Sulfasalazine-ene for inflammatory bowel diseases. Liver disorders

active substance: 1 enteric tablet contains 500 mg of sulfasalazine;

Excipients: povidone, pregelatinized starch, magnesium stearate, colloidal anhydrous silicon dioxide, titanium dioxide (E 171), yellow iron oxide (E 172), talc, triethyl citrate, macrogol 6000, sodium carboxymethylcellulose, methacrylate copolymer (type A).

Dosage form

Enteric tablets.

Pharmacotherapeutic group

Anti-inflammatory drugs used for intestinal diseases. Sulfasalazine.

ATC code A07E C01.

Indications

• Induction and maintenance of remission in ulcerative colitis (Crohn's disease, nonspecific ulcerative colitis);
• treatment of rheumatoid arthritis in adults in case of insufficient effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs);
• treatment of juvenile polysubglobal or oligosubglobal rheumatoid arthritis.

Contraindications

• Hypersensitivity to sulfasalazine or other ingredients of the drug, sulfonamides and salicylates.
• Porphyria.
• Granulocytopenia.
• Children's age up to 6 years.

Directions for use and doses

The dose should be selected individually, taking into account the severity of the disease and tolerability of the drug.

Patients should take the tablets with meals. The tablets should be swallowed whole, not broken or crushed, and washed down with 1 glass of liquid.

If the patient misses the next dose of the drug, it should be taken as soon as possible. If it is nearing the time of the next dose, you should continue the recommended treatment schedule (without doubling the dose).

Elderly patients: There are no special warnings.

Ulcerative colitis

Adults

Severe course: 2-4 tablets (1-2 g) 4 times daily, may be used in combination with steroids as part of a regimen intensive care. If the tablets are taken quickly, the effectiveness of the drug may decrease.

The nightly interval between doses should not exceed 8 hours.

Moderate stroke: 2-4 tablets 4 times a day, can be used in combination with steroids.

Light weight stroke: 2 tablets 4 times daily with or without steroids.

Maintenance therapy: after induction of remission, the dose is gradually reduced to 4 tablets per day. The drug must be taken continuously at this dose, since if treatment is stopped even several years after acute attack the risk of relapse increases 4 times.

Children

Reduce the dose in proportion to body weight.

In case of an acute attack or relapse: 40-60 mg/kg per day.

Maintenance treatment: 20-30 mg/kg per day.

Crohn's disease

For Crohn's disease, the drug should be taken according to the same regimen as for ulcerative colitis (see above).

Rheumatoid arthritis

Adults

Patients with rheumatoid arthritis and patients taking NSAIDs for a long time may have a sensitive stomach, so in the case of this disease, Sulfasalazine-EN should be used according to the following recommendations. Treatment should begin with 1 tablet per day, gradually increasing the dose by 1 tablet per day every week until the dose is 1 tablet 4 times a day or 2 tablets 3 times a day, depending on the tolerability and effectiveness of the drug. The action appears slowly and pronounced effect may not be observed for 6 weeks. Improved joint mobility should be accompanied by decrease in ESR and level C-reactive protein. Possibly concomitant use of NSAIDs and Sulfasalazine-EN.

Juvenile polysubglobian or oligosubglobian rheumatoid arthritis.

Children aged 6 years and older.

30-50 mg/kg/day, divided into 4 equal doses. Typically the maximum daily dose is 2000 mg/day. To reduce possible intolerance from the side gastrointestinal tract should begin with ¼ of the planned maintenance dose, followed by an increase of ¼ each week until the maintenance dose is reached.

Adverse reactions

Overall, approximately 75% of cases adverse reactions occurs during the first 3 months of treatment, and more than 90% - during the first 6 months. Some adverse events are dose-related and symptoms can often be relieved by reducing the dose of the drug.

Are common.

Sulfasalazine is broken down by intestinal bacteria to sulfapyridine and 5-aminosalicylate, so possible unwanted reactions to sulfonamide or salicylate. In patients with slow acetylation status with more likely Adverse reactions to sulfapyridine will occur.

From the cardiovascular system.

Allergic myocarditis, cyanosis, pericarditis, periarteritis nodosa, vasculitis.

From the gastrointestinal tract.

Abdominal pain, nausea, vomiting, diarrhea, loss of appetite, hepatitis, fulminant hepatitis, pancreatitis, stomatitis, mumps, exacerbation of ulcerative colitis, liver failure, pseudomembranous colitis.

Hematological disorders.

Macrocytosis, leukopenia, neutropenia, megaloblastic anemia, hemolytic anemia, methemoglobinemia, anemia, agranulocytosis, thrombocytopenia, aplastic anemia, hypoprothrombinemia, anemia with Heinz bodies, pancytopenia.

Patients with porphyria may experience an acute attack.

From the outside nervous system.

