.1 Sulphasalazine (Salazopyrin®Sulphasalazine is 5ASA chemically linked to sulphapyridine, a sulphur antibiotic. Sulphasalazine is not absorbed into the blood from the upper gut and cannot be broken down by the body. However, bacteria in the large bowel break the link between sulphapyridine and 5ASA, releasing free 5ASA into the bowel. There is very little absorption of 5ASA from the large bowel. In contrast sulphapyridine is almost completely absorbed into the blood and is thought to be responsible for most, but not all, of the side-effects of sulphasalazine. You should not take sulphasalazine if you are allergic to sulphur antibiotics. You should also tell your doctor if you think you are allergic to aspirin or if you have had a reaction to other types of drugs which may contain sulphur, such as tablets for diabetes.
1.1.1 Side Effects of Sulphasalazineabout 10% of individuals are unable to tolerate sulphasalazine because of side-effects. These usually occur within a few weeks of starting the drug and are more frequent with high doses (more than 4 tablets per day). In general it is best to start with a lower dose and gradually build up.
The most common side-effects are abdominal pain, nausea and vomiting, and reduced appetite. These can be helped by taking the tablets with food, rather than on an empty stomach, or by using enteric coated tablets (Salazopyrin EN). The enteric coating prevents release of sulphasalazine from the tablet until after it has left the stomach.
Headache and skin rashes are also relatively common. Occasionally sulphasalazine causes anaemia by a process called haemolysis. Red blood cells normally have a life span of 120 days before they are destroyed by the spleen. In some patients sulphasalazine accelerates this destruction. Rarely it can suppress the production of different types of blood cells in the bone marrow. Other uncommon side-effects include inflammation of the lung, hair loss, blistering of the face and mouth, and a flare-up of colitis.
Think I'll call my former doc in VA tomorrow and talk to him about all this. Will let you know what he says.