Azulfadine | Salazopyrin

How Azulfadine | Salazopyrin Works

It is not well understood why Sulfasalazine helps treat autoimmune diseases like arthritis.

The Sulfasalazine molecule is made of two components: 5-aminosalicylate (5-ASA, also known as mesalamine) and sulfapyridine that are bonded together with a type of chemical bond called an azo bond.

5-ASA is an anti-inflammatory that specifically works in the bowels. It is a salicylate similar to aspirin (acetylsalicylic acid). This component and its effectiveness in the bowels helps explain why Sulfasalazine is useful in treating diseases like ulcerative colitis and Crohn’s disease.

Sulfapyridine is a type of sulfa antibiotic. It is thought that this sulfa component of the medication is responsible for the benefits seen in arthritis patients who take Sulfasalazine.

Sulfapyridine is thought to block NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells) a protein complex that plays a role in the immune system response.

In blunting the immune system’s response, Sulfasalazine can help reduce the pain, joint swelling, and stiffness associated with types of arthritis that involve the immune system attacking the body’s own joints.

Side Effects of Azulfadine | Salazopyrin

The most common side effect of Sulfasalazine is nausea and feeling unwell. This can get better over time as patients get used to the medication. It can be helpful for patients to drink lots of water while taking this medicine.

MORE COMMON side-effects include:

  • Nausea, diarrhea, and abdominal pain
  • Headaches or slight dizziness
  • Rash – Patients should stop the medicine and let their doctor know if they develop a rash

RARE side-effects include:

  • Sensitivity to the sun – Patients are advised to wear sunscreen
  • Liver – Sulfasalazine can rarely irritate the liver. This does not usually cause symptoms but may be found on blood tests. Damage is rare and usually reversible when regularly monitored with monthly blood tests.
  • Blood Counts – Sulfasalazine can cause a drop in the numbers of white blood cells (which are needed to fight infection), red blood cells (which carry oxygen), and platelets (which help to stop bleeding). With regular blood tests, it is unusual for this to be a serious problem.
  • Fertility – Sulfasalazine may cause a drop in the sperm count resulting in temporary infertility. This reverses when the medication is stopped.
  • Kidneys – Sulfasalazine may rarely irritate the kidneys.
  • Urine may turn slightly orange

Patients should tell their doctor if they are concerned about any side effects.

Sulfasalazine can simply be stopped and doesn’t need to be weaned off. However, a patient’s arthritis may “flare” after they stop taking this medicine.

Who Should NOT Take Azulfadine | Salazopyrin

Patients who should NOT be taking Sulfasalazine include:

  • Patients who have had a prior serious allergic reaction to Sulfasalazine
  • Patients who have an allergy to medications containing Sulfa
  • Patients who have an allergy to ASA (acetylsalicylic acid = Aspirin).

When to Call a Doctor

Patients should call their doctor if they feel sick and want to stop, or they you are concerned about any side effects.

Other reasons to call a doctor while taking Sulfasalazine include:

  • Development of a rash
  • Becoming pregnant or planning pregnancy

Azulfadine | Salazopyrin Video

Watch Dr. Andy Thompson, a Canadian rheumatologist, introduce Azulfadine | Salazopyrin.