Azulfidine (sulfasalazine) belongs to the disease-modifying antirheumatic drugs (DMARDs) class of medications; how exactly it provides benefit is unclear. The medication is widely used to treat rheumatoid arthritis, and somewhat less commonly in ulcerative colitis and Crohn's disease. It may also be used in related conditions.

In general Azulfidine is used in patients age 6 and up, though it is rarely administered to younger patients. In children dosage is based on weight, which is best determined by a doctor.

Azulfidine is also widely considered safe to take while pregnant, though parents should discuss potential risks with a doctor. Breastfeeding does carry a small risk of serious side effects if taking Azulfidine.

Patients with a history of allergic reaction to aspirin or sulfonamide (also known as sulfa) drugs should not take this product.

Treatment Overview

In both rheumatoid arthritis and inflammatory bowel disease, Azulfidine will help reduce the severe active effects and, once in remission, will help prolong remission periods. Azulfidine will not cure these conditions, but can significantly improve quality of life.

Dosage does differ depending on if a patient is experiencing an active or remission phase, and to a lesser extent will vary to some degree according to patient response to treatment, and to what is being treated.

For active rheumatoid arthritis:

• The standard dose is 2 to 3 grams per day (2000 to 3000 mg).
• Patients may be started on lower doses of 500 mg to 1 gram (1000 mg) per day for 5 to 7 days before dosage is increased.
• Total daily doses should be divided into smaller doses taken at even intervals throughout the day.
• Ideally no more than 8 hours should pass between doses.

For rheumatoid arthritis in remission:

• The standard dose is 500 mg to 1 gram (1000 mg) per day.
• Total daily doses should be divided into smaller doses taken at even intervals throughout the day.

For active inflammatory bowel disease:

• The standard dose is 3 to 4 grams per day (3000 to 4000 mg).
• Patients may be started on lower doses of 1 to 2 grams (1000 to 2000 mg) per day for 5 to 7 days before dosage is increased.
• Total daily doses should be divided into smaller doses taken at even intervals throughout the day.
• Ideally no more than 8 hours should pass between doses.

For inflammatory bowel disease in remission:

• The standard dose is 2 grams (2000 mg) per day.
• Total daily doses should be divided into smaller doses taken at even intervals throughout the day.

Note there are many possible variables that may also influence dosage, including other medications being taken, other medical conditions, patient response, patient weight, and of course patient age---the above guidelines are for adults.

Warnings & Side Effects

About 25 percent of patients react poorly to Azulfidine. The most obvious symptoms are gastrointestinal distress, including:

• Stomach discomfort
• Nausea
• Vomiting
• Appetite loss
• Dizziness
• Fatigue

To some extent the above can be mitigated by taking tablets on a full stomach, but in other patients the above are present regardless, and may become so severe that treatment ends.

More subtle, but also more rare, side effects may also develop:

• Photosensitivity
• Allergic reaction
• Lowered white blood cell counts
• Anemia
• Liver failure
• Kidney failure
• Pancreatitis

The above are all severe, and if they begin to develop dosage will be lowered or treatment will end. With the exception of some allergic reactions, all of the above can be detected early if the patient attends regular doctor visits. Again, the above are rare.

Urine color may change to a vivid yellow or orange; this is not cause for concern. Skin can also become yellow or orange; while not necessarily dangerous (yellow skin may also indicate jaundice, however), it can be embarrassing.

Men taking Azulfidine may experience reduced sperm count, which can be so severe as to render a man temporarily infertile. This side effect is completely reversible if treatment ends, however.

Many other medications can interact with Azulfidine, including over-the-counter varieties, many of which are also used to help treat rhuematoid arthritis or inflammatory bowel disease, and consequences can be severe. Always double-check safety with a doctor prior to taking other medications with Azulfidine.