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Sulfasalazine Coupon - Sulfasalazine 500mg tablet

sulfasalazine

Generic Azulfidine
Used for Ulcerative Colitis
Used for Ulcerative Colitis

Sulfasalazine (Azulfidine) is an anti-inflammatory medication that comes in immediate-release and delayed-release tablets. Both formulations are used to treat ulcerative colitis (UC). The delayed-release tablets can also be used for rheumatoid arthritis (RA). Adults and children 6 years and older can take sulfasalazine (Azulfidine). It's best to split your total daily dose into a few smaller doses throughout the day. This medication can commonly cause stomach problems, such as nausea and indigestion, as side effects.

Reviewed by:
reviewer
Ally Tsai, PharmD
reviewer
Allison Gourley, PharmD
Last reviewed on January 3, 2024
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsImagesReferencesPricesMedicare
basics-icon

What is Sulfasalazine (Azulfidine)?

What is Sulfasalazine (Azulfidine) used for?

  • Ulcerative colitis (UC) - immediate-release and delayed release tablets

  • Rheumatoid arthritis (RA) - delayed-release tablets only

  • Polyarticular juvenile rheumatoid arthritis - delayed-release tablets only

How Sulfasalazine (Azulfidine) works

Sulfasalazine (Azulfidine) is an anti-inflammatory medication. It's also considered a disease-modifying antirheumatic drug (DMARD) for treating rheumatoid arthritis.

It's not completely clear how sulfasalazine (Azulfidine) works. But it's thought to break down in the body into chemicals called sulfapyridine and 5-aminosalicylic acid. These chemicals help block certain processes in the immune system, which lessen inflammation and pain.

Drug Facts

Common BrandsAzulfidine, Azulfidine EN-tabs
Drug ClassAnti-inflammatory
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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What are the side effects of Sulfasalazine (Azulfidine)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

For UC:
  • Nausea (33%)
  • Vomiting (33%)
  • Stomach upset (belly pain and cramping; 33%)
  • Low appetite (33%)
  • Headache (33%)
For RA (delayed-release tablets only):
  • Nausea (19%)
  • Indigestion (13%)
  • Headache (9%)
  • Belly pain (8%)
  • Vomiting (8%)
  • Fever (5%)

Other Side Effects

  • Urine or skin turning orange or yellow
  • Nerve pain
  • Depression
  • Hair loss
  • Hearing loss
  • Ringing in the ear
  • Dizziness
  • Drowsiness
  • Trouble sleeping

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious infections: fever, cough, chills, sore throat, runny or stuffy nose, body aches
  • Severe allergic or skin reaction: itching, rash, blistering or peeling of skin, hives, painful sores in your mouth or around your eyes, fever, trouble breathing, swollen lymph nodes
  • Serious bleeds: bleeding that's difficult to stop, vomiting blood, blood in the urine or stool, "coffee-ground" stool
  • Kidney problems: feeling sick, weak, or confused; dehydration; urinating less than usual; blood in urine; swelling in the legs, ankles, or feet
  • Liver problems: nausea, vomiting, not feeling hungry, pain in the right side of the stomach, yellowing of the whites of the eyes or skin, dark-colored urine, light-colored stool

Source: DailyMed

The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

Aching of joints

fever

headache (continuing)

increased sensitivity of the skin to sunlight

skin rash or itching

vomiting

Less common

Back, leg, or stomach pains

bleeding gums

bluish color of the fingernails, lips, skin, palms, or nail beds

chills

dark urine

difficulty breathing

fever

general body swelling

headache

loss of appetite

nausea

nosebleeds

pale skin

sore throat

troubled breathing with exertion

unusual bleeding or bruising

unusual tiredness or weakness

yellowing of the eyes or skin

Less common or rare

Aching of muscles

black, tarry stools

blistering, peeling, or loosening of the skin

bloating

blood in the urine or stools

bloody diarrhea

bluish fingernails, lips, or skin

chest pain

constipation

cough

difficulty with swallowing

dizziness

fainting spells

fast heartbeat

general feeling of discomfort or illness

general tiredness and weakness

hives

indigestion

inflammation of the joints

irregular heartbeat

light-colored stools

muscle aches

muscle cramps or spasms

muscle pain or stiffness

painful or difficult urination

pains in the stomach, side, or abdomen, possibly radiating to the back

pinpoint red spots on the skin

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

rash

red skin lesions, often with a purple center

red, irritated eyes

redness, blistering, peeling, or loosening of the skin

sores, ulcers, or white spots in the mouth or on the lips

swollen or painful glands

tightness in the chest

upper right abdominal or stomach pain

Incidence not known

Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Abdominal or stomach pain or upset

decreased weight

Less common

Welts

Less common or rare

Discoloration of the skin or urine

hair loss or thinning of the hair

swelling or inflammation of the mouth

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

pros-and-cons

Pros and cons of Sulfasalazine (Azulfidine)

thumbs-up

Pros

Available as a lower-cost generic medication

Safe to take for children 6 years and older

Available as immediate-release and delayed-release tablets

Delayed-release tablets helpful for people with bothersome stomach upset from the medication

thumbs-down

Cons

Can cause side effects like nausea, vomiting, and stomach upset

Might cause low sperm count

Might require regular blood work and lab tests to make sure your liver, kidneys, and blood counts are healthy and normal