Headache, peripheral neuropathy, dizziness, tinnitus, ataxia, insomnia, hallucinations, convulsions and aseptic meningitis, encephalopathy.

From the mental point of view.

Depression.

From the senses.

Impaired sense of taste, sense of smell, ringing in the ears, vertigo, injection of the conjunctiva and sclera.

From the genitourinary system.

Interstitial nephritis, proteinuria, hematuria, crystalluria, nephrotic syndrome, oligospermia and male infertility, which are reversible.

Allergic reactions

Skin rashes, urticaria, erythema, itching, exfoliative dermatitis, photosensitive reactions, exanthema multiforme, toxic epidermal necrolysis, Steven-Johnson syndrome, Sjögren's syndrome, systemic lupus erythematosus, serum sickness, lymphadenopathy, periorbital edema, conjunctival or scleral polyarteritis nodosa, anaphylaxis, alopecia, drug rash with eosinophilia and systemic symptoms(DRESS), toxic pustuloderma, lichen planus.

From the respiratory system.

Dyspnea, cough, eosinophilic infiltration, fibrous alveolitis, interstitial lung disease.

From the musculoskeletal system.

Arthralgia.

Laboratory tests.

During treatment with sulfasalazine, the levels of serum amylase, bilirubin, alkaline phosphatase and liver transaminases, induction of autoantibodies.

General condition and disorders associated with the method of administration of the drug.

Fever, swelling of the face, yellow discoloration of the skin and body fluids.

Overdose

Excessive doses of sulfasalazine cause nausea, vomiting and abdominal pain. When very high doses are used, anuria, crystalluria, hematuria and symptoms of central nervous system toxicity (convulsions) may occur. Toxicity is proportional to the concentration of sulfapyridine in the blood.

The patient's condition should be carefully monitored, since in some cases methemoglobinemia or sulfhemoglobinemia may occur, which requires appropriate treatment.

If symptoms of overdose appear, it is necessary to induce vomiting, rinse the stomach, cleanse the intestines, alkalize urine (increase pH to 7.0), and force diuresis. In case of anuria and/or renal failure Fluid and electrolyte intake should be limited. The effectiveness of the measures that are used can be assessed by the level of sulfapyridine concentration in the blood serum.

Use during pregnancy or breastfeeding.

Based on published data on the use of sulfasalazine in pregnant women, there is no evidence of teratogenic risks. Probability negative influence on the fetus when using sulfasalazine during pregnancy is low. At oral administration Sulfasalazine inhibits the absorption and metabolism of folic acid and may lead to folic acid deficiency. Because the harmful effects is not completely excluded, sulfasalazine can be prescribed to pregnant women only if there is a clear need for minimal doses.

During treatment you should stop breastfeeding.

Children

The drug is contraindicated in children under 6 years of age. The use of the drug in the treatment of children with a systemic form of juvenile rheumatoid arthritis often causes reactions similar to serum sickness; therefore, sulfasalazine is not recommended in these patients.

Features of application

All patients are recommended to undergo blood tests (complete blood count (including leukocyte formula); at the beginning of treatment 1-2 times a month, then every 3-6 months), as well as a urine test before starting treatment and during treatment.

Patients should be kept adequately hydrated during treatment.

Sulfasalazine should not be prescribed to patients with impaired liver or kidney function, or pathological changes blood unless the potential benefit outweighs the risk.

Special observation during treatment with sulfasalazine is necessary for patients with renal or liver failure, bronchial asthma and allergies (possible cross-hypersensitivity to furosemide, thiazide diuretics, sulfonylurea derivatives, carbonic anhydrase inhibitors). If allergic reactions or other serious unwanted effects Treatment with sulfasalazine should be discontinued immediately. For mild forms of allergy to sulfasalazine, desensitization may be performed.

The drug is not recommended for systemic forms of juvenile rheumatoid arthritis, as it often causes unwanted effects, such as serum sickness. Typical symptoms are fever, nausea, vomiting, headache, rash, liver dysfunction. This condition is often severe.

Patients should be warned to seek immediate medical attention if such symptoms occur. clinical signs such as sore throat, fever, malaise, pallor, purpura, jaundice or sudden onset of illness during treatment with sulfasalazine, as this may indicate myelosuppression, hemolysis or hepatotoxicity. If these signs are present, treatment with sulfasalazine should be discontinued pending blood test results.

Because sulfasalazine may cause hemolytic anemia, it should be used with caution in patients with glucose-6-phosphate dehydrogenase deficiency. Sulfasalazine, when administered orally, slows the absorption and metabolism of folic acid, which can cause folic acid deficiency and lead to serious violations from the blood (for example, macrocytosis and pancytopenia); The patient's condition can be normalized with the use of folic or folinic acid (leucovorin).

Since sulfasalazine causes crystalluria and the formation of kidney stones, you should drink enough fluids during treatment.

