Sulfasalazine

synonym

Salazosulfapyridine

Active ingredient

Sulfasalazine is an anti-inflammatory drug that is used to treat various medical conditions. In the intestine, sulfasalazine is metabolized into its two breakdown products, mesalazine and sulfapyridine. The drug requires a prescription.

application areas

Sulfasalazine is used for treatment inflammatory bowel disease (e.g. Crohn's disease and Ulcerative colitis), as well as in the therapy of chronic polyarthritis used.

The drug is used both for therapy acute flare-ups, as well as for the Long-term use suitable.

Contraindication

Sulfasalazine is allowed Not be used in patients who have a Allergy to sulfonamides or salicylates to have. In addition, the drug must not be used in cases of intestinal obstruction, porphyria (congenital blood formation disorder), deficiency white blood cells (Leukopenia), lack of blood platelets (thrombopenia), disorders of blood-forming organs, as well as severe liver- and Kidney dysfunction can be used.

Take special care is also advisable for patients who have a Have a tendency to allergies or asthma or under mild liver or kidney problems Suffer. These patients are only allowed to take sulfasalazine precise medical control and weighing the risks.

Mechanism of action

Sulfasalazine can only be used by the body when taken orally heavily absorbed become. Therefore, it reaches the in almost unchanged form Large intestine. There it is finally through the metabolized endogenous intestinal bacteria and split into its effective end products. In this form it can then develop its effect.
Sulfasalazine acts by inhibiting the arachidonic acid metabolism anti-inflammatory, since arachidonic acid normally produces inflammatory substances. In addition, sulfasalazine has one immunosuppressive effect. In most patients, it follows about three months of therapy to a definite improvement of the symptoms.

dosage

Usually the dose of the drug slowly increased and adapted to the needs of the patient. This is decided by the attending physician. The Therapy must be long-termto get a good clinical result. If the treatment is stopped prematurely, a renewed worsening of the clinical picture can be expected.

Side effects

During therapy with sulfasalazine you can various side effects occur. For example, it can be too Diarrhea, dizziness, headache, rash, inflammation of the heart muscle (myocarditis), inflammation of the pancreas (Pancreatitis) and Kidney problems come. The Liver enzymes can increase in the blood (Increase in transaminases) and the blood count may change during therapy.
It can be that individual rows of blood cells decreased such as a decrease in red blood cells (anemia) or platelets (Thrombopenia).

In rare cases this can also lead to a Agranulocytosis come, i.e. to a lack of certainty white blood cells (the granulocytes), which can be dangerous under certain circumstances. In some cases, the Sperm production in men on sulfasalazine therapy reduced so that there may be an inability to conceive during this period.
After the end of therapy, however, this condition usually recovers within two to three months. Sulfasalazine does not affect fertility in women.
Should strong side effects occur is the Immediately terminate therapy with sulfasalazine and not to be carried out again in the future.

Interactions

If you take other medications at the same time, the Effectiveness of sulfasalazine impaired become. This applies, for example, to the Antibiotics Neomycin, rifampicin, ampicillin and ethambutol, as these lead to the intestinal bacteria no longer breaking down the drug sufficiently. The full effect is then no longer guaranteed.
When taking Iron supplements against iron deficiency, the absorption of sulfasalazine in the intestine may be reduced. This also applies to certain Lipid lowering agents (Cholestyramine, Cholestipol), as these bind sulfasalazine in the intestine and thus hinder its absorption.

The Therapy with sulfonylureas at Type 2 diabetes mellitus can taking sulfasalazine act intensifiedso that it leads to an excessive blood sugar decrease with Hypoglycemia (Hypoglycaemia) can occur. Sulfasalazine can also die Admission of the drug digoxin (used to treat heart failure) reduceso that it loses its effectiveness. Digoxin and sulfasalazine should therefore not be taken at the same time but a few hours apart.

Pregnancy / lactation

Generally a Pregnancy should be avoided if possible during therapy with sulfasalazine. Especially in first third pregnancy is one Harm to the child not be ruled out.
However, women who are / become pregnant while on sulfasalazine therapy must be sure to take folic acidas their absorption is reduced by the drug.

However, folic acid is essential for the development of the unborn child, so that it is essential to ensure that it is supplied adequately. In principle, the baby can be breastfed despite treatment with sulfasalazine. The attending physician should provide a Weighing the risks and benefits respectively.