 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
s at Karolinska Institute by Prof. Nanna Svartz. It consists of two agents -- a sulfur (sulfapyridine) and a
salicylate component, 5 amino salicylic acid. The drug is introduced slowly over the first month to avoid
problems of nausea and gastrointestinal irritability - starting 0.5 g daily for one week, then 1 g daily for one
week, then 1.5 g daily for one week, and thereafter 2 g per day. Response takes between 1-6 months. The
dose can be increased to 3 g if inadequate response. An enteric form is advised to further reduce gastric
side effects. A reduction in erosions has been reported with sulphasalazine 25.
Adverse events are reported more in the first three months of use and have a generally low profile with no
long term effects reported 21. The drug is generally well tolerated. Dose reductions are usually effective for
minor side effects.
Mild side effects include:
Gastrointestinal discomfort, with nausea, vomiting, loss of appetite, abdominal pain.
Skin rashes and allergic manifestations are common.
Headaches, mood alterations.
Reduced sperm counts may be seen - reversible.
Rare severe problems requiring drug withdrawal include:
Marrow suppression.
G-6-PD deficiency related anemia with haemolysis.
Nephrotoxicity.
Hepatotoxicity.
Pulmonary toxicity.
Major allergic rashes - including Stevens-Johnson syndrome
Monitoring requires baseline blood count and liver function assessment including especially AST, ALT, GGT
and Urine analysis. The monitoring must be done monthly for 3 months and then every three - six monthly.
Despite low toxicity, only 40-70% of patients are still on the drug at 2 years, and 20 % at 5 years, due to
efficacy and side effect related difficulty.
Pregnancy: No teratogenicity is reported from over 2000 reports of pregnancy on the drug, mainly in
inflammatory bowel disease patients, but it is generally advised that the drug be discontinued in pregnancy
unless considered essential because of severe disease. The drug is considered safe in lactation, with little
sulphasalazine in the milk, and sulfapyridine levels 40% of plasma levels22,23,24.