Might not be safe for people with allergies to sulfa drugs, aspirin, or other salicylates

pharmacist-tips

Pharmacist tips for Sulfasalazine (Azulfidine)

pharmacist

  • Swallow sulfasalazine (Azulfidine) whole, particularly delayed-release tablets. Delayed-release tablets are coated to prevent stomach upset from the medication. Don't chew, crush, or split the tablets.

    • Take sulfasalazine (Azulfidine) with food (after a meal) to lower the risk of vomiting, nausea, or stomach problems.

      • Let your provider know if you experience nausea and vomiting while you're taking sulfasalazine (Azulfidine). Your provider might ask you to stop this medication for 5 to 7 days, then restart it at a lower dose.

        • Sulfasalazine (Azulfidine) might cause your urine or skin to turn orange. This side effect is harmless and typically goes away after you stop taking the medication.

          • Sulfasalazine (Azulfidine) can interact with some medications. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start sulfasalazine (Azulfidine). Talk with your provider or pharmacist if you have any questions about whether sulfasalazine (Azulfidine) is safe to take with your other medications.

            • Make sure to get any routine blood and urine tests done on time before and while you’re taking sulfasalazine (Azulfidine). This helps your provider make sure the medication is working for you and not causing side effects.

              faqs

              Frequently asked questions about Sulfasalazine (Azulfidine)

              Does sulfasalazine (Azulfidine) cause cancer?
              In clinical studies, conventional DMARDs, such as sulfasalazine (Azulfidine), haven't been shown to raise the risk of cancer in people with RA. In fact, some studies suggest that sulfasalazine (Azulfidine) might possibly help to slow down the growth of stomach or pancreatic cancer. Please be aware that more research is still needed on the effect of sulfasalazine (Azulfidine) on cancer. Talk with your provider if you have any questions.
              Is sulfasalazine (Azulfidine) an immunosuppressant?
              Some organizations might consider sulfasalazine (Azulfidine) an immunosuppressant, and others might not. This anti-inflammatory medication might not directly affect your immune system. But though rare, it might cause a drop in your white blood cell count in the first few months of treatment. As a result, this can weaken your immune system and raise your risk of serious infections. Talk with your provider if you're concerned about how sulfasalazine (Azulfidine) might affect your immune system.
              How long can you stay on sulfasalazine (Azulfidine)?
              There isn't a set amount of time that you should take sulfasalazine (Azulfidine). In general, you should take sulfasalazine (Azulfidine) for as long as directed by your provider. Don't stop taking this medication, unless you experience serious side effects or an allergic reaction. As long as you're not having bothersome side effects, it's especially important to continue treatment with sulfasalazine (Azulfidine), even if you feel better. Otherwise, your symptoms might come back or worsen. Follow up with your provider to discuss how long you should take sulfasalazine (Azulfidine).
              Does sulfasalazine (Azulfidine) cause weight gain or weight loss?
              Sulfasalazine (Azulfidine) isn't known to cause weight gain or weight loss. But it might cause diarrhea, which can contribute to a little weight loss if the side effect is severe. In addition, this medication can cause nausea and stomach upset, which can lower your appetite and potentially affect your weight. Typically, taking sulfasalazine (Azulfidine) with food can help alleviate nausea, diarrhea, and stomach upset. Let your provider know if your stomach upset doesn't go away or if you're having bloody diarrhea. Your provider might recommend that you temporarily stop taking this medication and restart at a lower dose when you feel better.
              Is sulfasalazine (Azulfidine) a sulfa drug?
              Yes, sulfasalazine (Azulfidine) is a sulfa drug. This means that you might have an allergic reaction to sulfasalazine (Azulfidine) if you're allergic to sulfa medications, such as Bactrim (sulfamethoxazole / trimethoprim). Let your provider or pharmacist know if you've had allergic reactions to any medications in the past.
              Is sulfasalazine (Azulfidine) an NSAID?
              Sulfasalazine (Azulfidine) isn't an NSAID, or a nonsteroidal anti-inflammatory drug. But after you take the medication, it gets broken down in your body into a chemical called 5-aminosalicylic acid (5-ASA). 5-ASA has a similar chemical structure to aspirin, which is an NSAID. Don't take sulfasalazine (Azulfidine) with other NSAIDs, especially aspirin, unless directed by your provider. Otherwise, you might be at higher risk for harm.
              Can you drink alcohol with sulfasalazine (Azulfidine)?
              It's best to avoid or limit drinking alcohol if you're taking sulfasalazine (Azulfidine). This medication can cause stomach problems, such as nausea and vomiting. Drinking too much alcohol while you're taking this medication might worsen these side effects. In addition, if you have UC, drinking too much alcohol can cause your UC symptoms to get worse. Speak with your provider about your drinking habits. Ask your provider for tips on how to lower the amount you consume if you drink alcohol regularly and need guidance on limiting or avoiding alcohol.
              How long does it take for sulfasalazine (Azulfidine) to work?
              How long it takes sulfasalazine (Azulfidine) to work can vary depending on your dose and your medical condition. For RA, it can take several weeks or months for your symptoms to start improving. For UC, studies show that people might start to experience improvement after 2 to 3 weeks of treatment. It's important to continue treatment for your condition, even if your symptoms are better, to prevent flare ups. Make sure to follow up with your provider about how well sulfasalazine (Azulfidine) is working for you.
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              What are the risks and warnings for Sulfasalazine (Azulfidine)?