In men treated with sulfasalazine, oligospermia and infertility are possible. After discontinuation of sulfasalazine therapy, these effects disappear within 2-3 months.

Life-threatening injuries have been reported with the use of sulfasalazine. skin reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis. Patients should be warned of the signs and symptoms and closely monitored for skin reactions, especially during the first weeks of treatment.

If symptoms or signs of Stevens-Johnson syndrome and toxic epidermal necrolysis (eg, progressive skin rash, often with blisters or mucosal lesions) are present, treatment with sulfasalazine should be discontinued.

The best treatment results are achieved with early diagnosis diseases. If patients have previously experienced symptoms or signs of Stevens-Johnson syndrome and toxic epidermal necrolysis, sulfasalazine is not recommended to be restarted in these patients at all.

The ability to influence the reaction rate when driving a vehicle or working with other mechanisms.

During treatment, you should refrain from driving vehicles and working with precision machinery.

Interaction with other drugs and other types of interactions

Sulfasalazine reduces the absorption of folic acid and digoxin. When administered simultaneously with anticoagulants and hypoglycemic agents - sulfonylurea derivatives - it enhances their effect. Due to the inhibition of the enzyme thiopurine methyltransferase by sulfasalazine, depression of function may occur when sulfasalazine is used concomitantly with thiopurine-6-mercaptopurine or azathioprine. bone marrow and leukopenia.

The use of sulfasalazine and methotrexate in patients with rheumatoid arthritis does not change the pharmacokinetic characteristics of the drug. However, an increased incidence has been reported side effects from the outside digestive tract, in particular nausea. Antibiotics may reduce the effectiveness of Sulfasalazine-EN.

Pharmacological properties.

Pharmacodynamics.

Accumulates in connective tissue intestines with the release of 5-aminosalicylic acid, which has anti-inflammatory properties, and sulfapyridine, which has an antimicrobial effect against diplococci, streptococci, gonococci, coli. It exhibits an immunosuppressive effect, especially in connective tissue, the intestinal wall and serous fluid, where its concentration is highest. Sulfapyridine reduces systemic inflammation and has antibacterial effect, interferes with the action of natural killer cells and the transformation of leukocytes. The anti-inflammatory effect of 5-aminosalicylic acid (mesalazine) is most significant in the treatment of inflammatory bowel diseases. Mainly locally, it inhibits cyclooxygenase and lipoxygenase in the intestinal wall and thus prevents the formation of prostaglandins, leukotrienes and other inflammatory mediators. Thanks to low absorption, it reduces inflammation in the large intestine.

Pharmacokinetics.

Approximately 30% dose taken sulfasalazine is absorbed into small intestine; the remaining 70% is metabolized by gut bacteria in the large intestine into sulfapyridine and 5-aminosalicylic acid. Maximum serum concentrations of sulfasalazine and its metabolites vary quite widely between patients - at low levels of acetylation they are much higher and are associated with increased incidence of adverse events. The maximum serum concentration of sulfasalazine is achieved 3-12 hours after taking enteric tablets. It binds well to blood plasma proteins and connective tissue. Most of the absorbed amount of sulfasalazine is returned with bile to the intestine; a small amount is excreted unchanged in the urine. The half-life of sulfasalazine is 5 to 10 hours.

Most of the released sulfapyridine is absorbed and reaches maximum serum concentrations 12-24 hours after dosing. Metabolized in the liver (by acetylation, hydroxyluvania and conjugation with glucuronic acid), excreted by the kidneys. The half-life is from 6 to 14 hours, depending on the rate of acetylation. Only almost 30% of 5-aminosalicylic acid is absorbed and acetylated in the liver and excreted through the kidneys in the urine. The rest is excreted unchanged in the feces.

Basic physical and chemical properties

round, light brown, slightly biconvex, film-coated tablets.

Best before date

Storage conditions

Store at a temperature not exceeding 25 °C in the original packaging. Keep out of the reach of children.

Package

10 tablets in a blister, 5 blisters in a cardboard box.

Vacation category

On prescription.

Manufacturer

KRKA, d.d., Novo Mesto, Slovenia/

KRKA, d.d., Novo mesto, Slovenia.

Location

Shmar"eshka cesta 6, 8501 Novo mesto, Slovenia/

The medication Sulfasalazine has a pronounced anti-inflammatory effect. This is an anti-inflammatory category of drugs that are widely used for various pathologies Gastrointestinal tract, as well as rheumatoid arthritis.

This article will present detailed description and reviews of the drug Sulfasalazine.

Sulfasalazine is produced in the pharmaceutical form of powder and tablets, which are enteric-coated and used for oral administration.

The capsules are presented in a round shape, convex, and have a yellowish or brownish tint. The main active ingredient is the substance Sulfasalazine; it is contained in one tablet in the amount of 500 mg.

Sulfasalazine tablets

In addition, the medication contains other substances, in particular titanium dioxide, magnesium stearate, sodium carmellose, etc.

