sulfasalazine

Sulfasalazine is a sulfonamide anti-inflammatory drug used to treat inflammatory bowel disease and rheumatoid arthritis. It is a prodrug that is cleaved in the colon by bacterial enzymes into sulfapyridine and 5-aminosalicylic acid (5-ASA). The 5-ASA component is thought to provide local anti-inflammatory effects in the intestinal mucosa, while sulfapyridine contributes systemic activity but is largely responsible for many adverse effects.

Medical uses include induction and maintenance therapy for ulcerative colitis and, to a lesser extent, Crohn’s disease. It is also prescribed as a disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis, either alone or in combination with other agents. In Crohn’s disease, its effectiveness is more limited and it is less commonly used as a primary therapy. The drug may be chosen when both bowel and joint involvement are present or when alternatives are unsuitable.

Administration and safety considerations: sulfasalazine is taken orally in divided doses. The sulfapyridine component commonly drives adverse effects such as nausea, headache, rash, photosensitivity, and hematologic changes (for example, leukopenia or anemia). Folate supplementation is often used to reduce some adverse effects. Rare but serious reactions include hepatotoxicity and hypersensitivity syndromes. Caution is advised in sulfa allergies.

Dosing varies by condition, typically ranging from about 2 to 4 g per day for ulcerative colitis and a similar or slightly lower range for rheumatoid arthritis, adjusted for tolerance and comorbidity. Pregnancy and lactation require medical advice, with care to balance potential benefits against risks.