sulfasalazine (Rx)

Brand and Other Names:Azulfidine, Azulfidine EN
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Dosing & Uses

AdultPediatric

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  

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Interactions

Interaction Checker

and sulfasalazine

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              • 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.

              • 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.

              • 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.

              • 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.

              Monitor Closely (217)

              • 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.

              • clobetasone

                sulfasalazine, clobetasone. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.

              • 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.

              • 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.

              • flucloxacillin

                flucloxacillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor.

                flucloxacillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. 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.

              • 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.

              • 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.

              • 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.

              • 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.

              • warfarin

                warfarin and sulfasalazine both increase anticoagulation. Modify Therapy/Monitor Closely.

              • 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.

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              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

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              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, 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

              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;

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              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.

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              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)

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Azulfidine oral
              -
              500 mg tablet
              Azulfidine EN-tabs oral
              -
              500 mg tablet
              sulfasalazine oral
              -
              500 mg tablet
              sulfasalazine oral
              -
              500 mg tablet
              sulfasalazine oral
              -
              500 mg tablet

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              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) or as directed by your doctor. To prevent stomach upset, your doctor may recommend a slow increase in your dosage when starting treatment. Dosage is based on your medical condition and response to therapy. 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.Inform your doctor if your condition does not improve or if it worsens. For the treatment of rheumatoid arthritis, it may take 1-3 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 persist or worsen, notify 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 your doctor has prescribed this medication because he or she 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 (e.g., 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 (e.g., hunger, cold sweat, blurred vision, weakness, fast heartbeat).This medication may rarely cause very serious allergic reactions (e.g., Stevens-Johnson syndrome), blood disorders (e.g., agranulocytosis, aplastic anemia), liver damage, nerve/muscle problems and infections. Get medical help right away if you have any very serious side effects, including: 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 fever, chills, persistent sore throat, 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, persistent/severe headache, unexplained neck stiffness, seizures, signs of liver problems (e.g., persistent nausea/vomiting, 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 (e.g., salicylates) if they have chickenpox, flu, or any undiagnosed illness, or if they have just been given a live virus vaccine (e.g., 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. Therefore, 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: severe stomach/abdominal pain, persistent vomiting, extreme drowsiness, seizures.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., complete blood count, liver and kidney function tests) should be performed periodically to monitor your progress or check for side effects. 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 2021. Copyright(c) 2021 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.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

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              • View the formulary and any restrictions for each plan.
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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.