The difference between the drug and Sulfasalazine-EN

Many patients cannot understand the difference between Sulfasalazine and Sulfasalazine-ene. The difference between these analogues lies in the special structure of the tablet film. The preparation with the prefix EH has an enteric coating, which has a positive effect on the absorption of the active ingredient. In terms of price, the medicine will cost more than its counterpart without a prefix.

Action

After the patient swallows the drug, it enters the stomach unchanged. There are bacteria in the gastrointestinal tract that affect the process, both active components begin to be released and treatment begins.

A certain portion of the product will remain on the surfaces of the intestines, the other part will travel through the bloodstream to the connective tissue and liver, where it will concentrate. About 30% of the medication enters the joint fluid, what does it say about high efficiency medicines.

It is worth emphasizing that a pharmaceutical product is of high quality if at least 10% reaches the painful area. In old age, the elimination of the drug takes much longer.

Today information has spread that the drug has an immunosuppressive effect. In other words, This drug has the ability to suppress the attack of protective cells against their own. The ability of the drug to influence allergization only expands the boundaries of its use.

The main principle of treatment with this medication is its ability to influence inflammatory mediators, as well as the prevention of allergic reactions, swelling, joint stiffness, pain and poisoning.

This remedy is number one in order to stop the current inflammatory process.

Many people are interested: Is Sulfasalazine an antibiotic or not? This is not an antibiotic, but a drug with a pronounced anti-inflammatory effect. He's just filming pain symptom, but does not cure the disease itself.

This pharmaceutical product may only be taken with the consent of a doctor. Under no circumstances should it be prescribed independently., since a person without medical education cannot determine the intensity of inflammation and stage pathological process.

Indications for use

Sulfasalazine EH

It is permissible to take this drug in a number of cases:

• with ulcerative colitis or chronic inflammatory process;
• with mild and average shape Crohn's disease, gastrointestinal pathologies;
• rheumatoid arthritis, as well as if there is an autoimmune effect of joint structures affecting motor abilities and functions. Usually small structures, hands and feet, knees, etc. are affected. Bright distinctive feature serves as a restriction of mobility, in which the patient begins to walk around for about an hour, and only after that begins to feel normal. There is evidence that this drug also helps with ankylosing spondylitis, which contributes to stiffness in movements. The medicine can help even when it no longer works, so there is no point in looking for better analogues.
• Inflammatory joint disease that affects children is also a reason to take medication. If such a diagnosis is established for a child, then it is completely unknown how long he will be sick. The product is recognized as harmless and safe for the child’s body. It can be taken on a long-term basis, combined with hormonal medications.

Before prescribing treatment, it is important to undergo a thorough diagnosis and only then consult a doctor.

Restrictions

Like anyone else medication, Sulfasalazine has a number of contraindications that must be taken into account:

1. Intolerance to the components included in the product. The medicine is not only the active ingredients, but also includes a shell and an inert base; a reaction can occur to any substance.
2. Genetic disease of the nervous system.
3. Reduced level of granulocytes in the blood.
4. Problems with the patency of the urinary tract.
5. Various blood pathologies Iron-deficiency anemia and etc.
6. Pathologies of the kidneys and liver, in which the normal load on the organs becomes very heavy.
7. Children under 5 years old.
8. Lactation. There is no information about the effect of the drug on breast milk, but it's better not to risk it.
9. Polyarthritis in childhood, in which the entire body is involved in the pathological process.

Adverse reactions

The percentage of adverse reactions to the drug is approximately 10-20%

Side effects at this drug are present, but there are very few of them, as evidenced by reviews of the drug Sulfasalazine. First of all, it is worth saying that the product colors urine and body fluids a bright yellow color.

This reaction is specific and does not threaten human health. In addition, inadequate reactions to the stimulus, which can be any component, may appear. If you are allergic to any substance, be sure to tell your doctor about it.

More details about how to treat idiopathic juvenile arthritis

A reaction from the digestive system may also occur. It is expressed by abdominal pain, nausea and vomiting, and lack of appetite. Kidney function may be impaired, requiring urgent dosage reduction. Before starting therapy, the doctor usually prescribes diagnostics in order to exclude such a reaction.

Minor changes in the composition of the blood were observed, which is also not fatal.

The incidence of adverse reactions is approximately 10-20%. To exclude all this, it is important to first undergo a thorough diagnosis.

Reception features

The instructions for use of Sulfasalazine EH tablets state that they must be taken orally after a meal.

For ulcerative colitis

For children under 16 years of age, the dosage of the medicine is 2 grams for the first time, which must be divided by 4 times. The second time, the patient needs to drink 4 grams per day in 4 doses. From the third time you need to do the dose 4 times in the amount of 6-8 grams.

As soon as the symptoms subside, the dosage is immediately reduced to two grams. You can take the drug for several more months, but children with low weight, up to 65 kg, are not included in this category.

