Immune Conditions

Question 1

What are the indications of sulfasalazine and their doses?

Answer 1

-Treatment of acute attack ulcerative colitis (any severity)= 1–2 g 4 times a day until remission
-Then, maintainence of remission= 500 mg 4 times a day

-Active rheumatoid arthritis= Initially 500 mg OD, increased in steps of 500 mg every week, up to 2–3g OD

Question 2

What are some of the cautions with sulfasalazine?

Answer 2

-G6PD deficiency
-History of allergy (salicylate)
-Asthma
-Haematological toxicity (rbc/ bone marrow suppression)

Question 3

What are some of the contraindications of sulfasalazine?

Answer 3

-Preggers
-Breastfeeding
-Salicylate hypersensitive

Question 4

What are some of the monitoring requirements for sulfasalazine?

Answer 4

-Renals- before, 3 months, then annually.
-Full blood count- before, monthly for 3 months
-Liver- monthly for 3 months

Question 5

Side effects of sulfasalazine?

Answer 5

Arthralgia, urine discolouration, cough, bone marrow disorders + blood disorders, taste alterations, photosensitivity, tinnitus, men’s infertility (reversible), pulmonary + hepatic dysfunction.
*report= fever, sore throat, purpura, bruise, bleeds

Question 6

What are some of the drug interactions for sulfasalazine?

Answer 6

-Statins, tetracyclines, antifungals & MTX, = hepatotoxicity
-Chemotherapeutic agents= myelosuppression
-Decreases folic acid and digoxin absorption

Question 7

What are the indications of sulfasalazine and their doses? And how are they different to sulfasalazine?

Answer 7

-Treatment of acute mild-mod ulcerative colitis attack= 2.4 g daily in divided doses
*Mesal. only for mild-mod UC attacks, sulfa. for any severity.
*mesal. has much lower max daily dose for this indication of 2.4g, but sulfa. goes up to 8g.

-Maintenance of remission of ulcerative colitis and Crohn’s ileo-colitis= 1.2–2.4 g daily in divided doses
* mesal used for UC attacks and crohns remission, sulfa only for UC attacks and arthritis.

Question 8

What are some of the cautions with mesalazine? And how is it different to sulfasalazine?

Answer 8

-Breastfeeding
-Elderly, adequate fluid intake, pulmonary disease
*mesal is okay in pregnancy, but sulfa. is NOT.

Question 9

Side effects of mesalazine?

Answer 9

-Arthralgia, cough, bone marrow disorders + blood disorders, photosensitivity, men’s infertility (reversible), pulmonary + hepatic dysfunction

Question 10

What are some of the contraindications of mesalazine?

Answer 10

Blood clotting abnormalities, salicylate hypersensitivity, severe liver + renal impairment

Question 11

What are some of the monitoring requirements for mesalazine?

Answer 11

Renals- before, 3 months, annually

Question 12

What are some of the drug interactions for mesalazine?

Answer 12

Preparations that lower stool pH (e.g. lactulose) might prevent the release of mesalazine