Dosing & Uses
Dosage Forms & Strengths
tablet
- 500mg
tablet, enteric coated (delayed release)
- 500mg
Ulcerative Colitis
Mild to moderate cases, adjunctive therapy in severe cases, and prolongation of remission
3-4 g/day PO divided TID after meals; may start 1-2 g Day; >4g/day can increase risk of toxicity
Maintenance: 2 g/day in divided doses at <8 hr intervals when endoscopic exam confirms improvement
Dosing modifications
- Reduce dose by 50% and gradually increase to desired dose over several days; stop therapy for 5-7 days if GI intolerance persists and reintroduce at lower daily dose
Rheumatoid Arthritis
Indicated in inadequate response or intolerance to salicylates or other NSAIDs
Delayed release: 0.5-1 g/day PO divided BID; increase weekly to maintenance dose of 2 g/day PO divided BID; if response inadequate, may increase to 3 g/day after administering for 12 weeks
Crohn Disease (Off-label)
3-6 g/day PO in divided doses for up to 16 wks
Administration
Take after meals
Administer in equally divided doses
Dosage Forms & Strengths
tablet
- 500mg
tablet, enteric coated (delayed release)
- 500 mg
Ulcerative Colitis
Mild to moderate cases, adjunctive therapy in severe cases, and prolongation of remission
<6 years old: Safety and efficacy not established
6 years or older
- Initial: 40-60 mg/kg/day PO divided q4-8hr after meals
- Maintenance: 30 mg/kg/day PO divided q6hr after meals
Juvenile Rheumatoid Arthritis
Polyarticular course with inadequate response to salicylates or other NSAIDs
<6 years old: Safety and efficacy not established
6 years or older: Gradually titrate at weekly intervals up to 30-50 mg/kg/day PO divided BID after meals; not to exceed 2 g/day
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (19)
- axicabtagene ciloleucel
sulfasalazine, axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
axicabtagene ciloleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - brexucabtagene autoleucel
sulfasalazine, brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
brexucabtagene autoleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - ciltacabtagene autoleucel
sulfasalazine, ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
ciltacabtagene autoleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - deferiprone
deferiprone, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis; if an alternative is not possible, monitor absolute neutrophil count more frequently.
- idecabtagene vicleucel
sulfasalazine, idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
idecabtagene vicleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - ketorolac
sulfasalazine, ketorolac. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- ketorolac intranasal
sulfasalazine, ketorolac intranasal. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated.
- lasmiditan
lasmiditan increases levels of sulfasalazine by Other (see comment). Avoid or Use Alternate Drug. Comment: Lasmiditan inhibits BCRP in vitro. Avoid coadministration of lasmiditan with BCRP substrates.
- leniolisib
leniolisib will increase the level or effect of sulfasalazine by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, a BCRP inhibitor, may increase systemic exposure of BCRP substrates
- lisocabtagene maraleucel
sulfasalazine, lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
lisocabtagene maraleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - measles, mumps, rubella and varicella vaccine, live
sulfasalazine, measles, mumps, rubella and varicella vaccine, live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.
- methotrexate
sulfasalazine increases levels of methotrexate by decreasing renal clearance. Avoid or Use Alternate Drug.
- pemetrexed
sulfasalazine increases levels of pemetrexed by unspecified interaction mechanism. Avoid or Use Alternate Drug. Interrupt dosing in all patients taking NSAIDs with long elimination half-lives for at least 5d before, the day of, and 2d following pemetrexed administration. If coadministration of an NSAID is necessary, closely monitor patients for toxicity, especially myelosuppression, renal toxicity, and GI toxicity.
- pexidartinib
sulfasalazine and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.
- pretomanid
sulfasalazine, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b, sulfasalazine. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.
- tisagenlecleucel
sulfasalazine, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
tisagenlecleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. - varicella virus vaccine live
sulfasalazine, varicella virus vaccine live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.
- zavegepant intranasal
sulfasalazine will increase the level or effect of zavegepant intranasal by Other (see comment). Avoid or Use Alternate Drug. NTCP inhibitors may result in a significant increase in systemic exposure of zavegepant (a NTCP substrate).
Monitor Closely (221)
- acalabrutinib
acalabrutinib increases levels of sulfasalazine by Other (see comment). Use Caution/Monitor. Comment: Acalabrutinib may increase exposure to coadministered BCRP substrates by inhibition of intestinal BCRP.
acalabrutinib, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may increase risk of myelosuppressive effects. - acebutolol
acebutolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of acebutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - aceclofenac
aceclofenac and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
aceclofenac and sulfasalazine both increase serum potassium. Use Caution/Monitor. - acemetacin
acemetacin and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
acemetacin and sulfasalazine both increase serum potassium. Use Caution/Monitor. - acetazolamide
acetazolamide, sulfasalazine. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
acetazolamide, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Use Caution/Monitor. Salicylate levels increased at moderate doses; risk of CNS toxicity. Salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid). - agrimony
sulfasalazine and agrimony both increase anticoagulation. Use Caution/Monitor.
