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Author: Anoma Ranaweera B.V. Sc; PhD (Clinical Biochemistry, University of Liverpool, UK), 2013.
Sulfasalazine is an anti-inflammatory medication consisting of a combination of 5-aminosalicylic acid and the sulphonamide sulfapyridine. Currently, this drug is approved by the US Food and Drug Administration (FDA) for the treatment of ulcerative colitis and rheumatoid arthritis. Sulfasalazine has also been used for some skin conditions.
Non-approved reported uses of sulfasalazine in dermatology include:
The mechanism of action of sulfasalazine has not yet been fully elucidated but is believed to be multiple.
Side effects are more likely in slow acetylators, who have higher plasma concentrations of sulfapyridine.
Common but harmless and transient adverse effects include:
Other rare but potentially serious adverse effects include:
Potential cutaneous adverse events due to sulfasalazine include:
As the dermatological indications are all off-label, treatment should only be started after receiving patient consent.
Contraindications to its use are:
A pretreatment workup should include:
The US FDA has classified sulfasalazine as Category B.
The Australian TGA has classified sulfasalazine as Category A. Category A medicines have been taken by a large number of pregnant women and women of childbearing age, without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed. However:
If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children).
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