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Sulphasalazine

Sulphasalazine is a medicine that is used to control rheumatoid arthritis or psoriatic arthritis. This is a disease-modifying antirheumatic drug [DMARD] (also called slow-acting antirheumatic drug [SAARD]) which helps to reduce the inflammation in the joints and prevent joint and cartilage destruction in the long term. It has no direct pain relieving effect. Hence, it will not reduce the pain and swelling acutely. HOW IS SULFASALAZINE TAKEN? Sulfasalazine should be taken with or after food. Sometimes the tablets upset the stomach at the start of therapy, but if the dose is increased slowly, your body will usually get used to it.

Do not crush or chew the tablets as they are enteric-coated in order to reach the colon. They should be swallowed whole with a full glass of water (unless otherwise directed). This drug does not work immediately. It may be weeks to months before you notice any benefit. Thus it is important that you take your medication regularly, otherwise, you may not receive any benefit at all You will need to continue your other arthritis and anti-inflammatory tablets unless your doctor advises otherwise. If you need to take sulfasalazine with iron supplements or antacids, space them at least 2 hours apart.

Please inform your doctor or pharmacist if you are taking other medications, including traditional remedies, that he is not aware of.

WHAT ARE THE IMPORTANT SIDE EFFECTS OF SULFASALAZINE?

Side effects can occur with any drug and this drug is no exception. When taken according to your doctor’s instructions, they are infrequent.

Side effect Warning signs To reduce this side effect
Nausea or loss of appetite or diarrhoea Take medication after food.
Headache or dizziness Improves as you get used to the medication or with dose reduction.
Staining of urine, skin and tears Orange-yellow staining This is harmless. However staining of soft contact lenses can occur and you may opt to wear spectacles instead.
Allergic reaction Generalised skin rashes or peeling, itching, swelling of the eyes. Inform your doctor immediately. These usually resolve readily on stopping treatment. Tell your doctor if you have ever had any unusual or allergic reaction to any sulfa medicines, aspirin or tartrazine dye before starting treatment.
Photosensitivity Skin rashes, redness or other discoloration of the skin, severe sunburn Stay out of direct sunlight between 10am and 3pm if possible. Wear protective clothing or sunglasses. Apply sunblock when necessary and do not use a sunlamp.
Liver disorder (rare) Yellow eyes or skin or constant abdominal pain The drug should be stopped. Avoid all alcohol.
Blood disorder (rare) There may be no warning signs but unusual bleeding or bruising, mouth ulcers with ‘flu-like’ symptoms may occur Inform your doctor immediately if these symptoms occur. Inform your doctor if you have G6PD deficiency.

WHY DO I NEED REGULAR BLOOD TESTS WHEN TAKING THIS DRUG?

Although blood and liver disorders are rare, abnormal blood counts and liver function tests can arise especially during the first month of treatment and whenever the dose of medication is increased. Even if you have been on treatment for a long time, you need to have your blood tests checked every 3 months. Regular blood tests ensure that these abnormalities are detected early, before the “warning signs” occur. These reverse when treatment is stopped. I AM “ALLERGIC” TO SULFA DRUGS. CAN I TAKE SULPHASALAZINE? Your doctor will verify your sulfa drug allergy with you as not all sulfa-containing drugs cross react.

Inform your doctor is you have G6PD deficiency (a blood disorder). SPECIAL PRECAUTIONS As with all medicines, it is important to inform your doctor if you intend to conceive or breast-feed while taking this medicine. If you are male and planning a family, you should be aware that the tablets may cause a drop in sperm count. This is usually reversible when the treatment is stopped.

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