- albuterol
sulfasalazine increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- alfalfa
sulfasalazine and alfalfa both increase anticoagulation. Use Caution/Monitor.
- alfuzosin
sulfasalazine decreases effects of alfuzosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- American ginseng
sulfasalazine and American ginseng both increase anticoagulation. Use Caution/Monitor.
- amiloride
amiloride and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.
- amoxicillin
amoxicillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
amoxicillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ampicillin
ampicillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ampicillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - antithrombin alfa
antithrombin alfa and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- antithrombin III
antithrombin III and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- apalutamide
apalutamide will decrease the level or effect of sulfasalazine by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces BCRP and may decrease systemic exposure of drugs that are BCRP substrates.
- arformoterol
sulfasalazine increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- argatroban
argatroban and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- asenapine
sulfasalazine decreases effects of asenapine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- aspirin
aspirin and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
aspirin and sulfasalazine both increase serum potassium. Use Caution/Monitor. - aspirin rectal
aspirin rectal and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
aspirin rectal and sulfasalazine both increase serum potassium. Use Caution/Monitor. - aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
aspirin/citric acid/sodium bicarbonate and sulfasalazine both increase serum potassium. Use Caution/Monitor. - atenolol
atenolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of atenolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - azilsartan
sulfasalazine, azilsartan. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
sulfasalazine decreases effects of azilsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - bemiparin
bemiparin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- benazepril
sulfasalazine decreases effects of benazepril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Potential for dangerous interaction. Use with caution and monitor closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
benazepril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - bendroflumethiazide
sulfasalazine increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- betaxolol
betaxolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of betaxolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - bisoprolol
bisoprolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of bisoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - bivalirudin
bivalirudin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- brinzolamide
brinzolamide, sulfasalazine. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- budesonide
sulfasalazine, budesonide. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- bumetanide
sulfasalazine increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
sulfasalazine decreases effects of bumetanide by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis. - bupivacaine implant
sulfasalazine, bupivacaine implant. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Local anesthetics may increase the risk of developing methemoglobinemia when concurrently exposed to drugs that also cause methemoglobinemia.
- candesartan
candesartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of candesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
candesartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - captopril
sulfasalazine decreases effects of captopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
captopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - carbenoxolone
sulfasalazine increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- carvedilol
carvedilol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of carvedilol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - celecoxib
celecoxib and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
celecoxib and sulfasalazine both increase serum potassium. Use Caution/Monitor. - celiprolol
celiprolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of celiprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - chlorothiazide
sulfasalazine increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- chlorpropamide
sulfasalazine increases effects of chlorpropamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- chlorthalidone
sulfasalazine increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- choline magnesium trisalicylate
choline magnesium trisalicylate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
choline magnesium trisalicylate and sulfasalazine both increase serum potassium. Use Caution/Monitor. - cinnamon
sulfasalazine and cinnamon both increase anticoagulation. Use Caution/Monitor.
- clomipramine
clomipramine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. Clomipramine inhib. serotonin uptake by platelets.
- clopidogrel
clopidogrel, sulfasalazine. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Clopidogrel and NSAIDs both inhibit platelet aggregation.
- cordyceps
sulfasalazine and cordyceps both increase anticoagulation. Use Caution/Monitor.
- cortisone
sulfasalazine, cortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- cyclopenthiazide
sulfasalazine increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- cyclosporine
cyclosporine will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Cyclosporine, a BCRP inhibitor, may increase levels of sulfasalazine (a BCRP substrate) when combined.
- dalteparin
dalteparin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- darolutamide
darolutamide will increase the level or effect of sulfasalazine by Other (see comment). Modify Therapy/Monitor Closely. Darolutamide is a BCRP inhibitor. Avoid coadministration with BCRP inhibitors. If use is unavoidable, closely monitor for adverse reactions and consider dose reduction of BCRP substrate drug (refer BCRP substrate prescribing information).
- deflazacort
sulfasalazine, deflazacort. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- dexamethasone
sulfasalazine, dexamethasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- diclofenac
diclofenac and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
diclofenac and sulfasalazine both increase serum potassium. Use Caution/Monitor. - dicloxacillin
dicloxacillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
dicloxacillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - diflunisal
diflunisal and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
diflunisal and sulfasalazine both increase serum potassium. Use Caution/Monitor. - digoxin
sulfasalazine and digoxin both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases levels of digoxin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Sulfasalazine >2 g/day. - dobutamine
sulfasalazine increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- dong quai
sulfasalazine and dong quai both increase anticoagulation. Use Caution/Monitor.
- dopexamine
sulfasalazine increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- doxazosin
sulfasalazine decreases effects of doxazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- drospirenone
drospirenone and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.
- duloxetine
duloxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- eltrombopag
eltrombopag increases levels of sulfasalazine by decreasing metabolism. Use Caution/Monitor. UGT inhibition; significance of interaction unclear.
