Sulfasalazine metabolizes to sulfapyridine. Serum levels should be monitored every three months, and more frequently at the outset. Serum levels above 50 μg/L are associated with side effects. In rare cases, sulfasalazine can cause severedepression in young males. It can also cause oligospermia and temporaryinfertility. Immunethrombocytopenia has been reported.[12]
Sulfasalazine can cause kidney stones.[18]Sulfasalazine may cause stomach upset,nausea, vomiting, loss ofappetite, headache,dizziness, or unusual tiredness.[5] Skin and urine can become orange, with occasional allergic reactions.[19][5]
Around 90% of a dose of sulfasalazine reaches the colon, where most of it is metabolized by bacteria intosulfapyridine andmesalazine (also known as 5-aminosalicylic acid or 5-ASA). Both metabolites are active; most of the sulfapyridine is absorbed and then further metabolized, but most mesalazine is not, and remains in the colon.[3]
A mix of unchanged, hydroxylated, and glucuronidated sulfapyridine is eliminated in urine, as is acetylated mesalazine and unmetabolized sulfasalazine.[3][2]
In people with rheumatoid arthritis, thecost-effectiveness of sulfasalazine is improved by combining it with other drugs.[22] It is commonly used in treatinginflammatory bowel disease in part due to its cost effectiveness.[23]
^abcdVallerand AH, Sanoski CA, Deglin JH (5 June 2014).Davis's drug guide for nurses (Fourteenth ed.). Philadelphia.ISBN978-0-8036-4085-6.OCLC881473728.{{cite book}}: CS1 maint: location missing publisher (link)
^abcdefghijk"Sulfasalazine". The American Society of Health-System Pharmacists.Archived from the original on 21 December 2016. Retrieved8 December 2016.
^Hamilton R (2015).Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. p. 464.ISBN9781284057560.
^World Health Organization (2019).World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization.hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^Gupta AK, Ellis CN, Siegel MT, Duell EA, Griffiths CE, Hamilton TA, et al. (April 1990). "Sulfasalazine improves psoriasis. A double-blind analysis".Archives of Dermatology.126 (4):487–493.doi:10.1001/archderm.1990.01670280071013.PMID1690970.
^McGirt LY, Vasagar K, Gober LM, Saini SS, Beck LA (October 2006). "Successful treatment of recalcitrant chronic idiopathic urticaria with sulfasalazine".Archives of Dermatology.142 (10):1337–1342.doi:10.1001/archderm.142.10.1337.PMID17043190.
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