Sulfasalazin

Sulfasalazin is a synthetic sulfonamide anti-inflammatory medication used mainly for inflammatory bowel disease and certain rheumatic conditions. It is a prodrug consisting of 5-aminosalicylic acid (5-ASA) linked to sulfapyridine by an azo bond. When taken orally, colonic bacteria cleave the bond, releasing 5-ASA in the colon and sulfapyridine systemically.

Indications include ulcerative colitis and Crohn’s disease with colonic involvement; it is also used for rheumatoid arthritis and some juvenile idiopathic arthritis cases, typically when other treatments are inadequate or as part of combination therapy.

Administration and dosing vary by indication and patient factors. Typical regimens range from 2 to 4 g per day in divided doses for inflammatory bowel disease; for arthritis, similar daily totals are used, adjusted for tolerance, renal and hepatic function. It is usually taken with food to reduce gastrointestinal upset.

Adverse effects include nausea, dyspepsia, headache, and rash. Because the drug contains a sulfonamide component, hypersensitivity reactions, cytopenias, hepatotoxicity, and pancreatitis can occur. Folate antagonism may contribute to anemia; folic acid supplementation is sometimes advised.

Contraindications include known hypersensitivity to sulfas or other sulfonamides; caution is advised in patients with sulfa allergy and during pregnancy; potential interactions with anticoagulants and other medicines require monitoring.

Brand names include Azulfidine and Salazopyrin; regional formulations vary. It remains in use in some settings, particularly where access to newer therapies is limited.