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.
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.
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.
For UC:
For RA (delayed-release tablets only):
Contact your healthcare provider immediately if you experience any of the following.
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
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
general body swelling
headache
loss of appetite
nosebleeds
pale skin
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
blood in the urine or stools
bloody diarrhea
bluish fingernails, lips, or skin
difficulty with swallowing
dizziness
fainting spells
fast heartbeat
general feeling of discomfort or illness
general tiredness and weakness
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:
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.
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.
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.
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).
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.
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.
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.
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 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.
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.
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.
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.
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.
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 | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 500mg | 120 tablets | $13.70 | $0.11 |
Ulcerative colitis — immediate-release and delayed-release tablets
Rheumatoid arthritis — delayed-release tablets only
Your provider might lower your dose if you have bothersome side effects like stomach upset.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
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.
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.