Gastroenterology: Medications

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All About Azulfidine (sulfasalizine)

Many patients are not as well-informed about prescription medications as they ought to be. We believe that the more you know about your medications, the better. Therefore, we have written this leaflet to explain more about Azulfidine and to explain the importance of taking it properly.

If any of this information causes you concern or if you want additional information about your medicine and its use, please check with your doctor or pharmacist.

Remember to keep all prescription drugs beyond the sight and reach of children when not in use. Store all drugs in their original labeled containers; the place of storage should be cool, dry, and away from light. Always read the label before each use.

What is Azulfidine?

Introduced in 1949, Azulfidine (A-zulf-a-deen) is a man-made sulfa compound that is taken by mouth to treat inflammatory disorders of the bowel such as ulcerative colitis, Crohn's disease, and other inflammatory conditions. It is sometimes given in conjunction with other medications such as the steroid, prednisone.

Sulfasalizine (sul-fa-SAL-a-zeen) is the generic form of this drug; other common brand names are Azulfidine, Azulfidine En-Tabs, SAS-500, and Salazopyrin.

What Azulfidine is not.

Although Azulfidine is chemically related to sulfa antibiotics, it does not have the same bacteria-killing properties needed to fight infection. Since only about one-third of each Azulfidine dose is absorbed into the blood stream, the bulk of the dose remains in the intestines where it acts to heal inflammation. Azulfidine is not habit forming; it does not cause drowsiness.

Taking Azulfidine properly

    1. Take each Azulfidine dose with an 8 ounce glass of water. Drink several extra glasses of water or other fluids daily. This helps reduce the risk of side effects such as kidney stones.

    2. Take each Azulfidine dose with food. Since Azulfidine can irritate the stomach lining, it is best tolerated when food serves as a buffer within the stomach. Patients with sensitive stomachs may require the more expensive enteric-coated form of this medication (En-tabs). En-tabs must be swallowed whole. Do not break or crush them.

    3. Take the dose as prescribed. There is no fixed rule for the correct dose of Azulfidine. Each case is different. Initially, your doctor will determine what dose is best for you on the basis of your age, weight, the activity of your disease, and any other medical conditions that you may have. Generally, most adults with inflammatory bowel disease take two 500 mg. tablets two to four times per day. Do not alter the prescribed dosage on your own. Your doctor will routinely reassess the optimal dose for you. The goal, of course, is to control your illness with the lowest possible dose of Azulfidine.

    4. Do not skip doses. There is no harm in an occasional missed dose. If you do miss a dose, simply skip the missed dose and then go back to your regular dosing schedule. Do not intentionally double doses.

    5. Do not stop taking this medication on your own. Typically, Azulfidine is prescribed for long-term treatment of inflammatory bowel disease. Not only does Azulfidine help reduce the symptoms of an acute attack, but it also helps to reduce the risk of future attacks. Stopping this medication may trigger another flare up of intestinal inflammation and make you ill. Only stop Azulfidine under your doctor's supervision.

    6. Take a multivitamin supplement daily. Azulfidine can affect the absorption of the vitamin Folic Acid from your diet. This can sometimes cause anemia. A multivitamin containing Folic Acid such as Centrum twice daily is helpful. Your doctor may also prescribe a daily dose of a vitamin supplement. Eating plenty of green vegetables is beneficial.

What are the side effects?

All medicines - even those purchased without a prescription - may sometimes produce unwanted side effects. In general, the risk of side effects depends on the dosage of Azulfidine. It is important that you keep all scheduled appointments with your doctor so that he can be sure the medication is working and check for possible side effects. (Note that it is common for Azulfidine to discolor your urine an orange-yellow color. This side effect does not require medical attention.)

These side effects should be reported to your doctor:

  • Persistent headaches
  • Skin rash, severe itching
  • Unexplained fever
  • Unusual bleeding or bruising
  • Unexplained skin blistering and peeling
The following side effects usually do not require medical attention. They often will go away as your body becomes used to the medication. However, if they continue or are bothersome, check with your doctor:
  • Increased sensitivity to sunlight
  • Upset stomach, heartburn
  • Nausea and vomiting
  • Dizziness
  • Decreased sperm count
Men should know that Azulfidine may temporarily inhibit fertility by affecting the sperm count as well as sperm motility and appearance. This medication does not, however, inhibit sexual desire or ability; it does not cause impotence. Couples should inform their doctor if they are planning a pregnancy while on Azulfidine so that another drug can be substituted. The sperm count will return to normal in a few weeks allowing normal conception. Azulfidine can then be resumed.

Some patients may experience side effects not listed above. If you notice any other symptoms, simply consult your doctor, nurse, or pharmacist.

Limiting side effects

You can help limit side effects by taking Azulfidine exactly as prescribed and by reporting any problems promptly to your doctor. Remember to drink plenty of fluids. Avoid prolonged exposure to sunlight. Until you are certain of your body's reaction, you should use a sunscreen and wear protective clothing while in the sun.


Do not take Azulfidine if you are allergic to sulfa antibiotics, aspirin, oral antidiabetic drugs, or thiazide diuretics. Inform your doctor if you are pregnant, planning to become pregnant soon, or breast-feeding. Although low doses of Azulfidine can be used safely in pregnancy and lactation if necessary, we feel it is best to avoid all potent prescription drugs at these times whenever possible.

Be sure your doctor knows if you are currently taking digitalis, Dilantin, or Coumadin. Also inform your doctor if you have been diagnosed with severe liver or kidney disease, porphyria, or G6PD deficiency.


Azulfidine is a powerful drug that can be of tremendous benefit to you. As with all medications, however, side effects may occur. You can best limit problems with this medication by taking it exactly as prescribed. If you have any questions or concerns, please do not hesitate to discuss them with your doctor.

Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved

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