"Sulfasalazine": instructions for use, analogues

“Sulfasalazine” is an anti-inflammatory antimicrobial drug prescribed for symptoms of ulcerative colitis and for Crohn’s disease. The peculiarity of the drug is its high efficiency and ease of administration. Before use, be sure to read the instructions for “Sulfasalazine”.

Dosage form and composition

Sulfasalazine is produced in the form of tablets having a round biconvex shape. The shell of the tablets has a yellow or brown tint. The smell is characterized as specific, the taste of the tablet is bitter.

The medicine is sold in different containers:

• Can be packaged in plastic blisters for 10 tablets. 5 sulfasalazine blisters and instructions are placed in a cardboard package.
• Another packaging option is a plastic bottle with 10-100 tablets.

The composition of these tablets contains the main active substance and auxiliary components.

In the list of basic elements: sulfasalazine in an amount of 500 mg. This substance has a second name - salazosulfapyridine.

Additional components of the composition are:

• magnesium stearate;
• povidone;
• propylene glycol;
• colloidal silicon dioxide anhydrous;
• pregelatinized starch;
• hypromellose.

“Sulfasalazine” and “Sulfasalazine EN”: differences

According to the composition and instructions for use, “Sulfasalazine EN” does not differ from “Sulfasalazine”. The only feature of this form of medication is the presence of a soluble smooth coating. This indicator affects the absorption and bioavailability of the active substance. The cost of the drug also varies. Enteric-coated tablets are manufactured by an American company, which explains the high cost of the drug.

pharmachologic effect

According to the instructions for use with “Sulfasalazine”, when a tablet enters the intestine under the influence of microflora, the active substance breaks down into 2 components:

• mesalazine (also has another name: 5-aminosalicylic acid) - has an anti-inflammatory effect;
• sulfapyridine - has an antimicrobial effect.

You can use this medication if the following pathological microorganisms are the causative agents of the disease:

• diplococci;
• streptococci;
• gonococci;
• E. coli.

Pharmacokinetics

Sulfasalazine absorption in the intestine is weak (about 10% of the total substance). Binding to plasma proteins is not uniform: for 5-ASA it is 43%, for sulfapyridine this indicator reaches 50%, for sulfasalazine - 99%.

After the substance enters the liver, the biotransformation process begins, as a result of which inactive metabolites are formed.

Withdrawal of the drug occurs through the intestines and through the kidneys. Duration of excretion is 3 days.

Indications for use

According to the instructions, “Sulfasalazine” is prescribed to patients with the following pathologies:

• Crohn's disease (in case of mild forms of the disease and moderate forms with symptoms of exacerbation);
• nonspecific ulcerative colitis - for therapeutic purposes with exacerbation and as a support agent during remission;
• rheumatoid juvenile arthritis;
• rheumatoid arthritis.

Scheme of use for adult patients

The dosage and frequency of use are selected taking into account the features (diagnosis and severity of symptoms). The doctor makes an appointment after a thorough diagnosis of the patient. Self-administration is not recommended.

Food does not have a significant effect on the absorption rate of the active components, therefore, it is not of fundamental importance when to take the prescribed dose of the drug (before or after a meal). Do not share the tablet or grind it. The tablet is swallowed and washed down with a glass of water.

Treatment of ulcerative colitis and Crohn's disease

With symptoms of Crohn’s disease and with exacerbation of ulcerative colitis, adult patients are often prescribed 4 times a day taking “sulfasalazine” with an increase in dosage:

• 1 day - 1 tablet (2 g per day).
• 2 day - the dosage is increased to 2 tablets per day.
• 3, 4 and all subsequent days there is an increase in dosage to 3 or 4 tablets (daily dose of 6-8 g).

In this amount, the drug is taken until the patient's condition stabilizes and the symptoms disappear. The maximum daily dose is 16 tablets; exceeding this indicator is not recommended.

After stopping the symptoms, the medicine is taken as maintenance therapy, 1 tablet 4 times a day. The course of treatment can last 1-3 months.

Rheumatoid arthritis treatment

For adult patients and children over 16 years of age, with the symptoms of rheumatoid arthritis, the following regimen is prescribed:

• 1 week - the medicine is taken 1 tablet 1 time per day;
• 2 weeks - increase the number of doses (1 tablet twice a day);
• 3 weeks - 1 tablet 3 times a day.