- eluxadoline
eluxadoline increases levels of sulfasalazine by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered BCRP substrates. .
- enalapril
sulfasalazine decreases effects of enalapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
enalapril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - encorafenib
encorafenib will increase the level or effect of sulfasalazine by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a BCRP inhibitor) may increase the concentration and toxicities of BCRP substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.
- enoxaparin
enoxaparin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- ephedrine
sulfasalazine increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine
sulfasalazine increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epinephrine racemic
sulfasalazine increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- epoprostenol
sulfasalazine and epoprostenol both increase anticoagulation. Use Caution/Monitor.
- eprosartan
eprosartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of eprosartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
eprosartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - escitalopram
escitalopram, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- esmolol
esmolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of esmolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - ethacrynic acid
sulfasalazine increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- etodolac
etodolac and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
etodolac and sulfasalazine both increase serum potassium. Use Caution/Monitor. - fennel
sulfasalazine and fennel both increase anticoagulation. Use Caution/Monitor.
- fenoprofen
fenoprofen and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
fenoprofen and sulfasalazine both increase serum potassium. Use Caution/Monitor. - feverfew
sulfasalazine and feverfew both increase anticoagulation. Use Caution/Monitor.
- fludrocortisone
sulfasalazine, fludrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- fluoxetine
fluoxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- flurbiprofen
flurbiprofen and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
flurbiprofen and sulfasalazine both increase serum potassium. Use Caution/Monitor. - fluvoxamine
fluvoxamine will increase the level or effect of sulfasalazine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding SSRIs inhib. serotonin uptake by platelets
- fondaparinux
fondaparinux and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- formoterol
sulfasalazine increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- forskolin
sulfasalazine and forskolin both increase anticoagulation. Use Caution/Monitor.
- fosinopril
sulfasalazine decreases effects of fosinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
fosinopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - fostamatinib
fostamatinib will increase the level or effect of sulfasalazine by decreasing metabolism. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of BCRP substrate drugs. Monitor for toxicities of BCRP substrate drug that may require dosage reduction when given concurrently with fostamatinib.
- fostemsavir
fostemsavir will increase the level or effect of sulfasalazine by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits BCRP transporters. If possible, avoid coadministration or modify dose of BCRP substrate coadministered with fostemsavir.
- furosemide
sulfasalazine increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- garlic
sulfasalazine and garlic both increase anticoagulation. Use Caution/Monitor.
- gentamicin
sulfasalazine increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ginger
sulfasalazine and ginger both increase anticoagulation. Use Caution/Monitor.
- ginkgo biloba
sulfasalazine and ginkgo biloba both increase anticoagulation. Use Caution/Monitor.
- glecaprevir/pibrentasvir
glecaprevir/pibrentasvir will increase the level or effect of sulfasalazine by decreasing metabolism. Use Caution/Monitor. Glecaprevir/pibrentasvir may increase plasma concentration of BCRP substrates.
- glimepiride
sulfasalazine increases effects of glimepiride by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glipizide
sulfasalazine increases effects of glipizide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glyburide
sulfasalazine increases effects of glyburide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- griseofulvin
griseofulvin decreases levels of sulfasalazine by unknown mechanism. Use Caution/Monitor.
- heparin
heparin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- horse chestnut seed
sulfasalazine and horse chestnut seed both increase anticoagulation. Use Caution/Monitor.
- hydralazine
sulfasalazine decreases effects of hydralazine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- hydrochlorothiazide
sulfasalazine increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- hydrocortisone
sulfasalazine, hydrocortisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- ibuprofen
ibuprofen and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ibuprofen and sulfasalazine both increase serum potassium. Use Caution/Monitor. - ibuprofen IV
ibuprofen IV will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
ibuprofen IV and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ibuprofen IV and sulfasalazine both increase serum potassium. Use Caution/Monitor. - indapamide
sulfasalazine increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- indomethacin
indomethacin and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
indomethacin and sulfasalazine both increase serum potassium. Use Caution/Monitor. - irbesartan
irbesartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of irbesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
irbesartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - isoproterenol
sulfasalazine increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ketoprofen
ketoprofen and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ketoprofen and sulfasalazine both increase serum potassium. Use Caution/Monitor. - ketorolac
ketorolac and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ketorolac and sulfasalazine both increase serum potassium. Use Caution/Monitor. - ketorolac intranasal
ketorolac intranasal and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
ketorolac intranasal and sulfasalazine both increase serum potassium. Use Caution/Monitor. - L-methylfolate
sulfasalazine decreases effects of L-methylfolate by Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Signs of folate deficiency reported.
- labetalol
labetalol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of labetalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - levalbuterol
sulfasalazine increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- levomilnacipran
levomilnacipran, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. SNRIs may further impair platelet activity in patients taking antiplatelet or anticoagulant drugs.
