SULFASALAZINE

02 July 2024
Volume 6 · Issue 7

Abstract

In this column, Sharon Rees aims to refresh knowledge and interest in some of the commonly used drugs in a series of posts on X. This month she is talking about #sulfasalazine

Day 1: Convinced that rheumatoid arthritis (RA) had a bacterial cause, Professor Nanna Svartz tested sulfapyridine on her patients. After minimal success, a drug company helped her to combine this with an aspirin-like drug (5-ASA). This compound #sulfasalazine was formed around 1940 & showed efficacy for RA & ulcerative colitis

Day 2: #sulfasalazine is licensed for use for acute treatment & ‘remission maintenance’ for inflammatory bowel disease, as well as active RA. Oral & rectal delivery with dose dependent on acute/remission status & severity. Licensed for adult & children >2, but not for juvenile ideopathic athritis. #sulfasalazine is currently one of the first-line ‘conventional’ DMARDs in RA. As for all DMARDs, effects can take up to 3 months

Day 3: Prodrug #sulfasalazine is too big for intestinal absorption. The active components are released in the colon by action of gut bacteria. 5-ASA is eliminated in faeces, but sulfapyridine is systemically absorbed & liver metabolism occurs mainly acetylation. Renal excretion; t½ ~8hrs. Genetic variation for slow acetylators can be issue as prolonged time to eliminate the sulfapyridine component increases risk of adverse effects (t½ ↑ 14+hrs). For all, renal impairment/elderly may need dose reduction. Avoid in severe impairment

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