Sulfasalazine

All about Sulfasalazine medication ( Uses, MOA, Side effects )

1. SULFASALAZINE
Walaa Fahad Ali Aljuaid .

2. WHAT IS SULFASALAZINE?

3. SULFASALAZINE IS AN ANTI-
INFLAMMATORY AGENT USE TO
RELIVE THE PAIN OF THE
BOWEL DISEASES AND
RHEUMATOID ARTHRITIS AND
OTHER DISEASES .

4. RHEUMATOID
ARTHRITIS?

5. RHEUMATOID ARTHRITIS (RA) :
➤ is an autoimmune disease in
which the body’s immune
system mistakenly attacks the
joints , this creates
inflammation that causes the
tissue that lines the inside of
joints (the synovium) to
thicken, resulting in swelling
and pain in and around the
joints.
REFERENCE : ,Rowland W. (Bing) Chang,2011,
Arthritis Foundation organization,

6. ➤ it can damage cartilage as well as the bones themselves.
➤ Joints can become loose, unstable, painful and lose their
mobility and joint deformity also can occur.
➤Joint damage cannot be reversed, and because it can
occur early, we recommend early diagnosis and aggressive
treatment to control RA.

7. RHEUMATOID ARTHRITIS CAUSES :
➤The cause of RA is not yet fully understood but the doctors
think :
➤Obesity
➤Genetic
➤Trauma
➤Bacterial or viral infections
➤could be the reasons of RA .

8. RHEUMATOID ARTHRITIS SYMPTOMS
➤In the early stages, people with RA may not initially see
redness or swelling in the joints, but they may experience
tenderness and pain.
➤Joint pain, tenderness, swelling or stiffness for six weeks or
longer
➤Morning stiffness for 30 minutes or longer
➤More than one joint is affected
➤Small joints (wrists, certain joints of the hands and feet) are
affected
➤The same joints on both sides of the body are affected .

9. DIAGNOSIS
➤Medical History : ( recent and current symptoms
(pain, tenderness, stiffness, difficulty moving).
➤Physical Examination
➤Blood Tests will measure inflammation levels
(antibodies) (RF)
➤Erythrocyte sedimentation rate (ESR) and C-
reactive protein (CRP) level
➤Radiological .
➤2010 Rheumatoid Arthritis Classification Criteria

11. TREATMENT

12. ➤The goals of rheumatoid arthritis (RA) treatment are to:
➤Stop inflammation (put disease in remission)
➤Relieve symptoms
➤Prevent joint and organ damage
➤Improve physical function and overall well-being
➤Reduce long-term complications

13. NON-PHARMACOLOGIC
➤Rest, weight
reduction,
physical therapy.
➤Surgery such as
joint replacement
➤Patient education
PHARMACOLOGIC
➤DMARDs ( disease-
modifying antirheumatic
drugs)
➤NSAIDs
➤SAID (Corticosteroids)
TREATMENT

15. BACK TO SULFASALAZINE
REFERENCE :Peppercorn MA "Sulfasalazine. Pharmacology, clinical use, toxicity, and related new drug
development." Ann Intern Med 101 (1984): 377-86

16. SULFASALAZINE
CLASS OF
MEDICATION :
SULFONAMIDE .
DOSES AND
DOSAGE FORM :
ORAL ( TABLET 500 MG ) RECTAL ( ENEMA ) 3 G
MECHANISM OF
ACTION :
THE ACTION OF ANTI-INFLAMMATORY EFFECTS DUE TO 5-
AMINOSALICYLIC ACID SUBSTANCE ( PRODRUG ) , AND IT IS INHIBIT
THE PRODUCTION CYTOKINES AND INFLAMMATORY MEDIATORS .
SIDE EFFECTS :
COMMONLY GASTRIC DISTRESS , HEADACHE , NAUSEA , VOMITING
AND ANOREXIA , INCREASE SENSITIVITY TO SUNLIGHT .

17. SULFASALAZINE
PREGNANCY
CATEGORY :
CATEGORY B , THERE IS NO RISK ON HUMANS BUT USE WITH
CAUTION IN LACTATION BECAUSE IT IS DISTRIBUTE WITH MILK.
TOXICITY :

SULFONAMIDES HAVE BEEN ASSOCIATED WITH RENAL TOXICITY DUE
TO CRYSTALLURIA : NEPHROTIC SYNDROME AND HEMOLYTIC-UREMIC
SYNDROME .
CONTRAINDICATION : THE HYPERSENSITIVITY TO SALICYLATE , INTESTINAL OR URINARY
OBSTRUCTION .
PRECAUTIONS:

SULFASALAZINE MEDICATION SHOULD BE GIVEN WITH CAUTION
TO PATIENTS WITH SEVERE ALLERGY OR BRONCHIAL ASTHMA.

18. ADMINISTRATION :
taking after meal and with adequate fluid intake to prevent
gastric ulcer , crystal urea formation or stone .
take the medication according your doctor instruction , do
not miss doses as possible as you can .

19. IMPORTANT SAFETY INFORMATION:
➤1- avoid the sun or use sunscreen ( sunburn may occur
due to the sulfasalazine increase skin sensitivity to
sunlight ) .
➤2-discoloration of urine or skin into orange-yellow it is
normal .
➤3-Diabetes patients - Sulfasalazine may affect blood suga r
( hypoglycemia )
➤4- elderly patient must take the medication with caution .

20. ➤5- Sulfasalazine should not be used in CHILDREN
younger than 2 years old , safety have not be conformed
➤6- if you take other medication of going to under lab test
or investigation tell your doctor about it .
➤7- if you notice any weird symptoms or skin rash tell your
doctor about it .

21. DRUG INTERACTIONS :
➤1- tacrolimus increase renal toxicity .
➤2- cyclosporine increase renal toxicity and organ transfer
rejection .
➤3- warfarin increase bleeding risk .
➤4- Sodium nitrite due to methemoglobinemia condition
( reduce oxygen transferring capacity ) .
➤5-reduced absorption of folic acid and digoxin

22. ➤1- Ulcerative colitis which is a
disease that causes
inflammation and sores
(ulcers) in the lining of the
large intestine (colon ).
➤Crohn's disease
➤Juvenile arthritis
OTHER USES OF SULFASALAZINE

23. “
There are no secrets to success. It is
the result of preparation, hard work,
and learning from failure.
-Colin Powell

24. THANK YOU