- lisinopril
sulfasalazine decreases effects of lisinopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
lisinopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - lithium
sulfasalazine increases levels of lithium by decreasing renal clearance. Use Caution/Monitor.
- lornoxicam
lornoxicam and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
lornoxicam and sulfasalazine both increase serum potassium. Use Caution/Monitor. - losartan
losartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of losartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
losartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - meclofenamate
meclofenamate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
meclofenamate and sulfasalazine both increase serum potassium. Use Caution/Monitor. - mefenamic acid
mefenamic acid and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
mefenamic acid and sulfasalazine both increase serum potassium. Use Caution/Monitor. - meloxicam
meloxicam and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
meloxicam and sulfasalazine both increase serum potassium. Use Caution/Monitor. - mesalamine
mesalamine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive nephrotoxicity.
- metaproterenol
sulfasalazine increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- methazolamide
methazolamide, sulfasalazine. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- methyclothiazide
sulfasalazine increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
- methylprednisolone
sulfasalazine, methylprednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- metolazone
sulfasalazine increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- metoprolol
metoprolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of metoprolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - milnacipran
milnacipran, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- mistletoe
sulfasalazine increases and mistletoe decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- moexipril
sulfasalazine decreases effects of moexipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
moexipril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - momelotinib
momelotinib increases toxicity of sulfasalazine by plasma protein binding competition. Modify Therapy/Monitor Closely. Momelotinib (BCRP inhibitor) may increase exposure of BCRP substrates, which may increase the risk of BCRP substrate adverse reactions. Dose adjustment of other BCRP substrates may necessary.
- moxisylyte
sulfasalazine decreases effects of moxisylyte by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- mycophenolate
sulfasalazine will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- nabumetone
nabumetone and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
nabumetone and sulfasalazine both increase serum potassium. Use Caution/Monitor. - nadolol
nadolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of nadolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nafcillin
sulfasalazine decreases effects of nafcillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.
- naproxen
naproxen and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
naproxen and sulfasalazine both increase serum potassium. Use Caution/Monitor. - nebivolol
nebivolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - nefazodone
nefazodone, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- nettle
sulfasalazine increases and nettle decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- norepinephrine
sulfasalazine increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- olmesartan
olmesartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of olmesartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
olmesartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - oteseconazole
oteseconazole will increase the level or effect of sulfasalazine by Other (see comment). Modify Therapy/Monitor Closely. Otesezonale, a BCRP inhibitor, may increase the effects and risk of toxicities of BCRP substrates. Use lowest starting dose of BCRP substrate, or consider reducing BCRP substrate dose.
- oxaprozin
oxaprozin and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
oxaprozin and sulfasalazine both increase serum potassium. Use Caution/Monitor. - panax ginseng
sulfasalazine and panax ginseng both increase anticoagulation. Use Caution/Monitor.
- parecoxib
parecoxib and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
parecoxib and sulfasalazine both increase serum potassium. Use Caution/Monitor. - paroxetine
paroxetine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- pau d'arco
sulfasalazine and pau d'arco both increase anticoagulation. Use Caution/Monitor.
- pegaspargase
pegaspargase increases effects of sulfasalazine by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of bleeding events.
- penbutolol
penbutolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of penbutolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - perindopril
sulfasalazine decreases effects of perindopril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
perindopril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - phenindione
phenindione and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- phenoxybenzamine
sulfasalazine decreases effects of phenoxybenzamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phentolamine
sulfasalazine decreases effects of phentolamine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- phytoestrogens
sulfasalazine and phytoestrogens both increase anticoagulation. Use Caution/Monitor.
- pindolol
pindolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of pindolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - pirbuterol
sulfasalazine increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- piroxicam
piroxicam and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
piroxicam and sulfasalazine both increase serum potassium. Use Caution/Monitor. - pivmecillinam
pivmecillinam, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
pivmecillinam, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - ponatinib
ponatinib increases levels of sulfasalazine by Other (see comment). Use Caution/Monitor.
- potassium acid phosphate
sulfasalazine and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium chloride
sulfasalazine and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
- potassium citrate
sulfasalazine and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
- prazosin
sulfasalazine decreases effects of prazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- prednisolone
sulfasalazine, prednisolone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- prednisone
sulfasalazine, prednisone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- pretomanid
pretomanid will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Increase monitoring for drug-related adverse effects if pretomanid is coadministered with sensitive BCRP substrates.
- probenecid
sulfasalazine will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
sulfasalazine decreases effects of probenecid by unknown mechanism. Use Caution/Monitor. - propranolol
propranolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - protamine
protamine and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.
- quinapril
sulfasalazine decreases effects of quinapril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
quinapril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - ramipril
sulfasalazine decreases effects of ramipril by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
ramipril, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - regorafenib
regorafenib will increase the level or effect of sulfasalazine by Other (see comment). Modify Therapy/Monitor Closely. Regorafenib likely inhibits BCRP (ABCG2) transport. Coadministration with a BCRP substrate may increase systemic exposure to the substrate and related toxicity.
