Salazopyrine / Sulphasalazine by drdoc on-line

Sulphasalazine ( Salazopyrine ) is one of the widest used DMARDS (disease modifying) drugs that is used today-especially in the UK. We use it widely in South Africa, for RA as well as the Seronegative Spondyloarthropathy and reactive arthritis groups.
****It is probably the first designer drug in medical history****.
It is a Sulphur combined with a salicylate

It was made in approx. 1940 by chemists of Pharmacia in Sweden. who developed the ideas of Prof Nanna Svartz at the Karolinska institute--- who theorized that the sulphur would sort out an infective agent and the salicylate would be anti inflammatory. The drug was forgotten as a therapy for arthritis, and was used for inflammatory bowel disease. In 1978 McKonkey et al reported its use in RA and it was rediscovered.

It takes approximately 6 weeks to 2 months before benefit is noted.

Side effects ...

A. Gastrointestinal----Range from nausea / vomiting and gastrointestinal vague non specific discomfort/ flatulence. The discomfort is different to the heartburn of NSAIDS. Because of these side effects the drug is usually given as an enteric coated preparation - Sulphasalazine EN. In addition we usually start it slowly....The Gastric side effects are usually mild , but 2/10 cannot tolerate them 1 daily for 1 week...then 1 twice daily for 1 week...then 2 in the morning and 1 at night for 1 week ...then.... and then 2 twice a day ongoing....

B. Rashes./ allergy...from mild to severe.

C. Hepatotoxicity - (- requires monitoring liver functions 3 monthly at least)

D. Hematological - blood count abnormalities -( - requires monitoring Blood count 3 monthly at least)

E. Pulmonary reactions - pneumonitis bronchospasm (rare) -requires baseline chest X ray )

F. Irritability, headache, insomnia.

G. Male infertility (REVERSIBLE reduction in sperm counts). NOTE THERE IS NO REPORTED DANGER TO FETUS IF SOMEONE GETS SOMEONE PREGNANT WHILST ON IT....i.e. no teratogenicity.

H. Fevers/fatigue/Lupus like syndromes

side effects, c,d,e,f,g,h, are unusual....but require awareness and watching...

I find it an excellent drug, and don’t want to scare you by its side effect profile. The chances of problems are less than the dangers of the disease if used for appropriate reasons. Its efficacy is considered better than the antimalarials, and probably better than gold and Penicillamine, but less than methotrexate. The side effect profile is less than Methotrexate and gold or Penicillamine (other than the rash and gastric effects- which are usually minor, but are the commonest reasons for drug withdrawal). The antimalarials are similarly less toxic than Sulphasalazine.

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