Inflammatory bowel disease, Rheumatoid arthritis
Should be taken with food. Take after meals. Ensure adequate fluid intake.
Oral Inflammatory bowel disease Adult: Initially, 1-2 g 4 times daily until remission occurs. Maintenance: 2 g/day in divided doses. Rheumatoid arthritis Adult: As enteric-coated tablet: Initially, 500 mg daily for the 1st wk increased by 500 mg every wk. Max: 3 g daily in 2-4 divided doses. Rectal Inflammatory bowel disease Adult: As suppository: 0.5-1 g in the morning and night, either alone or as an adjunct to oral treatment. Hepatic impairment: Avoid use.
Oral Inflammatory bowel disease Child: >2 yr: 40-60 mg/kg/day in divided doses. Maintenance: 20-30 mg/kg/day in divided doses. Rheumatoid arthritis Child: For polyarticular juvenile rheumatoid arthritis: >6 yr: As enteric-coated tablet: 30-50 mg/kg/day in 2 divided doses. Begin treatment with 1/4 to 2/3 of expected maintenance dose and increase wkly to reach maintenance dose in 1 mth. Max: 2 g daily. Rectal Inflammatory bowel disease Child: As suppository (may be given as divided doses): 5-8 yr: 500 mg bid; 8-12 yr: 500 mg in the morning and 1 g at night; 12-18 yr: 1 g bid.
Renal impairment: CrCl (ml/min) Dosage Recommendation 10-30ml/min Admin twice daily. <10ml/min Admin once daily.
Hypersensitivity to sulphonamides or salicylates, porphyria, <2 yr of age, intestinal or urinary obstruction, blood dycrasias, history of leucopenia with gold therapy.
Actual mechanism not determined. Sulphasalazine may have direct anti-inflammatory action in the colon. It also systemically interferes with secretion by prostaglandin synthesis inhibition.
Hepatic/renal impairment, G6PD deficiency, allergic bronchial asthma, lactation. Lactation: Excreted into human breast milk; caution with breastfeeding, some reports of bloody stools or diarrhea in human milk fed infants of mothers taking sulfasalazine
>10% Anorexia (~33%),Headache (~33%),Nausea (~33%),Vomiting (~33%),Gastric distress (~33%),Apparently reversible oligospermia (~33%) <1% Skin rash,Pruritus,Urticaria,Fever,Heinz body anemia,Hemolytic anemia,Cyanosis Potentially Fatal: Severe hypersensitivity reactions, blood dyscrasias, renal and hepatic toxicity, fibrosing alveolitis.
Pregnancy category: B; D if used for prolonged periods or near term; increased potential for kernicterus in the newborn
Plasma levels reduced by rifampicin and ethambutol. Interferes with absorption of folic acid. Additive leucopaenia with gold therapy for rheumatoid arthritis. Increased haematological toxicity with azathioprine. Reduced serum levels of digoxin.