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Updated April 2019
Sulfasalazine (brand names Pyralin EN, Salazopyrin EN) is a medicine used to treat rheumatoid arthritis. It can also be used to treat other diseases such as psoriatic arthritis, Crohn’s disease and ulcerative colitis.
It is a combination of an aspirin-like anti- inflammatory component and a sulphur antibiotic-like component.
It is not clear how sulfasalazine works. It appears to have anti-inflammatory effects and to reduce the activity of the immune system. In rheumatoid arthritis, these actions help to reduce inflammation in the joints and thus reduce pain and swelling. It also limits damage to the joints and helps to prevent disability in the long term.
Because sulfasalazine acts to reduce the damage to the joints, rather than just relieve the pain, it belongs to the group of medicines called disease modifying antirheumatic drugs (DMARDs).
Between 50 and 70% of people treated with sulfasalazine respond well to the treatment.
Sulfasalazine does not work straight away. Improvement in symptoms occurs gradually from about 6 to 12 weeks after commencing treatment.
Other medicines may be given to improve your symptoms while waiting for the sulfasalazine to work.
Sulfasalazine is taken by mouth in tablet form. It is usually taken twice a day but may also be taken as a single daily dose.
There are two types of tablet available – plain and enteric coated. The enteric coated tablet (Pyralin EN and Salazopyrin EN) is usually prescribed as it may have fewer side effects.
The enteric coated tablets should be taken with or after meals with a glass of water. They should not be broken, crushed or chewed.
Treatment is started slowly, with one tablet (500mg) or two tablets a day. The dose is increased each week. The usual maintenance dose is two tablets twice a day.
Sulfasalazine may be used with other arthritis medicines including:
Treatment with sulfasalazine may be continued indefinitely as long as it is effective and no serious side effects occur.
If you stop sulfasalazine treatment for more than a few weeks there is a risk that your condition may worsen. Continue with your treatment unless advised by your doctor or unless side effects develop.
You might experience side effects with your treatment. Tell your doctor if you are concerned about possible side effects.
A reduction in dose may minimise side effects so that you can continue to take this treatment. Your doctor will advise on any dose changes that are necessary.