Makindo Medical Notes

⚠️ Patient advice: Report immediately if rash, sore throat, purpura, bruising, bleeding, fever, or infection symptoms develop. These may signal blood dyscrasias or hypersensitivity.

💊 About: Always check the BNF link here

• 🔹 A combination drug of 5-aminosalicylate (5-ASA) linked to sulphapyridine via an azo bond.
• 🧪 The 5-ASA component → local anti-inflammatory effect in the colon. The sulphapyridine carrier → systemic effects, esp. useful in rheumatoid arthritis.
• 📉 Poor bowel absorption keeps drug concentrated in the gut lumen.

⚙️ Mode of Action

• 🧪 In the colon, gut bacteria split sulfasalazine into: – 5-ASA → reduces prostaglandins & cytokines, ↓ inflammation in IBD. – Sulphapyridine → provides immunomodulatory activity in RA.
• 📍 Dual activity makes it useful in both IBD and rheumatology.

🎯 Indications / Dose

• 🤲 Rheumatoid Arthritis: start 500 mg daily → titrate to 2 g/day PO in divided doses over weeks.
• 💥 Acute UC / Crohn’s colitis: 1–2 g PO 6-hourly in active disease → reduce to 500 mg QDS for maintenance.
• 📍 Rectal formulations (distal UC): – Suppositories: 0.5–1 g BD. – Enemas: 3 g nocte.

🔄 Interactions

• ⚠️ Use cautiously with other bone marrow suppressants (risk of additive toxicity).

⛔ Contraindications

• 🚫 Severe renal or hepatic impairment.
• 🚫 Acute porphyrias.
• ⚠️ G6PD deficiency (risk of haemolysis).
• ⚠️ Allergy, asthma (higher risk of hypersensitivity reactions).
• 🤰 Can be used in pregnancy, but supplement with folic acid (antifolate activity).

⚠️ Side Effects

• 🍽️ GI: nausea, vomiting, diarrhoea, gallstones.
• 🧑‍🧑 Male infertility: reversible azoospermia.
• 🤕 Hypersensitivity: rash, Stevens–Johnson syndrome, interstitial nephritis, lupus-like syndrome.
• 🩸 Haematological: agranulocytosis, aplastic anaemia, neutropenia, thrombocytopenia → urgent FBC if unexplained anaemia, infection, or bleeding.
• 🫁 Pulmonary: fibrosing alveolitis, eosinophilia.
• 🧠 Neurological: depression, peripheral neuropathy.
• 🟠 Cosmetic: orange urine & tears (warn contact lens wearers).

📌 Cautions & Monitoring

• 📊 FBC: every 2 weeks for first 12 weeks, then at least monthly until stable.
• 📊 LFTs: monthly for 12 weeks, then periodically.
• ⚠️ Monitor renal function periodically (U&E, creatinine).
• 👀 Advise patients about early warning signs (rash, sore throat, bleeding, bruising).

📚 References

• Sulfasalazine – BNF
• British Society for Rheumatology Guidelines