Sulphasalazine (Salazopyrine) - Azulfidine in USA

What is it?
It is a chemical combination of a substance called sulphapyridine (a sulpha antibiotic) and 5-Aminosalicylic acid (5-ASA, an aspirin-like compound) linked by a chemical bond which is split in the colon by colonic bacteria, releasing the active 5-ASA.

The sulphapyridine ensures the active ingredient of the drug (5-ASA) reaches the colon without being broken down in the small intestine.

What is it used for?
It is used for the treatment and maintenance of remission in ulcerative colitis and Crohn's disease affecting the large intestine.

How do I take them?
Salazopyrin is presented in several forms:

Tablet (oval shaped and yellow or brown coloured) These are to be swallowed whole with plenty of water, and are available coated or uncoated.

Suspension Orange-lemon flavoured liquid.

Enema The enemas are used to act directly on the inflammation in left-sided colitis.. Taken last thing at night and to be retained for 1 hour.

Suppository These act directly on recto-sigmoid inflammation Taken morning and night following a bowel movement.

The above medications will be prescribed according to the site and severity of the inflammation and may be used in combination.

Once symptoms have been controlled, you will be given a lower maintenance dose. Although you might feel better, you must continue taking the medication as instructed to prevent the symptoms from coming back.

Are there any precautions?
You should not take this drug if you are allergic to sulphonamides or aspirin. A blood test should be taken every month for 5 months after starting treatment.

Are there any side effects?
Salazopyrin has been known to cause certain side effects in some people. However, some of these tend to only occur when starting the treatment and should soon disappear once tolerance is established, e.g. nausea and headaches. They are usually dose related and it may help to start with a lower dose and build it up.

Most patients experiencing gastric problems with uncoated Salazopyrin improve when switched to the enteric coated version. Other reactions are due to hypersensitivity patients should contact their doctor immediately, e.g. vomiting, stomach pain, skin rashes.

(Unpleasant side effects tend to be associated with the sulphapyridine portion of the drug).

Other reported side effects include:
• Fever
• Anaemia, (possibly due to impaired folic acid absorption)
• Low white blood cells
• Reduced sperm production (reversible on stopping treatment)

It rarely causes:
• Inflammation of the pancreas.
• Inflammation of the liver.
• Kidney damage.
• A worsening of the symptoms of colitis.

Use in pregnancy
Long-term clinical use and experimental studies have shown no adverse effects during pregnancy and the developing foetus.

A small amount does pass into breastmilk, but should not cause any harm to the baby.

Other information
Urine may become orange coloured.
Soft contact lenses may become stained.
In the USA it is known as Azulfidine.
It is recommended that folic acid supplements are taken.

NB: If you have any unexplained bleeding, bruising, sore throat, fever or generally feel unwell whilst taking the treatment, you should see your doctor for a blood test and further advice who may stop the treatment.