- reishi
sulfasalazine and reishi both increase anticoagulation. Use Caution/Monitor.
- sacubitril/valsartan
sacubitril/valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sacubitril/valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
sulfasalazine decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. - safinamide
safinamide will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.
- salicylates (non-asa)
salicylates (non-asa) and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
salicylates (non-asa) and sulfasalazine both increase serum potassium. Use Caution/Monitor. - salmeterol
sulfasalazine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- salsalate
salsalate and sulfasalazine both increase anticoagulation. Use Caution/Monitor.
salsalate and sulfasalazine both increase serum potassium. Use Caution/Monitor. - sertraline
sertraline, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- Siberian ginseng
sulfasalazine and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.
- silodosin
sulfasalazine decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- sodium picosulfate/magnesium oxide/anhydrous citric acid
sulfasalazine, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.
- sofosbuvir/velpatasvir
sofosbuvir/velpatasvir will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Velpatasvir is an inhibitor of the drug transporter BCRP. Coadministration may increase systemic exposure of drugs that are BCRP substrates.
- sotalol
sotalol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - spironolactone
spironolactone and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.
- stiripentol
stiripentol will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.
- succinylcholine
sulfasalazine and succinylcholine both increase serum potassium. Use Caution/Monitor.
- sulindac
sulfasalazine and sulindac both increase anticoagulation. Use Caution/Monitor.
sulfasalazine and sulindac both increase serum potassium. Use Caution/Monitor. - tafamidis
tafamidis will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.
- tafamidis meglumine
tafamidis meglumine will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.
- telmisartan
telmisartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
telmisartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - temocillin
temocillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
temocillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - terazosin
sulfasalazine decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
- terbutaline
sulfasalazine increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- ticarcillin
ticarcillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.
ticarcillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor. - timolol
timolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. - tobramycin inhaled
tobramycin inhaled and sulfasalazine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity
- tolazamide
sulfasalazine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolbutamide
sulfasalazine increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolfenamic acid
sulfasalazine and tolfenamic acid both increase anticoagulation. Use Caution/Monitor.
sulfasalazine and tolfenamic acid both increase serum potassium. Use Caution/Monitor. - tolmetin
sulfasalazine and tolmetin both increase anticoagulation. Use Caution/Monitor.
sulfasalazine and tolmetin both increase serum potassium. Use Caution/Monitor. - tolvaptan
sulfasalazine and tolvaptan both increase serum potassium. Use Caution/Monitor.
- torsemide
sulfasalazine increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- trazodone
trazodone, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- triamcinolone acetonide injectable suspension
sulfasalazine, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.
- triamterene
triamterene and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.
- valoctocogene roxaparvovec
sulfasalazine and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.
- valsartan
valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
sulfasalazine decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. - venlafaxine
venlafaxine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.
- vitamin K1 (phytonadione)
sulfasalazine increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.
- voclosporin
voclosporin, sulfasalazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- warfarin
sulfasalazine increases effects of warfarin by anticoagulation. Use Caution/Monitor.
- zotepine
sulfasalazine decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.
Minor (115)
- aceclofenac
aceclofenac will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acemetacin
acemetacin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acyclovir
sulfasalazine will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- alendronate
sulfasalazine, alendronate. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI ulceration.
- aluminum hydroxide
aluminum hydroxide, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- amikacin
sulfasalazine increases levels of amikacin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- aminohippurate sodium
sulfasalazine will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- anamu
sulfasalazine and anamu both increase anticoagulation. Minor/Significance Unknown.
- aspirin
aspirin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
aspirin rectal will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- balsalazide
sulfasalazine will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- budesonide
budesonide decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- bumetanide
sulfasalazine, bumetanide. Other (see comment). Minor/Significance Unknown. Comment: Salicylates are less likely than other NSAIDs to interact w/bumetanide.
- calcium carbonate
calcium carbonate, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- cefaclor
cefaclor will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefadroxil
cefadroxil will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefamandole
cefamandole will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefazolin
cefazolin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefepime
cefepime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefotaxime
cefotaxime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefpirome
cefpirome will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cefprozil
cefprozil will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ceftazidime
ceftazidime will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ceftibuten
ceftibuten will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- celecoxib
celecoxib will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cephalexin
cephalexin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorpropamide
sulfasalazine will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
sulfasalazine increases effects of chlorpropamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate. - chlorthalidone
chlorthalidone will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
choline magnesium trisalicylate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cortisone
cortisone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- creatine
creatine, sulfasalazine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. (Theoretical interaction) Combination may have additive nephrotoxic effects.
- cyanocobalamin
sulfasalazine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- cyclopenthiazide
cyclopenthiazide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- danshen
sulfasalazine and danshen both increase anticoagulation. Minor/Significance Unknown.
- deflazacort
deflazacort decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- devil's claw
sulfasalazine and devil's claw both increase anticoagulation. Minor/Significance Unknown.