Thus, you can increase the daily dosage to 3 g. The course of treatment lasts an average of 6 months.

Children's dosage

In the instructions to “Sulfasalazine” manufacturers indicate the recommended schedule of appointments for children 5-17 years old.

For the treatment of Crohn's disease and colitis:

• Children 5-7 years old are recommended to take 0.25-0.5 g of the drug 3-6 times a day.
• For children 7-16 years old, the dosage can be increased - taking 1 tablet 3 or 4 times a day.
• Children 16-18 years old can take an adult dose of the medicine.

The maximum daily dosage should not exceed 4 tablets.

“Sulfasalazine” for colitis and Crohn’s disease in children is prescribed only for the purpose of treatment. Maintenance therapy is not provided.

For the treatment of juvenile and rheumatoid arthritis

As in previous cases, the frequency and single dosage depend on the age of the child:

• 6-7 years - twice a day for 1 tablet of the drug;
• 8-12 years - at the discretion of the doctor 2 or 3 times a day, 1 tablet;
• 12-16 years old - 1 tablet three times a day (you can use another scheme: 2 tablets twice a day).

The maximum daily dosage for children is 2 g of the drug. Such a volume is indicated in the official instructions for “Sulfasalazine”. Reviews confirm that children easily take and tolerate the medicine.

Side effects

Most patients tolerate treatment with this drug well. However, side effects are possible:

• disorders of the lymphatic and circulatory system (neutropenia, leukopenia, macrocytosis, anemia, thrombocytopenia, agranulocytosis);
• headaches, cramps, dizziness, peripheral neuropathy, ataxia;
• cough, dyspnea, pulmonary infiltration, very rarely fibrous alveolitis;
• tinnitus;
• hematuria (blood impurities in the urine), crystalluria, nephrotic syndrome, proteinuria;
• bouts of nausea and vomiting, stomatitis, pancreatitis, mumps, diarrhea;
• oligospermia (reversible), male infertility (reversible);
• hepatitis, staining of the skin and urine in yellow;
• insomnia, depression, rarely hallucinations;
• rarely, periorbital swelling, epidermal toxic necrolysis, serum sickness, Stevens-Johnson syndrome;
• multiform exanthema, sensitivity to light, redness, itching and urticaria.

When one or another named symptom is detected, the patient should consult a doctor. Depending on the severity of side effects and the form of the disease, the question of replacing the drug or continuing the course will be decided. Mild symptoms resolve themselves several days after the start of treatment.

Overdose

According to reviews and instructions for the use of “Sulfasalazine”, if you follow the doctor’s recommendations and the dosage regimen, the drug is well tolerated by both adult patients and children. If the therapeutic dose is exceeded, the following symptoms are possible:

• bouts of severe nausea;
• vomiting
• epigastric pain;
• crystalluria;
• anuria
• hematuria;
• cramps.

To block symptoms and normalize the condition appoint:

• gastric lavage in order to reduce the absorption of the drug;
• forced diuresis;
• reduced intake of fluid and electrolytes in the body (if serious kidney pathologies are detected.

Contraindications

To prevent complications, the drug is not recommended for patients with the following pathologies and conditions:

• children 0-5 years old;
• in the presence of serious violations of the kidneys and liver;
• during lactation;
• in case of individual hypersensitivity to the components of the drug;
• with a deficiency of the enzyme glucose-6-phosphate dehydrogenase;
• in the presence of anemia and porphyria.

Analogs of “Sulfasalazine”

With the instructions for the drug, indications, contraindications and features of the reception, we figured out. The question of substitutes for the drug remained unresolved. The only generic drug for this drug is Sulfasalazine EN.

In the list of drugs whose active substance is mesalazine, Salofalk should be called. It can be purchased in the form of tablets, suppositories, foams and suspensions.

Mesacol is another analogue of Sulfasalazine. Instructions for use recommend this drug for Crohn's disease.

To stop the symptoms of ulcerative colitis, doctors often prescribe Asakol and Pentasa. They have a similar effect to the described medicine.

These drugs differ in composition, features of action and recommended dosages. For this reason, before replacing, consult a doctor for advice.