              Sulfasalazine (Azulfidine) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

              risk-warning

              Risk of liver, kidney, and blood problems

              • Risk factors: History of liver, kidney, or blood problems | Genetic problem called glucose-6 phosphate dehydrogenase deficiency (G6PD deficiency)

                Some people taking sulfasalazine (Azulfidine) have had liver, kidney, or blood problems. In rare cases, these problems can even be fatal. To prevent serious injury to your body, it's recommended that you let your provider know if you have a history of liver damage, kidney injury, or different blood conditions.

                Before starting and during treatment with sulfasalazine (Azulfidine), your provider will order blood work or urine tests to make sure this medication is safe for you. Tell your provider right away if you have bone or muscle pain, pain in your arms or legs, or general weakness that doesn't go away. These might be signs of kidney problems. Also call your provider right away if you have sore throat, fever, pale skin, abnormal bruising, or yellowing of the whites of the eyes or skin. These might be signs of liver or blood problems.

                risk-warning

                Low sperm count

                In some cases, some people who take sulfasalazine (Azulfidine) can have lower sperm counts, which might affect your ability to have children. But this side effect generally goes away once you stop the medication. Make sure to discuss family planning with your provider to find the best anti-inflammatory treatment for you if you're concerned about this side effect.

                risk-warning

                Serious infections

                • Risk factors: History of recurring or long-term infections | Taking immunosuppressants | Having a medical condition that weakens your immune system

                  Some people who've taken sulfasalazine (Azulfidine) reported serious infections, including pneumonia and blood infections. Your provider will check for signs and symptoms of infection before and during treatment to make sure this medication is safe for you. Let your provider know if you have an infection while you're taking this medication. Watch out for symptoms of fever, chills, sweating, trouble breathing, nausea, vomiting, or general weakness.

                  risk-warning

                  Severe skin and allergic reactions

                  • Risk factors: History of allergies to sulfasalazine (Azulfidine), sulfa drugs, or salicylates

                    Sulfasalazine (Azulfidine) can sometimes cause rash and other severe skin reactions. In rare cases, these skin reactions can lead to hospitalization and other complications. The risk is higher if you have a history of allergies to sulfasalazine (Azulfidine), sulfa drugs or salicylates (e.g., aspirin). Get medical care immediately if you have a rash, blistering or peeling skin, painful sores on your face, swelling, or trouble breathing.

                    Note that severe allergic reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS), can sometimes happen with or without a rash. Although these reactions are rare, they can cause organ failure or blood problems. Get medical help right away if you have signs like sudden rash, mouth sores, fever, chills, body aches, or swollen lymph nodes.

                    dosage

                    Sulfasalazine (Azulfidine) dosage forms

                    The average cost for 120 tablets of 500mg of Sulfasalazine (Azulfidine) is $13.70 with a free GoodRx coupon. This is 65.56% off the average retail price of $39.78.
                    tablet
                    Tablet
                    DosageQuantityPrice as low asPrice per unit
                    500mg120 tablets$13.70$0.11

                    Typical dosing for Sulfasalazine (Azulfidine)

                    Ulcerative colitis — immediate-release and delayed-release tablets

                    • Adults: The typical starting dose is 3 to 4 grams by mouth daily, split evenly into doses that are taken up to 8 hours apart. Your provider will then lower your dose to prevent stomach problems. The usual maintenance dose is 2 grams by mouth daily.