- dexamethasone
dexamethasone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- diclofenac
diclofenac will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- diflunisal
diflunisal will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- eplerenone
sulfasalazine decreases effects of eplerenone by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- ethanol
ethanol increases toxicity of sulfasalazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.
- etodolac
etodolac will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- fenoprofen
fenoprofen will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- feverfew
sulfasalazine decreases effects of feverfew by pharmacodynamic antagonism. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- folic acid
sulfasalazine decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- furosemide
sulfasalazine decreases effects of furosemide by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- ganciclovir
sulfasalazine will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- gentamicin
sulfasalazine increases levels of gentamicin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- glimepiride
sulfasalazine increases effects of glimepiride by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- glipizide
sulfasalazine increases effects of glipizide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- glyburide
sulfasalazine increases effects of glyburide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- ibuprofen
ibuprofen will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- imidapril
sulfasalazine decreases effects of imidapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- indapamide
indapamide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- indomethacin
indomethacin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- insulin aspart
sulfasalazine increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin detemir
sulfasalazine increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin glargine
sulfasalazine increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin glulisine
sulfasalazine increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin lispro
sulfasalazine increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin NPH
sulfasalazine increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin regular human
sulfasalazine increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- ketoprofen
ketoprofen will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac
ketorolac will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac intranasal
ketorolac intranasal will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- L-methylfolate
sulfasalazine decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- lornoxicam
lornoxicam will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meclofenamate
meclofenamate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mefenamic acid
mefenamic acid will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meloxicam
meloxicam will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mesalamine
sulfasalazine will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- metolazone
metolazone will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- nabumetone
nabumetone will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- naproxen
naproxen will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- neomycin PO
sulfasalazine increases levels of neomycin PO by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- noni juice
sulfasalazine and noni juice both increase serum potassium. Minor/Significance Unknown.
- ofloxacin
ofloxacin, sulfasalazine. Other (see comment). Minor/Significance Unknown. Comment: Risk of CNS stimulation/seizure. Mechanism: Displacement of GABA from receptors in brain.
- oxaprozin
oxaprozin will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- parecoxib
parecoxib will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- paromomycin
sulfasalazine increases levels of paromomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- piroxicam
piroxicam will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- prednisolone
prednisolone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- prednisone
prednisone decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- rose hips
rose hips will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
sulfasalazine decreases levels of rose hips by increasing renal clearance. Minor/Significance Unknown.
rose hips increases levels of sulfasalazine by decreasing renal clearance. Minor/Significance Unknown. - salicylates (non-asa)
salicylates (non-asa) will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salsalate
salsalate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sodium bicarbonate
sodium bicarbonate, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- sodium citrate/citric acid
sodium citrate/citric acid, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- streptomycin
sulfasalazine increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- sulfadiazine
sulfasalazine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfamethoxazole
sulfasalazine increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
- sulfisoxazole
sulfasalazine increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.
- sulindac
sulfasalazine will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- teniposide
sulfasalazine increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.
- tobramycin
sulfasalazine increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.
- tolazamide
sulfasalazine increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- tolbutamide
sulfasalazine increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- tolfenamic acid
sulfasalazine will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tolmetin
sulfasalazine will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- trandolapril
sulfasalazine decreases effects of trandolapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.
- triamterene
triamterene, sulfasalazine. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity.
sulfasalazine increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity. - valganciclovir
sulfasalazine will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- vancomycin
sulfasalazine increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.
- verapamil
verapamil increases effects of sulfasalazine by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.
- willow bark
sulfasalazine will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
willow bark increases effects of sulfasalazine by pharmacodynamic synergism. Minor/Significance Unknown. Willow bark contains salicylic acid, which may have additive effects/toxicity with salicylate drugs.