In the case of left-sided spread of the pathological process, it is allowed to wash with enemas and insert Sulfasalazine suppositories.

For rheumatoid arthritis

The drug must be taken orally after a meal

Starting from the first week of treatment you need to take daily dose at 500 mg for adults. From the second week the dose is doubled in two doses, from the third week it is increased threefold and divided into three doses.

The therapeutic dosage varies between one and a half to three grams. In order to achieve a clinical result, the drug should be taken for 6-10 weeks, up to six months.

How to take the medicine Sulfasalazine for ankylosing spondylitis

When therapy with anti-inflammatory drugs and hormonal agents does not give any results, is prescribed this medicine as a basic one, in order to stop inflammation in the joints.

You need to take the medication on a long-term basis, up to 6 months; as soon as the patient gets better, it is immediately discontinued. After this, the maximum dosage is applied and other drugs are discontinued, then the dosage is reduced and the anti-inflammatory drug is discontinued.

The achieved results can last up to two months, after which treatment is prescribed again.

Combination with alcohol and other drugs

The compatibility of Sulfasalazine and alcohol is a very relevant and frequently asked question. The instructions for the medication do not say anything about this compatibility, since no studies have been conducted.

Experts advise drinking the product a few hours after you drink alcohol.

Taking medication together with folic acid and digoxin reduces the effect of the latter. The drug stimulates the effect of anticoagulants and anti-allergy drugs. Not recommended joint reception with antibiotics, because similar action affects the effectiveness of treatment.

Analogs

What to replace the drug with? The ideal solution will be a product with the prefix EH, - Sulfasalazine-EN which you see in the photo below. Also similar in their effects are drugs such as Mesakol, Asakol, Pentasa and many others.

Photo Sulfasalazine EH

Patients often ask which is better: Sulfasalazine or Methotrexate. The drugs have a similar effect. In order to get an answer to this question, consult a doctor.

Only a specialist can analyze the specific effects of medications, taking into account all the restrictions and adverse reactions in your case.

If you ask which is better: Sulfasalazine or Salofalk, then you will receive the same answer as in the previous case. In fact, these are two identical drugs and it is quite difficult to determine which is better. There is an opinion that the latter is more modern and safer.

Efficiency

Easy to find in pharmacies

Side effects

average rating

Based on 3 reviews

Sulfasalazine is one of the most effective and popular drugs with an anti-inflammatory effect. The product helps with Crohn's disease and NUC.

The drug Sulfasalazin is manufactured in China by Zhejiang Jiuzhou Pharmaceutical Co. Especially for the Slovenian-Russian company KRKA. International non-proprietary name The INN drug is called a mesalazine derivative under the ATC code A07EC01. The product has antimicrobial properties. According to its chemical structure, it is a combination of aminosalicylic acid and sulfapyridine substance. thirty% taken drug adsorbed from the intestinal lumen. Then it penetrates into connective tissue. The drug is affected by intestinal microflora. The molecules of the main component begin to disintegrate.

The main component is sulfasalazine, which belongs to pharmacological group sulfonamides.

Only 10% is absorbed from the gastrointestinal tract. Has binding to plasma proteins. May undergo biotransformation in the liver. 5% is excreted through feces and 67% through the kidneys. 91% of the substance is eliminated within three days.

Ask your question to a neurologist for free

Irina Martynova. Graduated from Voronezh State University medical University them. N.N. Burdenko. Clinical resident and neurologist of the BUZ VO \"Moscow Polyclinic\".

Release forms and composition

Pills Sulfasalazine has an amber-brown tint. Available in an unusual shape with a beveled edge. Small inclusions are allowed in the tablets. One blister contains ten tablets. One paper box there are from one to five blisters. The cost of the drug depends on the markup of resellers. The cost is 310 rubles or more.

One tablet contains 500 milligrams of the main active ingredient. Also includes:

• Starch;
• Magnesium salt;
• Amorphous substance silicon monoxide;
• Hypromellose;
• Organic compound propylene glycol;

Candles Sulfasalazine must be injected into the rectum twice a day.

One candle contains the main active ingredient sulfasalazine and cocoa butter. One package contains from five to twenty candles. The cost of the drug is 300 rubles and more.

Sulfasalazine and Sulfasalazine EH: what is the difference?

Sulfasalazine EH differs from regular Sulfalazine in the chemical structure of the film shell of the tablets. The new generation drug EH has a special enteric coating. Thanks to the new formula, this drug has the best bioavailability. The absorption effect of the main active component has also been increased. 90% of the total dosage taken can directly reach the colon. The absorption of regular Sulfalazine reaches only 70%.

But a new form of the drug is produced by the American company Pfizer. Therefore, this medicine costs 1/3 higher than its usual predecessor.

