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Updated February 2023
Sulfasalazine is a medication used to treat certain childhood rheumatic conditions (diseases which may affect joints, muscles, skin or eyes). This can include juvenile arthritis (JIA) and inflammatory bowel disease.
It is a medication that works by suppressing your immune system. It reduces the damage done by inflammation, rather than just reducing pain. Because of this, it is called a disease modifying antirheumatic drug (DMARD). Other medications in this group include leflunomide, methotrexate and hydroxychloroquine.
Sulfasalazine is a medication that works slowly. You can expect your child to gradually start feeling better, but it might take one to three months.
Sulfasalazine is usually given as a tablet. There are two types of tablets available: plain and enteric coated. The enteric coated should not be crushed, as these tablets have a special coating which makes them more gentle on the stomach.
Treatment starts slowly: usually one tablet a day. This is increased over a few weeks. The dose is adjusted to your child’s weight.
Sulfasalazine can be continued long-term to maintain disease control.
Sulfasalazine is usually effective, however as with all medications, side effects can occur. Some are common, and some are rare. Most people don’t have any problems when they take sulfasalazine.
Most common side effects
Treatment
Nausea (feeling sick) vomiting, loss of appetite & diarrhoea
Orange coloured urine and tears
Headaches
Sulfur allergy (Itchy skin rash)
Skin rash / sun sensitivity
Mouth ulcers Sore gums Sore throat
Rare side effects
Disturbance in the blood counts (change in blood tests results)
Upset liver function
Lowered sperm count in males
Mood changes
Allergic reactions and severe skin reactions
All children taking sulfasalazine should be seen regularly by their paediatric rheumatologist to help monitor their health and minimise side effects.
What to do if your child is sick It is safe to give sulfasalazine if your child is sick with a mild cold or cough. Don’t give sulfasalazine if your child:
If you’re not sure, talk to your doctor and get them checked if necessary before giving mycophenolate.
Interactions Sulfasalazine can interact with other medications. Talk to your doctor before taking any prescription medications, natural medications and medications that you can buy over the counter.
Immunisations Sulfalasazine is safe with all immunisations. Children should follow the standard immunisation schedule.
Infections There is no increased risk of infections for children on sulfasalazine.
Alcohol Sulfasalazine and alcohol are both broken down by the liver. Drinking alcohol while you are on this medication can put extra strain on the liver. It is not known how much is safe, so it is suggested that anyone on sulfasalazine should avoid drinking alcohol.
Sexual health and pregnancy Sulfasalazine has been safely used in women who are pregnant and breastfeeding. Having been on sulfasalazine in the past does not change the chances of having babies later. Sulfasalazine can decrease the sperm counts in males, but this usually goes back to normal once the medication is stopped.
Myths and misconceptions You may hear a lot of different information about sulfasalazine from friends, pharmacists or people that you know. If you are worried about anything, please talk to your child’s doctor or nurse for more information. If your child is taking sulfasalazine they should see their paediatric rheumatologist regularly to make sure the treatment is working and to minimise any possible side effects.