Azulfidine: Effective Control for Chronic Inflammatory Conditions
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Synonyms | |||
Azulfidine (sulfasalazine) is a time-tested disease-modifying antirheumatic drug (DMARD) combining anti-inflammatory and antibacterial properties. This prescription medication has demonstrated clinical efficacy in managing autoimmune conditions through its dual mechanism of action. Physicians have trusted Azulfidine for decades as a foundational therapy for rheumatoid arthritis and inflammatory bowel diseases. Its well-established safety profile and predictable pharmacokinetics make it a cornerstone in long-term treatment strategies.
Features
- Contains sulfasalazine 500 mg enteric-coated tablets
- Proprietary delayed-release formulation for targeted delivery
- Combines 5-aminosalicylic acid (5-ASA) and sulfapyridine
- Manufactured under strict pharmaceutical quality standards
- Available in convenient oral tablet form
- Stable shelf life of 36 months when stored properly
Benefits
- Reduces joint inflammation and pain in rheumatoid arthritis
- Maintains remission in ulcerative colitis and Crohn’s disease
- Slows disease progression and prevents joint damage
- Improves physical function and quality of life
- Minimizes flare frequency and severity
- Offers cost-effective long-term management
Common use
Azulfidine is primarily indicated for the management of moderately to severely active rheumatoid arthritis in patients who have responded inadequately to salicylates or other non-steroidal anti-inflammatory drugs (NSAIDs). It is also approved for the treatment of ulcerative colitis, particularly for maintaining remission and treating mild to moderate acute exacerbations. Off-label uses include juvenile idiopathic arthritis, ankylosing spondylitis, and psoriatic arthritis. The medication works systemically to modulate immune response and reduce inflammatory mediators throughout the body.
Dosage and direction
For rheumatoid arthritis in adults: Initial dosage typically begins with 500 mg daily, gradually increasing to a maintenance dose of 2-3 grams daily divided into two to four doses. For ulcerative colitis: Initial adult dosage is 3-4 grams daily in divided doses, with maintenance therapy at 2 grams daily. Pediatric dosing for juvenile arthritis is based on body weight, starting at 10 mg/kg/day and increasing to 30-50 mg/kg/day. Tablets should be swallowed whole with a full glass of water, preferably with food to minimize gastrointestinal discomfort. Regular blood monitoring is recommended during therapy.
Precautions
Patients should undergo complete blood count, liver function tests, and renal function assessment before initiation and regularly during treatment. Those with glucose-6-phosphate dehydrogenase (G6PD) deficiency require careful monitoring due to increased hemolysis risk. Adequate hydration is essential to prevent crystalluria and stone formation. Sun protection measures are recommended due to photosensitivity potential. Patients should report any signs of infection, unusual bleeding, bruising, or yellowing of skin/eyes immediately. Regular ophthalmologic examinations are advised for long-term users.
Contraindications
Azulfidine is contraindicated in patients with known hypersensitivity to sulfonamides, salicylates, or any component of the formulation. It should not be used in patients with intestinal or urinary obstruction, porphyria, or children under 2 years of age. Additional contraindications include severe liver impairment, severe renal impairment (creatinine clearance <30 mL/min), and history of sulfonamide-induced blood dyscrasias. The medication is pregnancy category B and should be used during pregnancy only if clearly needed.
Possible side effect
Common adverse effects include nausea (19%), headache (13%), anorexia (9%), and gastrointestinal distress (10%). Reversible oligospermia has been reported in 30-50% of male patients. Orange-yellow discoloration of skin and urine is expected and harmless. Serious but rare side effects include Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, hepatotoxicity, and pneumonitis. Most side effects occur within the first three months of therapy and often diminish with continued treatment or dosage adjustment.
Drug interaction
Azulfidine may decrease absorption of digoxin and folic acid. It potentiates effects of oral hypoglycemics, warfarin, and methotrexate. Concurrent use with hepatotoxic drugs increases liver injury risk. Antibiotics may alter intestinal flora and affect sulfasalazine metabolism. Urinary acidifiers increase crystallization risk, while alkalinizers decrease it. The medication may interfere with some laboratory tests including urinary normetanephrine measurements.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed one. If multiple doses are missed, contact your healthcare provider for guidance on resuming therapy. Maintain a consistent dosing schedule to ensure stable blood levels and optimal therapeutic effect.
Overdose
Sulfasalazine overdose may cause nausea, vomiting, gastric distress, dizziness, and headache. Severe overdose can lead to crystalluria, hemolytic anemia, methemoglobinemia, and central nervous system toxicity. There is no specific antidote; treatment involves gastric lavage if presented early, supportive care, and management of specific symptoms. Hemodialysis may be considered in severe cases. Contact poison control center immediately for guidance.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in the original container with tight closure. Protect from light and moisture. Keep out of reach of children and pets. Do not use if tablets show signs of discoloration or deterioration. Properly discard any unused medication after the expiration date or when no longer needed.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before starting or changing any medication regimen. Individual response to therapy may vary, and proper medical supervision is essential throughout treatment. The prescribing physician should be informed of all medications, supplements, and medical conditions.
Reviews
Clinical studies demonstrate Azulfidine’s efficacy with 60-70% of rheumatoid arthritis patients showing significant improvement after 6 months of therapy. Gastroenterologists report maintenance of remission in 70-80% of ulcerative colitis patients. Many patients appreciate the predictable response and long-term safety data. Some users report initial gastrointestinal side effects that typically resolve with continued use. Physicians value the medication’s established history and cost-effectiveness compared to newer biologic agents.