Adverse Effects
>10%
Anorexia (~33%)
Headache (~33%)
Nausea (~33%)
Vomiting (~33%)
Gastric distress (~33%)
Apparently reversible oligospermia (~33%)
<1%
Skin rash
Pruritus
Urticaria
Fever
Heinz body anemia
Hemolytic anemia
Cyanosis
Postmarketing Reports
Blood dyscrasias: Pseudomononucleosis
Cardiac disorders: Myocarditis
Hepatobiliary disorders: reports of hepatotoxicity, including elevated liver function tests (SGOT/AST, SGPT/ALT, GGT, LDH, alkaline phosphatase, bilirubin), jaundice, cholestatic jaundice, cirrhosis, hepatitis cholestatic, cholestasis and possible hepatocellular damage including liver necrosis and liver failure; some of these cases were fatal; 1 case of Kawasaki-like syndrome
Immune system disorders: Anaphylaxis
Metabolism and nutrition system disorders: Folate deficiency
Renal and urinary disorders: Nephrolithiasis
Respiratory, thoracic and mediastinal disorders: Oropharyngeal pain
Skin and subcutaneous tissue disorders: Angioedema, purpura
Vascular disorders: Pallor
Hypersensitivity reactions: Erythema multiforme, epidermal necrolysis (SJS/TEN) with corneal damage, exfoliative dermatitis, DRESS, serum sickness syndrome, interstitial lung disease, pneumonitis with or without eosinophilia, vasculitis, fibrosing alveolitis, pleurisy/pleuritis, pericarditis with or without tamponade, allergic myocarditis, polyarteritis nodosa, lupus erythematosus-like syndrome, hepatic necrosis with or without immune complexes, fulminant hepatitis, sometimes leading to liver transplantation, parapsoriasis varioliformis acuta (Mucha-Haberman syndrome), rhabdomyolysis, photosensitization, arthralgia, periorbital edema, conjunctival and scleral injection, and alopecia
Warnings
Contraindications
Hypersensitivity to sulfasalazine or its metabolites, to sulfonamides, or to salicylates
Intestinal or urinary tract obstruction
Porphyria
Cautions
Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, and toxic epidermal necrolysis; discontinue at first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity
Severe hypersensitivity reported; may include internal organ involvement, such as hepatitis, nephritis, myocarditis, mononucleosis-like syndrome (ie, pseudomononucleosis), hematological abnormalities (including hematophagic histiocytosis), and/or pneumonitis including eosinophilic infiltration; if signs or symptoms are present, the patient should be evaluated immediately; Sulfasalazine drug should be discontinued if an alternative etiology for signs or symptoms cannot be established
Administer tablets with caution to patients with severe allergy or bronchial asthma; adequate fluid intake must be maintained in order to prevent crystalluria and stone formation; patients with glucose-6 phosphate dehydrogenase deficiency should be observed closely for signs of hemolytic anemia; reaction is frequently dose-related; if toxic or hypersensitivity reactions occur, the drug should be discontinued immediately
Oligospermia and infertility reported; however, withdrawal of drug appears to reverse these effects
Hepatic, renal, and hematologic toxicity
- Only after critical appraisal should therapy be administered to patients with hepatic or renal damage or blood dyscrasias; deaths associated with administration of sulfasalazine reported from hypersensitivity reactions, agranulocytosis, aplastic anemia, other blood dyscrasias, renal and liver damage, irreversible neuromuscular and central nervous system changes, and fibrosing alveolitis
- The presence of clinical signs such as sore throat, fever, pallor, purpura, or jaundice may be indications of serious blood disorders or hepatotoxicity; complete blood counts, as well as urinalysis with careful microscopic examination, should be done frequently in patients receiving therapy; discontinue treatment with sulfasalazine while awaiting results of blood tests
- Discontinue therapy if renal function deteriorates
Infections
- Blood dyscrasias; serious infections reported, including fatal sepsis and pneumonia
- Some infections were associated with agranulocytosis, neutropenia, or myelosuppression; discontinue therapy if patient develops a serious infection
- Closely monitor patients for the development of signs and symptoms of infection during and after treatment
- Frequently perform complete blood counts, as well as urinalysis with careful microscopic examination; discontinue treatment while awaiting results of blood tests;
Pregnancy & Lactation
Pregnancy category: B; D if used for prolonged periods or near term; increased potential for kernicterus in the newborn
Oral sulfasalazine inhibits the absorption and metabolism of folic acid which may interfere with folic acid supplementation and protection from neural tube defects
Lactation: Excreted into human breast milk; caution with breastfeeding, some reports of bloody stools or diarrhea in human milk fed infants of mothers taking sulfasalazine
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Sulfasalazine is a prodrug that is metabolized to its active components, sulfapyridine and 5-aminosalicylic acid (5-ASA; mesalamine); beneficial effects are predominantly from the anti-inflammatory properties of 5-ASA, which inhibits leukotriene synthesis and lipoxygenase
Absorption
Bioavailability: <15% of parent drug; 60% (sulfapyridine); 10-30% (5-ASA)
Peak plasma time: 6 hr; 10 hr (sulfapyridine and 5-ASA)
Peak plasma concentration: 6 mcg/mL
Distribution
Protein bound: >99% to albumin; 70% (sulfapyridine)
Vd: 7.5 L
Metabolism
Approximately 90% of sulfasalazine is converted by colon bacteria into its active components, sulfapyridine and mesalamine
Elimination
Half-life: 10.4-14.8 hr (sulfapyridine)
Renal clearance: 37%
Excretion: Urine (systematically absorbed sulfapyridine and 5-ASA); feces (majority of 5-ASA)
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Azulfidine oral - | 500 mg tablet |  | |
| sulfasalazine oral - | 500 mg tablet |  | |
| sulfasalazine oral - | 500 mg tablet |  | |
| sulfasalazine oral - | 500 mg tablet |  | |
| sulfasalazine oral - | 500 mg tablet |  | |
| Azulfidine EN-tabs oral - | 500 mg tablet |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
sulfasalazine oral
SULFASALAZINE - ORAL
(sull-fuh-SAL-uh-zeen)
COMMON BRAND NAME(S): Azulfidine
USES: Sulfasalazine is used to treat a certain type of bowel disease called ulcerative colitis. This medication does not cure this condition, but it helps decrease symptoms such as fever, stomach pain, diarrhea, and rectal bleeding. After an attack is treated, sulfasalazine is also used to increase the amount of time between attacks. This medication works by reducing irritation and swelling in the large intestines.In addition, delayed-release tablets of sulfasalazine are used to treat rheumatoid arthritis. Sulfasalazine helps to reduce joint pain, swelling, and stiffness. Early treatment of rheumatoid arthritis with sulfasalazine helps to reduce/prevent further joint damage so you can do more of your normal daily activities. This medication is used with other drugs, rest, and physical therapy in patients who have not responded to other medications (salicylates, nonsteroidal anti-inflammatory drugs-NSAIDs).