Dosages, application regimen

For Crohn's disease, ulcerative colitis:

• For adults and adolescents over sixteen years of age, the first daily dosage should be two grams. It is divided into four doses.
• The second daily dosage should be four grams. As in the first case, it is divided into four steps.
• The third and subsequent dosages should be equal to six or eight grams. They are divided into four or five receptions.

At initial stage diseases, when clinical manifestations subside in acute and chronic form, it is necessary to take a maintenance daily dosage of 1.5-2.0 grams. It is divided into three or four doses. This maintenance course of therapy can last from one month to six months. But for children and adolescents under sixteen years of age, a maintenance course is not recommended. Such therapy can negatively affect the development of the child’s body. Also this therapy not recommended for patients whose weight is less than 65 kilograms.

The maximum daily dosage depends on the patient's age. Adults should not take more than eight grams of the component per day. In children, the dosage should not exceed two grams.

For distal localization of the lesion on the left side, patients are recommended to use suppositories and special microenemas. They are introduced into the intestines no more than twice a day. The recommended daily dosage of sulfasalazine should be at least one gram, cocoa butter - at least 1.6 grams.

Sulfasalazine for rheumatoid arthritis:

• Recommended daily dosage for adult patients and adolescents over sixteen years of age in the first seven days of therapy should be at least five hundred milligrams.
• From 8 to 15 days of therapy, you need to take 1000 milligrams of the component per day. This dosage divided into two steps.
• From days 16 to 21 of therapy, the daily dosage should exceed 1500 milligrams. It is divided into three even doses.

The therapeutic dosage can be 1.5-3.0 milligrams. The most accurate information on dosing of the product should be obtained from a specialist. In order to achieve clinical effect, the course of therapy should last at least six to ten weeks.

Treatment of the disease can last more than six months.

Sulfasalazine instructions for use in pediatrics:

• Small children from six to eight years old with a body weight of 20 to 29 kilograms should take one tablet twice a day;
• Children from six to twelve years old weighing from 30 to 39 kilograms professional specialists It is recommended to take one tablet three times a day;
• Adolescents from twelve to sixteen years old with a body weight of 40 to 45 kilograms can take one tablet three times a day or two tablets twice a day;
• Adults, adolescents over sixteen years of age and children weighing over 50 kilograms should take two tablets twice a day;

For reactive arthritis:
The course of therapy begins with one tablet per day. The dosage is gradually increased. Max daily dosage for treatment of this disease There should not be more than four to six tablets. The medicine must be taken thirty minutes before meals. The product is washed down with distilled water without gas. The duration of therapy is three months or more.

You should consult your doctor for the most accurate information.

For ankylosing spondylitis:

If treatment with non-steroidal anti-inflammatory drugs and hormones is ineffective, then doctors prescribe therapy with Sulfasalazine. It is used as a basic medicine. The medicine easily stops inflammation in the joints. The product must be drunk for three to six months. The drug is taken until the patient's condition improves. After formation healing effect dosages are increased to the maximum. At the same time as therapy, treatment with other drugs is discontinued. Their dosages are reduced gradually.

Pathological processes in this disease cannot be stopped. But the maximum effect can last for two to three months. As a supportive effect, patients take non-steroidal anti-inflammatory drugs in small dosages.

After the condition worsens, the therapeutic course is re-prescribed.

Sulfasalazine indications for use:

• Maintenance course of therapy for remission of ulcerative colitis;
• Heavy chronic illness intestines, manifested in the form of severe inflammation;
• Systemic disease of connective tissue with damage to joints, with the formation of erosions and destructive polyarthritis;
• Rheumatoid arthritis developing in children and adolescents;

Contraindications

The drug Sulfasalazine is contraindicated in the following cases:

• For any hematopoietic diseases;
• With a hereditary disorder of pigment metabolism;
• For any allergic reactions;
• Lack of G6PD enzyme;
• In case of malfunction of the liver and kidneys;

special instructions

• The drug is not recommended for patients with problems with the functioning of the kidneys and liver. The product is prohibited for people undergoing hemodialysis.
• The drug can cause Negative consequences in people suffering from bronchial asthma.
• The product is not recommended for use together with similar drugs similar action;

Application nuances

• The drug contains components that may adversely affect the development of the fetus. That's why this remedy not recommended for pregnant girls in the first and second trimester. When using the medicine in III trimester newborns develop kernicterus. If it is necessary to use the product for nursing mothers, the child must be switched to artificial nutrition.
• The drug is not recommended for people over 65 years of age. In particular severe cases patients must undergo therapy under the supervision of a physician.
• The product can be used by children and adolescents over two years of age. But giving the entire recommended dosage at once is not recommended. The therapeutic course should be gradual. The exact dosage and duration of treatment should be prescribed by a specialist.

