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Sulfasalazine
Systematic (IUPAC) name
6-oxo-3-(2-[4-(N-pyridin-2-ylsulfamoyl)phenyl]hydrazono)cyclohexa-1,4-dienecarboxylic acid
Identifiers
CAS number 599-79-1
ATC code A07EC01
PubChem 5384001
DrugBank APRD00152
Chemical data
Formula C18H14N4O5S 
Mol. mass 398.394 g/mol
Pharmacokinetic data
Bioavailability <15%
Half life 5-10 hours
Therapeutic considerations
Pregnancy cat.  ?
Legal status
Routes oral
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Sulfasalazine (brand name Azulfidine in the U.S., Salazopyrin in Europe) is a sulfa drug, a derivative of mesalazine (also called 5-aminosalicylic acid, or 5-ASA), used primarily as an anti-inflammatory agent in the treatment of inflammatory bowel disease as well as for rheumatoid arthritis. It may be abbreviated SSZ. It is not a pain killer.

Contents

Indications

See also Disease-modifying antirheumatic drugs for its role in rheumatoid arthritis

Sulfasalazine is mainly used for treatment of inflammatory bowel disease, including ulcerative colitis and Crohn's disease. It is also effective in several types of arthritis, particularly rheumatoid arthritis.

The use of sulfasalazine in the treatment of inflammatory arthritis may result in serious hepatotoxicity - an adverse effect which appears to be ‘under-appreciated’ in practice[citation needed].

However, in recent British research involving animal studies, and more recently, human trials for the treatment of chronic alcoholics, sulfasalazine has been found to reverse the scarring associated with cirrhosis of the liver. Cells called myofibroblasts, which contribute to scar tissue in a diseased liver, also appear to secrete proteins that prevent the breakdown of the scar tissue. Sulfasalazine appears to retard this secretion.

A study at University of Newcastle found that the drug may also act to aid the healing of cirrhosis of the liver.[1]

It is usually not given to children under 2 years of age.

The use of sulfasalazine has declined due mainly to the fact that it yields the metabolite sulfapyridine which gives rise to side-effects such as agranulocytosis and hypospermia. However, the other metabolite of sulfasalazine, 5-aminosalicylic acid (5-ASA) is attributed to the drug's therapeutic effect. Therefore, 5-ASA and other derivatives of 5-ASA, are now usually preferred and given alone (as mesalazine), despite their increased cost, due to their more favourable side-effect profile.

Sulfasalazine has also been used successfully to treat cases of idiopathic urticaria that do not respond to antihistamines. (McGirt et al, 2006)

Mode of action

Sulfasalazine, and its metabolite 5-ASA, are poorly absorbed from the gut. Its main mode of action is therefore believed to be inside the intestine.

Bowel disease

In Crohn's disease and ulcerative colitis, it is thought to be an antinflammatory drug that is essentially providing topical relief inside the intestine. It does this via a number of mechanisms such as reducing the synthesis of inflammatory mediators known as eicosanoids and inflammatory cytokines. However, unlike glucocorticoids (another class of drug used in the treatment in inflammatory bowel disease), sulfasalazine has no immunosuppressant action.

Arthritis

When treatment for arthritis is successful, pain, joint swelling and stiffness will be reduced and this may slow down or stop the development of joint damage. The precise reasons why sulfasalazine is effective in various forms of arthritis is not clearly understood.

Because sulfasalazine and its metabolite 5-ASA are poorly absorbed into the bloodstream, it is surprising that the drug is effective against symptoms outside of the intestine. One possible explanation is that, given that ulcerative colitis produces arthritic symptoms, the arthritic symptoms are actually a product of unrecognized ulcerative colitis, which is effectively treated with sulfazalazine.

The other metabolite, sulfapyridine, is absorbed into the blood, and is believed to be the source of the side-effects discussed below. It is possible that the sulfapyridine is responsible for some of the anti-arthritic effects of sulfasalazine.

Side effects

Refer to external links for a full listing of known side effects.

In rare cases, Sulfasalazine can cause severe depression in young males [2]

Sulfsalazine metabolizes to sulfapyridine. Serum levels should monitored every three months, and more frequently at the outset. Serum levels above 50 micrograms/L are associated with side effects.

Immune thrombocytopenia has been reported.[3]

References

  1. ^ "BBC NEWS". http://news.bbc.co.uk/1/hi/health/5382172.stm. 
  2. ^ http://www.medic8.com/medicines/Azulfidine.html
  3. ^ Cantarini L, Tinazzi I, Biasi D, Fioravanti A, Galeazzi M (June 2007). "Sulfasalazine-induced immune thrombocytopenia". Postgraduate medical journal 83 (980): e1. doi:10.1136/pgmj.2006.055194. PMID 17551063. 

3. McGirt, L.Y., Vasagar, K., Gober, L.M., Saini, S.S., Beck, L.A. (2006) Successful treatment of recalcitrant chronic idiopathic urticaria with sulfasalazine. Arch Dermatol, 142:1337-1342.

External links








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