Azulfidine
Generic available: yes
Tablet size: 500 mg
Enteric-coated tablets: 500 mg
Liquid form is available.
Usual dose: two or three pills twice daily
Effective within: two to six months
Sulfasalazine, a medication commonly prescribed to treat colitis, was developed by Professor Nanna Svartz in Stockholm and was originally designed in the 1930s for the treatment of RA. Sulfa drugs were just being developed at that time, when RA was considered to be an infectious condition. Sulfasalazine contained both an antibiotic (sulfa) and an anti-inflammatory (salicylate) component. It was used throughout the 1940s with proven effectiveness but eventually fell into disfavor for political reasons and because the new miracle drug, cortisone, became available.
There has been a resurgence of interest in sulfasalazine in the past decade after several new studies proved its effectiveness. Despite these findings, use of this drug for RA has not yet been approved by the Federal Drug Administration (FDA). Nevertheless, rheumatologists (including the authors) frequently prescribe sulfasalazine for RA because of its effectiveness and low incidence of serious side effects.
Side effects of sulfasalazine. Individuals taking this medication complain more frequently of stomach problems than of any other side effects. Although sulfasalazine is most effective when taken on an empty stomach, taking it with meals is acceptable and helps prevent stomach discomfort. Enteric-coated tablets (available at a higher price than un-coated tablets) also help in this regard. Beginning treatment with low doses and increasing the dose slowly also improve stomach acceptance.
Decreased sperm counts and changes in the sperm can occur, temporarily decreasing fertility. Sperm counts return to normal approximately two months after sulfasalazine use has been discontinued.
Serious side effects are rare and usually appear early in the course of treatment. Most worrisome are severe sulfa allergic reactions, hepatitis, and a decrease in the number of white blood cells, red blood cells, and platelets. The majority of people recover from these side effects when the medication is discontinued and proper treatment is given.
Before starting sulfasalazine therapy discuss the following with your physician:
•      Allergy to sulfa or antibiotics.
•      A history of kidney or liver problems.
•      Any medications you are taking to treat diabetes, blood pressure, seizures, or heart ailments or to thin the blood.
While taking sulfasalazine:
•     Avoid or protect yourself against sun exposure.
•      Inform your physician immediately if you develop a rash, blood in your urine, fever, bruising or easy bleeding, sore throat, cough, or shortness of breath.
•       Your physician will intermittently order complete blood counts, liver function tests, and urine tests to monitor and control the side effects.
Pregnancy and breastfeeding. Avoid use of this medication during pregnancy. Although birth defects have not been reported, caution suggests the use of birth control methods until sulfasalazine has been discontinued for two months.
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ARTHRITIS