Overdose and side effects

Patients may feel:

• Headaches of various manifestations;
• Migraine;
• Depression;
• Irritability;
• Manifestation of nausea;
• Vomiting;
• Limb spasms;
• Insomnia;
• Sense of anxiety;
• Noise in ears;

There may be a malfunction of the kidneys and liver, manifestation interstitial nephritis. May be affected lung tissue. Thrombocytopenia may develop. Girls are violated reproductive functions, infertility occurs.

Hypersensitive people experience allergic reactions.

Interaction with other drugs

Is it possible to use Sulfasalazine simultaneously with prebiotics?? Prebiotics must be used in therapy with other drugs. The interaction effect of Sulfasalazine increases with simultaneous administration probiotics. Are decreasing painful sensations, inflammation is eliminated.

Is it possible to drink Mesacol after Sulfasalazine?? In especially severe cases, when the drug Mesacol is poorly effective, it is replaced with other similar ones. medicines, including sulfasalazine. But interrupt the recommended course of therapy experienced specialists not recommended.

Interaction with alcohol

Sulfasalazine and alcohol are incompatible. While undergoing therapy with this drug, consuming any alcoholic beverages is not recommended. Otherwise, they may form side effects up to fatal outcome. But there are no specific studies or reliable data, since each person reacts individually to chemical reactions. If there is a need to consume alcohol, then taking the drug is allowed only after eight to ten hours. In this case, the dose of alcoholic beverages taken should be minimal.

This period of time is necessary to ensure that there is no contact between two incompatible substances.

Storage, release from pharmacies

The drug Sulfasalazine can only be purchased upon provision prescription form specialist The drug must be stored in a dry room at a temperature not exceeding 25°C. It is not recommended to store the drug in the refrigerator. The shelf life is five years from the date of production. It is prohibited to use the medicine after the expiration date. The year of the last adjustment of the means is 2010.

Analogs

Sulfasalazine analogues differ in cost, main active component, effectiveness, duration of therapy.

Reviews

Most reviews about the drug are positive. But in order to achieve maximum effect, you must take this medicine for long period. The effectiveness of Sulfasalazine reaches 95% after two to four weeks. The medicine has an antimicrobial effect. Easily removes any inflammatory processes. Eliminates pain effects. Designed for both adults and children. Negative reviews published by patients exceeding recommended dosages. In this case, side effects are detected. There is information about the low effectiveness of the drug in therapy lasting less than one week.

Before starting to take the medicine, you should consult with a professional specialist in advance.

FAQ

Is the drug effective for UC?? The drug stops the development of the disease. The duration of the course of therapy should be prescribed by a specialist. The recommended daily dosage should be at least five hundred milligrams.

Sulfasalazine or Methotrexate, which is better?? Both drugs have antirheumatic effects. Both are manufactured in two release forms. They are used for rheumatoid arthritis. The difference between the funds is in the cost and duration of the course.

Use of Sulfasalazine in the treatment of prostatitis. A course of this drug along with antibiotic therapy is necessary. The minimum daily dosage for the treatment of prostatitis should be at least 1000 milligrams.

Which is better Mesacol or Sulfasalazine? Both drugs treat ulcerative colitis. Suitable for both adult patients and children. Mesacol is good for preventing and treating diseases. The cost of the drug is more than a thousand rubles.

Which is better Sulfasalazine or Salofalk? Both drugs are the same in purpose. But the combination of drugs is incompatible. Salofalk is the newest, most effective and safe means unlike its predecessor.

Sulfasalazine is an effective and popular drug intended for long-term treatment. It is prescribed to both adult patients and children over two years of age.

Easily relieves inflammation and any pain in joints and muscles.

