Sulfasalazine Interactions

Brand names: Sulfasalazine

Aminosalicylate

Route: Oral

Contraindications

CONTRAINDICATIONS Sulfasalazine tablets are contraindicated in: Patients with intestinal or urinary obstruction, Patients with porphyria as sulfonamides have been reported to precipitate an acute attack, Patients hypersensitive to sulfasalazine, its metabolites, sulfonamides, or salicylates.

Pregnancy & Breastfeeding

Pregnancy: There are no adequate and well-controlled studies of sulfasalazine in pregnant women. Reproduction studies have been performed in rats and rabbits at doses up to 6 times the human maintenance dose of 2 g/day based on body surface area and have revealed no evidence of impaired female fertility or harm to the fetus due to sulfasalazine. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. There have been case reports of neural tube defects (NTDs) in infants born to mothers who were exposed to sulfasalazine during pregnancy, but the role of sulfasalazine in these defects has not been established. However, oral sulfasalazine inhibits the absorption and metabolism of folic acid which may interfere with folic acid supplementation (see Drug Interactions ) and diminish the effect of periconceptional folic acid supplementation that has been shown to decrease the risk of NTDs. A national survey evaluated the outcome of pregnancies associated with inflammatory bowel disease (IBD). In a group of 186 women treated with sulfasalazine alone or sulfasalazine and concomitant steroid therapy, the incidence of fetal morbidity and mortality was comparable to that for 245 untreated IBD pregnancies as well as to pregnancies in the general population. 1 A study of 1,455 pregnancies associated with exposure to sulfonamides indicated that this group of drugs, including sulfasalazine, did not appear to be associated with fetal malformation. 2 A review of the medical literature covering 1,155 pregnancies in women with ulcerative colitis suggested that the outcome was similar to that expected in the general population. 3 No clinical studies have been performed to evaluate the effect of sulfasalazine on the growth development and functional maturation of children whose mothers received the drug during pregnancy. Clinical Considerations: Sulfasalazine and its metabolite, sulfapyridine, pass t

47 interactions on record

Sulfasalazine + SepiapterinContraindicated

Sepiapterin reductase (SR) inhibitor that may reduce sepiapterin metabolism to BH4. Avoid concomitant use.

Source: NLP:sepiapterin

Sulfasalazine + LidocaineMajor

Increased risk of methemoglobinemia when used concurrently with lidocaine.

Source: NLP:lidocaine

Sulfasalazine + Lidocaine Patch 5%Major

Increased risk of methemoglobinemia; drugs associated with methemoglobinemia when used with local anesthetics.

Source: NLP:lidocaine patch 5%

Sulfasalazine + Lidothol PatchMajor

Increased risk of methemoglobinemia when local anesthetics are concurrently exposed to sulfa drugs.

Source: NLP:lidothol patch

Sulfasalazine + MercaptopurineMajor

May inhibit TPMT enzyme, increasing risk of myelosuppression when coadministered with mercaptopurine. Use lowest possible doses and monitor frequently for myelosuppression.

Source: NLP:mercaptopurine

Sulfasalazine + MethotrexateMajor

Patients receiving concomitant therapy with methotrexate and sulfasalazine should be closely monitored for possible increased risk of hepatotoxicity.

Source: NLP:methotrexate

Sulfasalazine + Triamcinolone AcetonideMajor

Increased risk of methemoglobinemia when concurrently exposed.

Source: NLP:bupivacaine hydrochloride, lidocaine hydrochloride, triamcinolone acetonide, povidine iodine

Sulfasalazine + AzathioprineModerate

Aminosalicylate derivative inhibits TPMT enzyme. Concomitant use should be done with caution.

Source: NLP:azathioprine

Sulfasalazine + BupivacaineModerate

May increase risk of methemoglobinemia when concurrently exposed with bupivacaine.

Source: NLP:bupivacaine

Sulfasalazine + DigoxinModerate

Reduced absorption of digoxin reported when administered concomitantly with sulfasalazine.

Source: NLP:sulfasalazine

Sulfasalazine + EltrombopagModerate

BCRP substrate; eltrombopag may increase exposure. Monitor closely for signs of excessive exposure.

Source: NLP:eltrombopag

Sulfasalazine + EtanerceptModerate

Concurrent use may result in mild decrease in mean neutrophil counts compared to monotherapy; clinical significance unknown.

Source: NLP:etanercept

Sulfasalazine + Folic AcidModerate

Reduced absorption of folic acid reported when administered concomitantly with sulfasalazine.

Source: NLP:sulfasalazine

Sulfasalazine + RiluzoleModerate

Hepatotoxic drug; riluzole-treated patients taking this may have increased risk for hepatotoxicity.

Source: NLP:riluzole

Sulfasalazine + ThioguanineModerate

Inhibits TPMT enzyme; should be administered with caution to patients receiving concurrent thioguanine therapy.

Source: NLP:thioguanine

Sulfasalazine + VadadustatModerate

Vadadustat may increase sulfasalazine exposure as a BCRP substrate. Monitor for adverse effects and reduce dosage if needed.

Source: NLP:vadadustat

Sulfasalazine + PretomanidUnknown

BCRP substrate. In vitro studies suggest pretomanid may inhibit BCRP, potentially increasing sulfasalazine exposure. Clinical impact unknown; monitor for adverse reactions.

Source: NLP:pretomanid