Sulfasalazine dosage

Adverse effects that are not dose related most commonly include rash, fever, or hepatotoxicity, as well as relatively uncommon but serious reactions such as bone marrow suppression, thrombocytopenia, pancreatitis, and hepatitis. For most patients with idiosyncratic reactions, sulfasalazine must be discontinued. In some patients who have experienced allergic reactions to sulfasalazine, a desensitization procedure can be instituted. By gradually increasing sulfasalazine dosage over weeks to months, patient tolerance has been improved. Most of the idiosyncratic reactions observed with sulfasalazine are similar to those with the class of sulfonamides in general. 

The primary health care provider prescribed sulfasalazine oral suspension 500 mg every 8 hours. The nurse has sulfasalazine oral suspension 250 mg 5 mL on hand. What dosage would the nurse give ... 

Ulcerative colitis Inform patients with this condition that ulcerative colitis rarely remits completely, and that the risk of relapse can be substantially reduced by continued administration of sulfasalazine at a maintenance dosage. Glucose-6-phosphate dehydrogenase deficiency Observe patients with glucose-6-phosphate dehydrogenase deficiency closely for signs of hemolytic anemia. This reaction is frequently dose-related. 

E, enterohepatic cycling H, not recommended for patients with hepatic impairment R, dosage adjnstment necessary for patients with renal impairment SZ, sulfasalazine SR sulfapyridine Me, mesalamine. 

Nausea and vomiting, taste disturbances (SEDA-17, 424), anorexia, stomatitis, flatulence (59), and abdominal discomfort can occur in patients taking sulfasalazine and mesalazine. They are particularly common in slow acetylators, but symptoms remit with dosage reduction. Diarrhea is more common with olsalazine than with sulfasalazine. 

A 57-year-old man took prednisone 20-30 mg/day for 13 years for rheumatoid arthritis (45). He had been treated unsuccessfully with gold, azathioprine, hydroxychloroquine, and sulfasalazine tapering his glucocorticoid dosage had been unsuccessful. He developed worsening back pain in his thoracic spine and lateral... 

Sulfasalazine, a sulfonamide antibiotic (3 to 4 g p.o. daily in divided dosage), is indicated in the treatment of ulcerative colitis. 

A study in rats found that colestyramine binds with sulfasalazine so that the azo-bond is protected against attack by the bacteria within the gut. As a result the active 5-aminosalicylic acid is not released and the faecal excretion of intact sulfasalazine increases 30-fold. It seems possible that this interaction could also occur in humans, but confirmation of this is lacking. Separating the drug dosages to prevent their admixture in the gut has proved effective with other drugs that bind with colestyramine. Standard advice is to avoid other drugs for one hour before, and 4 to 6 hours after colestyramine. 

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