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Sulfasalazine (salazosulfasalazine) has been successfully used in the treatment of inflammatory bowel diseases for more than half a century. The drug was obtained by combining aminosalicylic acid and sulfapyridine. Both parts of the drug are connected by a nitrogen group. The effect of the drug is based on the action of both its constituent acetylsalicylic acid, and sulfo compounds. 5-aminosalicylic acid, having an anti-inflammatory effect, inhibits the synthesis of prostaglandins and the action of cyclooxygenase. Sulfapyridine, an antagonist of p-aminobenzoic acid, has antimicrobial effect, and also inhibits monocytes and blocks the transformation of lymphocytes. Sulfasalazine is active against both humoral and cellular immunity. After oral administration About a quarter of the dose of sulfasalazine is absorbed in the upper parts of the digestive tract, and more than half of this amount re-enters the intestine due to enterohepatic circulation. Thus, more than 90% of the oral dose of the drug reaches the colon. Sulfasalazine, under the influence of colon microflora, is broken down into its component parts (aminosalicylic acid and sulfapyridine). 5-Aminosalicylic acid is poorly absorbed and has a pronounced local anti-inflammatory effect. Sulfapyridine is absorbed and then, subjected to pre-acetylation, is excreted in the urine. With a genetically determined reduced level of sulfapyridine acetylation, the concentration of the drug in the blood serum is increased, which can lead to an increased incidence of side effects.
Controlled studies conducted in the 60s of the last century demonstrated the effectiveness of treatment with Sulfasalazine in mild and moderate cases of ulcerative colitis. Clinical improvement occurred in 64-80% of patients, while the administration of placebo led to a positive effect only in 30-40% of cases. Controlled studies have shown that the clinical effect of the drug is dose-dependent. However, high daily doses of Sulfasalazine are more likely to cause side effects drug therapy.
Behind Last year we purchased clinical experience application of new dosage form Sulfasalazine EH (Gastroresistent tablets) and tried to evaluate its clinical effectiveness and safety.
Sulfasalazine EH was administered to 28 patients with ulcerative colitis. Average age of patients (17 women, 11 men) was 43.6±9.1 years. Among the studied patients. The duration of the disease ranged from one year to 20 years. Clinical characteristics patients are presented in Figure 1. In the group examined, patients with proctosigmoiditis predominated (21 patients), pancolitis was detected in 7 patients. Disease activity was mild or moderate severity. If necessary, Sulfasalazine was combined with the administration of corticosteroids (in 8 patients). Complaints made by patients are presented in Figure 2. All patients had diarrhea. Hematochezia was present in more than half of the patients (17 people). Less common were abdominal pain, fever, extraintestinal manifestations.
While taking the drug at a dose of 1.5-3.0 g/day. diarrhea decreased or disappeared in 22 patients (78.6%). The majority of patients noted a disappearance or a significant decrease in blood discharge in the stool (12 patients – 70.6%). Clinical effect usually occurred 7-12 days after starting the drug. After stabilization of the clinical picture, the dose of the drug was reduced to a maintenance dose (1.0-1.5 g/day); Subsequently, similar therapy was carried out for 2-3 months.
The comparison group consisted of patients with ulcerative colitis (proctosigmoiditis) - 10 patients who received the usual form of Sulfasalazine at a dose of 1.5-3.0 g/day. In the comparison group, diarrhea decreased or disappeared in 9 out of 10 patients (90%). Hematochezia resolved in 3 of 6 patients (50%). Thus, it was not possible to note differences in the clinical effectiveness of the 2 forms of the drug studied (p > 0.05).
According to the literature, various side effects of Sulfasalazine are observed in 10-45% of patients receiving this drug. Patients may experience loss of appetite, nausea and vomiting, abdominal pain, itchy skin, more rarely - fever, pancytopenia, drug-induced pancreatitis, etc. Along with clinical effectiveness possible side effects of the compared 2 forms of Sulfasalazine were studied (Fig. 3). Of the 28 patients with ulcerative colitis who were prescribed Sulfasalazine EH, side effects of the drug occurred in only 4 patients (14.2%). The most significant, in our opinion, was the development in a 30-year-old patient who received Sulfasalazine for 4 days in the amount of 3 g/day. drug-induced pancreatitis. The patient developed severe pain in the upper abdomen, worsening after eating, and bloating. Blood tests showed hyperamylasemia. Canceling Sulfasalazine EH, prescribing an appropriate diet, detoxification therapy, and antisecretory drugs quickly helped positive effect. In 2 other patients, nausea was noted (and in one case it was transient). Allergic rash developed during the use of the drug in 1 patient; such skin changes completely disappeared 2 days after its discontinuation. In the group of patients receiving the usual form of Sulfasalazine, side effects of drug therapy were noted in 4 patients (40%). Side effects included dyspeptic complaints, increased abdominal pain, and headache. In 2 cases, due to the presence of the above complaints, treatment had to be interrupted.
Thus, although the frequency of side effects when using Sulfasalazine EH did not differ significantly from that when using the usual form of the drug (p>0.05), there is still a pronounced tendency to reduce the number of side effects when prescribed new form drug (14.2 and 40%) (Fig. 3). The development of drug-induced pancreatitis during the use of a fairly high dose of the drug (3 g/day) in the first days of treatment confirms the opinion that most often side effects may occur in patients in whom sulfapyridine acetylation occurs slowly and, therefore, the level of sulfapyridine increases in serum. Sulfasalazine EH turned out to be effective means in the treatment of mild and moderate forms of ulcerative colitis and is relatively well tolerated by patients. The new drug can be recommended for wide clinical use in such patients.

Literature
1. A short guide to gastroenterology. Edited by V. T. Ivashkin, F. I. Komarov, S. I. Rapoport “M-Vesti” Moscow, 2001
2. Guido Adler “Crohn’s disease and ulcerative colitis” “GEOTAR_MED”
Moscow, 2001
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6. Rutgeerts P, Mayer L, Schreiber S, et al. Infiximab (Remicade) maintenance treatment strategy is superior to episodic treatment in patients with Crohn`s disease. Am. J. Gastroenterol. 2001; 96:S302-S303.