Sulphasalazine

Question 1

What are other drugs in the same class as sulphasalazine?

Answer 1

balsalazide sodium
mesalazine
olsalazine sodium

Question 2

What is the name given to the class of sulphasalazines?

Answer 2

aminosalicylates

Question 3

What is sulphasalazine indicated for?

Answer 3

Rheumatoid arthritis, unresponsive to NSAIDs

Inflammatory bowel disease as an antidiarrhoeal

Question 4

What is the mechanism of action of sulphasalazine?

Answer 4

Inhibits prostaglandin and leukotriene synthesis, thus decreasing pain and inflamamation

Question 5

What is the place of therapy for sulphasalazine in rheumatoid arthritis?

Answer 5

To treat patients with mild-mod disease,
to treat patients intolerant to MTX,
to treat patients part of triple therapy (with MTX and hydroxychloroquine)

Question 6

What is the dose regimen of sulphasalazine for rheumatoid arthritis ?

Answer 6

0.5g daily.

increase by 500mg every week to

1g three times daily if inadequate.

Question 7

What are the precuations of sulphasalazine?

Answer 7

Pregnancy class A but there is a theoretical risk of neonatal haemolysis in 3rd trimester. Give mother adequate folic acid supplements.

Compatible with breastfeeding but may cause diarrhoea in infant.

History of allergy, asthma, G6PD deficiency, slow acetylator status, risk of haemotological and hepatic toxicity.

Question 8

What are the adverse effects with sulphalazine use?

Answer 8

GI: anorexia, nausea, vomiting, diarrhoea
Dermalogic: rash, urticaria,
Haematologic: leukopenia, agranulocytosis (rare)
Hepatic: elevated enzymes

Question 9

can any of the adverse effects associated with sulphalazine use be minimised?

Answer 9

Yes. GI efects can be minised by starting on low doses, and dividing the dose more evenly throughout the day.
Can also take the drug with food.

Question 10

What are the contraindications of Sulphasalazine use?

Answer 10

hypersenstivity to salicylates, sulfonamides.
In children <2 years of age
in patients with acute porphyria. (rare metabolic disorder which affects the production of heme)

Question 11

What are the alarm bells associated with sulphasalazine use?

Answer 11

Monitor renal function before initiating treatment, again at 3 months into treatment and then annually if no renal impairment.

LFTs will be elevated in blood tests.