USMLE

Sulfasalazine

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Musculoskeletal Drugs
  1. Azathioprine
  2. Corticosteroids
  3. Sulfasalazine
  4. TNF Inhibitors
  5. Immunosuppressants (Cyclosporine, Mycophenolate, Tacrolimus)
  6. Acetaminophen
  7. NSAIDs
  8. Colchicine
  9. Allopurinol
  10. Rasburicase
  11. Dantrolene
  12. Muscle Relaxants
  13. Bisphosphonates: Alendronate, Risedronate

Summary

Sulfasalazine is an anti-inflammatory medication used to treat autoimmune inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease, and ulcerative colitis. Since sulfasalazine is a sulfa drug, patients should be monitored for signs of allergic reaction. Other side effects of sulfasalazine include photosensitivity, crystalluria causing a decline in kidney function, and an orange discoloration of the skin and urine. Sulfasalazine can also cause folic acid deficiency, so patients may be instructed by their doctor to take folic acid supplements.

Key Points

  • Mechanism
    • Sulfonamide and disease-modifying antirheumatic drug (DMARD)
      • Inhibits prostaglandin production to reduce inflammation
    • Clinical Use
      • Anti-inflammatory
        • Treats inflammatory autoimmune diseases
          • Irritable Bowel Syndrome (IBS)
          • Ulcerative colitis (UC)
          • Rheumatoid arthritis
    • Side Effects and Adverse Reactions
      • Allergic Reactions (sulfa allergy)
        • Because sulfasalazine is a sulfonamide, it has common side effects with the sulfonamide antibiotics, even though it is used for a different clinical purpose
      • Crystalluria
        • Can lead to kidney damage
        • Encourage patient to stay well-hydrated to maintain adequate urine output
      • Photosensitivity
        • Avoid direct sun exposure and wear sunscreen
        • Skin damage may progress to Steven-Johnson syndrome with necrosis of the skin
      • Orange/Yellow urine and skin discoloration
        • A normal, expected finding that should disappear with discontinuation of drug
      • Folic acid (folate) deficiency
        • Patient may be instructed to take folic acid supplementation
        • Encourage patient to eat foods high in folate, like green leafy vegetables
      • Agranulocytosis
        • Rare, but life-threatening
        • Report fever and sore throat immediately