermia and temporary infertility. Immune thrombocytopenia has been reported.
Around 90% of a dose of sulfasalazine reaches the colon, where most of it is metabolized by bacteria into sulfapyridine and mesalazine (also known as 5-aminosalicylic acid or 5-ASA). Both metabolites are active; most of the sulfapyridine is absorbed and then further metabolized, but most mesalazine is not, and remains in the colon.
The mechanism of action is not clear, but it appears that sulfasalazine and its metabolites have immunosuppressive, antibacterial, and anti-inflammatory effects. It also appears to inhibit the cystine-glutamate antiporter.
Society and culture
Use for rheumatoid arthritis cost about US$500 per year for sulfazalazine in the United States in 2002 versus up to $25,000 per year for TNF blocking agents. This was for a 2 gm per day dose of the 500 mg tablets. In the United States in 2020 the wholesale cost is 0.16 for the 500 mg immediate release tablets and 0.23 for the 500 mg slow release tablets. The wholesale cost in 4 countries in the developing world varies from 0.11 to 0.24 per 500 mg tablet as of 2015. The daily defined dose is 2 grams. It is commonly used in IBD in part due to its cost effectiveness.
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