HOW TO USE: Take this medication by mouth after meals with a full glass of water (8 ounces or 240 milliliters) as directed by your doctor. To prevent stomach upset, your doctor may recommend a slow increase in your dosage when starting treatment. The dosage is based on your medical condition and response to treatment. In children, dosage is also based on weight.If you are taking the delayed-release tablets, swallow them whole. Do not crush, chew, or break the tablets. Doing so may increase the chance of stomach upset.Drink plenty of fluids during treatment with this medication unless otherwise directed by your doctor. This will help prevent kidney stones.Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition does not improve or if it worsens. For the treatment of rheumatoid arthritis, it may take 1 to 3 months before you notice any improvement in your symptoms.
SIDE EFFECTS: Stomach upset, nausea, vomiting, loss of appetite, headache, dizziness, or unusual tiredness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.This medication may cause your skin and urine to turn orange-yellow. This effect is harmless and will disappear when the medication is stopped.Rarely, delayed-release tablets of sulfasalazine may appear whole or only partly dissolved in your stool. If this occurs, tell your doctor right away so your treatment can be changed.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: hearing changes (such as ringing in the ears), mental/mood changes, signs of kidney problems (such as change in the amount of urine, painful urination, blood in the urine), new lump/growth in the neck (goiter), numbness/tingling of the hands/feet, signs of low blood sugar (such as hunger, cold sweat, blurred vision, weakness, fast heartbeat).This medication may rarely cause very serious allergic reactions (such as Stevens-Johnson syndrome), blood disorders (such as agranulocytosis, aplastic anemia), liver damage, nerve/muscle problems and infections. Get medical help right away if you have any very serious side effects, including: headache that is severe or doesn't go away, skin rash/blisters/peeling, mouth sores, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing, chest pain, signs of infection (such as sore throat that doesn't go away, fever, chills, cough), swollen lymph nodes, easy bruising/bleeding, severe tiredness, muscle pain/weakness (especially with fever and unusual tiredness), pale or blue skin/lips/nails, new/worsening joint pain, confusion, unexplained neck stiffness, seizures, signs of liver problems (such as nausea/vomiting that doesn't stop, severe stomach/abdominal pain, yellowing eyes/skin, dark urine).This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking sulfasalazine, tell your doctor or pharmacist if you are allergic to it; or to sulfa drugs; or to aspirin and related drugs (salicylates, NSAIDs such as ibuprofen); or to mesalamine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: intestinal blockage, urinary blockage, kidney disease, liver disease, blood disorders (such as aplastic anemia, porphyria), a certain genetic condition (G6PD deficiency), asthma, severe allergies, current/recent/returning infections.This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication may make you more sensitive to the sun. Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Get medical help right away if you get sunburned or have skin blisters/redness.This medication is similar to aspirin. Children and teenagers younger than 18 years should not take aspirin or aspirin-related medications (such as salicylates) if they have chickenpox, flu, or any undiagnosed illness, or if they have just been given a live virus vaccine (such as varicella vaccine), without first consulting a doctor about Reye's syndrome, a rare but serious illness.This medication can temporarily affect fertility in males. Ask your doctor for more details.During pregnancy, this medication should be used only when clearly needed. Caution is advised if this medication is used near the expected delivery date because similar drugs may cause harm to a newborn. Discuss the risks and benefits with your doctor. If you become pregnant while taking this drug, contact your doctor right away. This medication may lower your folic acid levels, increasing the risk of spinal cord defects. Check with your doctor to make sure you are taking enough folic acid. Prenatal care should include tests for spinal cord defects.This drug passes into breast milk and could have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: digoxin, folic acid, methenamine, PABA taken by mouth.Sulfasalazine is very similar to mesalamine. Do not use mesalamine medications taken by mouth while using sulfasalazine.This medication may interfere with certain lab tests (such as urine normetanephrine levels, liver function tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: vomiting that doesn't stop, severe stomach/abdominal pain, extreme drowsiness, seizures.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as complete blood count, liver/kidney function) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised May 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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