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What is this medication?

Sulfasalazine, Salazopyrin/Azulfidine
5-Aminosalicylic Acid Derivative

Officially indicated to treat juvenile rheumatoid arthritis, rheumatoid arthritis, and ulcerative colitis.

How does this medication work?

Sulfasalazine, Salazopyrin/Azulfidine is a 5-aminosalicylic acid derivative that has anti-inflammatory properties.  The exact mechanism of action is unknown; but it is thought to modulate local inflammatory mediators such as leukotrienes and tumor necrosis factor.

How should I take this medication?

Rheumatoid Arthritis
Oral (Delayed Release): Take 500mg once daily or 1000mg in two divided doses.  The maximum daily dose is 3000mg daily.

Ulcerative Colitis
Oral (Immediate and/or Delayed Release): Initial, take 3000mg to 4000mg daily in divided doses at < 8-hour intervals; Doses greater than 4000mg daily can increase the risk of toxicity.

*If GI intolerance occurs, reduce the dose by 50% and gradually increase the dose back to the target dose.  If GI intolerance persists, stop therapy for 5 to 7 days and start again but at a lower daily dose.

How to Take Sulfasalazine, Salazopyrin/Azulfidine:  The tablets should be taken in evenly divided doses after meals to reduce gastric irritation.  Tablets that are delayed release should be swallowed whole.

What should I watch for while using this medication?

Do not use in patients with a “sulfa allergy” due to cross-allergy potential

Use in extreme caution in patients with blood dyscrasias

Be watchful of dermatologic reactions including Stevens-Johnson syndrome (SJS), exfoliative dermatitis and toxic epidermal necrolysis (TENS)

Can cause hepatotoxicity and infections

Be Watchful of Children Taking Sulfasalazine, Salazopyrin/Azulfidine: Children who are being treated for juvenile arthritis should be carefully monitored for additional adverse reactions such as serum-sickness-like reaction which presents as a fever, nausea, vomiting, headache, rash and changes in their liver enzymes.  If serum-sickness-like reaction is suspected/occurs discontinue use of Sulfasalazine/Azulfidine, Salazopyrin.

What if I miss a dose?

If you miss a dose of medication, try to take it as soon as possible.  However, if it is almost time for your next dose, take only that scheduled dose.  Do not take double or extra doses.

How should I store this medication?

Keep out of the reach of children at all times.  Store at room temperature, 59 to 86° F (15 to 30° C).  Protect from light.  Keep the container tightly closed.  Properly dispose of any unused medication after the expiration date.

What are the possible side effects of using this medication?

Has an extensive side effect profile which can be accessed through an official drug monograph.  The most common side effects include:


Dermatologic: Skin rash (RA 13%)

Gastrointestinal: Nausea (RA 19%), dyspepsia (RA 13%), anorexia, gastric distress, vomiting

Genitourinary: Oligospermia (reversible)

Nervous System: Headache (RA 9%)