                    • Children age 6 years and older: Dosing for children will depend on weight. The dosage starts from a total of 40 mg/kg to 60 mg/kg of body weight by mouth daily, split evenly into 3 or 6 doses throughout the day. The usual maintenance dose is 30 mg/kg of body weight by mouth daily, split evenly into 4 doses in the day.

                    Rheumatoid arthritis — delayed-release tablets only

                    • Adults: The typical dose is 1 gram by mouth twice daily.

                    • Children age 6 years and older: Dosing for children will depend on weight. The dosage starts from a total of 30 mg/kg to 50 mg/kg of body weight by mouth daily, split evenly into 2 doses throughout the day. The maximum total dose is 2 grams daily.

                    Your provider might lower your dose if you have bothersome side effects like stomach upset.

                    interactions

                    Interactions between Sulfasalazine (Azulfidine) and other drugs

                    Sulfasalazine (Azulfidine) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Sulfasalazine (Azulfidine). Please note that only the generic name of each medication is listed below.

                    Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

                    Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

                    Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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                    How much does Sulfasalazine (Azulfidine) cost?

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                    contraindications-icon

                    Sulfasalazine (Azulfidine) contraindications

                    Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Sulfasalazine (Azulfidine) will not be safe for you to take.
                    alternatives

                    What are alternatives to Sulfasalazine (Azulfidine)?

                    There are a number of medications that your doctor can prescribe in place of Sulfasalazine (Azulfidine). Compare a few possible alternatives below.
                    Sulfasalazine (Azulfidine)
                    Used for:

                    • Ulcerative colitis (UC) - immediate-release and delayed release tablets

                    • Rheumatoid arthritis (RA) - delayed-release tablets only

                    • Polyarticular juvenile rheumatoid arthritis - delayed-release tablets only

                    $13.70 Lowest GoodRx priceView Prices
                    Mesalamine
                    Used for:

                    • Ulcerative colitis (UC)

                    $55.66 Lowest GoodRx priceView Prices
                    Methotrexate (Trexall)
                    Used for:
                    $195.48 Lowest GoodRx priceView Prices
                    latest news

                    What is the latest news about Sulfasalazine (Azulfidine)?

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                    Sulfasalazine (Azulfidine) images

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                    This medicine is Orange, Round, Scored Tablet Imprinted With "G 500".Orange Round G 500 - Sulfasalazine 500mg Tablet
                    Orange Round G 500 - Sulfasalazine 500mg Tablet
                    This medicine is Orange, Round, Scored Tablet Imprinted With "G 500".Orange Round G 500 - Sulfasalazine 500mg Tablet

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                    References

                    Best studies we found

                    American Academy of Orthopaedic Surgeons. (2022). Juvenile arthritis.

                    Choi, J., et al. (2022). Sulfasalazine. StatPearls.

                    Desreumaux, P., et al. (2006). Review article: Mode of action and delivery of 5-aminosalicylic acid – new evidence. Alimentary Pharmacology & Therapeutics.

                    View All References (14)

                    Greenstone LLC. (2022). Sulfasalazine- sulfasalazine tablet, delayed release [package insert].

                    Leukemia & Lymphoma Society. (2022). Acute lymphoblastic leukemia.

                    Lo, M., et al. (2010). Potential use of the anti-inflammatory drug, sulfasalazine, for targeted therapy of pancreatic cancer. Current Oncology.

                    Ludmann, P. (2023). Cutaneous T-cell lymphoma: Overview. American Academy of Dermatology Association.

                    MedlinePlus. (2022). Crystals in urine.

                    National Cancer Institute. (2023). Non-Hodgkin lymphoma treatment (PDQ®)–patient version.

                    National Institute of Diabetes and Digestive and Kidney Diseases. (2020). Porphyria.

                    Piovezani Ramos, G., et al. (2021). Alcohol use in patients with inflammatory bowel disease. Gastroenterology & Hepatology.

                    Rath, L. (2022). Everything you need to know about immunosuppressants. Arthritis Foundation.

                    Teva Pharmaceuticals USA, Inc. (2023). Sulfasalazine tablet [package insert]. DailyMed.

                    Vasudevan, A., et al. (2017). Time to clinical response and remission for therapeutics in inflammatory bowel diseases: What should the clinician expect, what should patients be told? World Journal of Gastroenterology.

                    Wadelius, M., et al. (2018). Sulfasalazine-induced agranulocytosis is associated with the human leukocyte antigen locus. Clinical Pharmacology and Therapeutics.

                    Zhang, Y., et al. (2022). Cancer risks in rheumatoid arthritis patients who received immunosuppressive therapies: Will immunosuppressants work? Frontiers in Immunology.

                    Zhuang, J., et al. (2021). Sulfasalazine, a potent suppressor of gastric cancer proliferation and metastasis by inhibition of xCT: Conventional drug in new use. Journal of Cellular and Molecular Medicine.

                    GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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