Home Drug Guide Sulfasalazine

Drug Guide

Generic Name

Sulfasalazine

Brand Names Azulfidine, Azulfidine En-tabs, S.a.s.-500

Classification

Therapeutic: Anti-inflammatory, Disease-modifying antirheumatic drug (DMARD)

Pharmacological: Immunomodulator, Anti-inflammatory

FDA Approved Indications

  • Ulcerative colitis
  • Rheumatoid arthritis

Mechanism of Action

Sulfasalazine is metabolized in the colon to sulfapyridine and 5-aminosalicylic acid (5-ASA). The active metabolites exert anti-inflammatory effects by inhibiting prostaglandin synthesis and suppressing inflammatory mediators, leading to decreased inflammation in the colon and joints.

Dosage and Administration

Adult: Typically, 2-4 g/day in divided doses; dosage varies based on condition and response.

Pediatric: Use is based on weight and clinical response; consult specific guidelines.

Geriatric: Start at lower doses due to potential renal or hepatic impairments; monitor closely.

Renal Impairment: Adjust dose based on severity; monitor renal function.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Moderate oral absorption, subject to variability.

Distribution: Widely distributed; crosses placental barrier but minimal into CSF.

Metabolism: Partially metabolized in the liver, with active metabolites.

Excretion: Excreted primarily in urine; some in feces.

Half Life: Approximately 10 hours.

Contraindications

  • Hypersensitivity to sulfonamides or salicylates
  • History of sulfa allergies
  • Intestinal or urinary tract obstruction

Precautions

  • Use with caution in patients with hepatic or renal impairment, blood dyscrasias, G6PD deficiency, or pregnancy/lactation. Regular blood counts and liver function tests are recommended.

Adverse Reactions - Common

  • Nausea, vomiting (Common)
  • Headache (Common)
  • Rash (Common)

Adverse Reactions - Serious

  • Hematologic reactions (e.g., agranulocytosis, aplastic anemia) (Rare)
  • Liver toxicity, hepatitis (Rare)
  • Uveitis, peripheral neuropathy (Rare)

Drug-Drug Interactions

  • Methotrexate (risk of hematologic toxicity)
  • Warfarin (increased anticoagulant effects)

Drug-Food Interactions

  • Avoid Alcohol (may increase hepatotoxicity)

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts, liver and renal function tests regularly.

Diagnoses:

  • Risk for gastrointestinal disturbances
  • Risk for hematologic abnormalities

Implementation: Administer with food to decrease GI upset. Educate patients about potential side effects.

Evaluation: Assess for improvement in symptoms and monitor labs for adverse effects.

Patient/Family Teaching

  • Take medication with food to minimize GI discomfort.
  • Report signs of allergic reactions, unusual bleeding, fatigue, or jaundice.
  • Maintain regular lab monitoring appointments.

Special Considerations

Black Box Warnings:

  • Hematologic reactions including agranulocytosis and aplastic anemia, which can be fatal.

Genetic Factors: G6PD deficiency can increase risk of hemolytic anemia. Consider screening before initiation.

Lab Test Interference: May cause false-positive tests for glucose or ketones in urine.

Overdose Management

Signs/Symptoms: Gastrointestinal distress, vomiting, dizziness, and hematologic abnormalities.

Treatment: Supportive care; hemodialysis may be considered in severe cases.

Storage and Handling

Storage: Store at room temperature away from moisture and heat.

Stability: Stable under proper storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.