Sulfasalazine instructions for use analogues. Combined drug Sulfasalazine: instructions for use, price, reviews, analogues of medication for the treatment of arthritis and polyarthritis. Side effects and overdose

A large number of diseases cannot be treated without the use of antimicrobial drugs. After all, these remedies help to cope either with the consequences of pathology, or with the cause of the development of the disease - microbes. This group of drugs is very extensive, and Sulfasalazine is one of these drugs, the instructions for use of which are discussed below.

Pharmacological affiliation of the drug

For an antimicrobial to work, its active ingredient must be certain substance, capable of fighting pathogens. The drug "Sulfasalazine" reviews are quite positive in therapy certain group diseases. IN medical practice this drug belongs to the group of sulfonamides, which are the first chemotherapeutic medicinal substances, capable of fighting microorganisms that cause diseases.

In what form is the drug available?

The medicine "Sulfasalazine" has had quite positive reviews from patients and specialists for more than a decade. This drug is sold in pharmacies in the form of tablets coated film-coated.

What does the medicine consist of?

The drug "Sulfasalazine" contains one component, after which it is named - sulfasalazine (Sulfasalazinum). This substance belongs to sulfonamides. Other components included in the tablets antimicrobial drug, have only formative functionality, making up the mass of the tablet and its shell in the form of an enteric film.

How does the medicine work?

For the antimicrobial drug "Sulfasalazine", the instructions for use describe the prerequisites for prescribing it in treatment. They are based on the potential effect of the drug in solving certain problems that have arisen against the background of microbial activity. The drug works due to the action of one substance - sulfasalazine. It exhibits maximum activity in the intestines, helping to get rid of pathogens such as gonococci, diplococci, streptococci and E. coli. In the intestine, the drug goes through two phases of functional activity - sulfasalazine itself is absorbed in the small intestine in an amount of about 30%, the rest of the drug, passing into colon, metabolizes into working components: 5-aminosalicylic acid, which has an anti-inflammatory effect, and sulfaperidine, which blocks the synthesis of folates in microbial cells, which has an antibacterial effect. Metabolites are excreted in feces and urine within 3 days.

For the drug "Sulfasalazine" the indications for use will be as follows:

nonspecific ulcerative colitis (UC);
Crohn's disease;
rheumatoid arthritis.

This dispersion in the activity of the drug is not yet fully understood by specialists, although its positive effect is both in the treatment of joints and in therapy intestinal problems Obviously many years of practice.

When should you not take the product?

The antimicrobial drug "Sulfasalazine", like the vast majority of such drugs, has certain contraindications for use. These include:

anemia;
obvious disturbances in liver function;
disorders of the kidneys;
hypersensitivity to the components of the drug, including sulfonamides and derivatives salicylic acid;
deficiency of glucose-6-phosphate dehydrogenase;
blood diseases;
porphyria.

This medicine is not prescribed for the treatment of diseases in children. younger age- up to 5 years, since research in this aspect has not been carried out and potential negative reaction child's body has not been established for the medicinal substance.

The drug should not be taken by pregnant women 6-9 months old, as well as by those who are breastfeeding a newborn. If it is necessary to carry out treatment with Sulfasalazine, then stop breastfeeding and transfer the baby to artificial nutrition.

Patients require maximum attention bronchial asthma and allergies who are prescribed treatment with this drug due to the potential for exacerbation of the underlying disease.

How to take the drug?

For the drug "Sulfasalazine", the instructions for use recommend the following treatment regimens.

In the treatment of ulcerative colitis and granulomatous enteritis, otherwise called Crohn's disease, the treatment algorithm for adults and children over 16 years of age is the same:

the first day - use the drug four times in the amount of 0.5 grams per dose, that is, you need to take 2 grams of the drug per day;
second day - 1 gram 4 times a day;
starting from the third day, you need to take 6 to 8 grams of medicine per day, dividing them into 4 doses.

The exact dose and duration of treatment with this amount of the drug is determined by the attending physician. Once sharp clinical manifestations the diseases will subside, treatment is carried out in a maintenance daily dosage of 1.5-2 g, divided into 4 doses. It should be noted that such maintenance treatment with this drug is not recommended for children whose body weight is less than 65 kilograms. For adults, the duration of therapy is determined by the doctor, and it can last several months. For children under 16 years of age maximum daily dose, divided into 4 doses, is only 2 grams.

In the treatment of rheumatoid, including juvenile arthritis, can also be used this drug. It is prescribed by the attending physician according to this algorithm. Adults and children over 16 years of age take the medicine at a dosage of 500 mg per day in the first week of treatment, in the second week 1000 mg per day, in the third - 1500 mg per day. Recommended daily amount The drug is divided into two or three servings. In some cases, the maximum daily dose may be 3 grams. Treatment in this case is a course of treatment, which can last more than six months, as determined by a specialist.

If it is necessary for a child to undergo Sulfasalazine therapy, the following recommendations should be taken into account:

children weighing more than 29 kilograms aged 6 to 8 years can take 1 tablet of the drug 2 times a day;
if the child’s weight is no more than 39 kilograms, and this age is from 8 to 12 years, then the daily dosage is 3 tablets - 1 in the morning, at lunch and in the evening;
if the body weight of a child 12-16 years old is in the range of 40-45 kilograms, then treatment is carried out either 1 tablet 3 times a day, or 2 tablets in 2 doses per day, the decision remains with the doctor.

In some cases, treatment with Sulfasalazine is indicated for ankylosing spondylitis. This occurs when therapy with nonsteroidal anti-inflammatory drugs and hormonal agents is ineffective. Then this antibiotic becomes the basis of treatment, as it inhibits the processes of joint inflammation. This therapy is very long - from 3-6 months until the patient’s condition significantly improves. In this case, when the maximum daily dose of the drug is reached, other medications are first discontinued, and then Sulfasalazine is gradually withdrawn. It should be remembered that this drug is not able to cure the disease itself, it only helps fight inflammatory manifestations in the joints, improving the patient’s quality of life, and therefore traditional therapy should be continued after 2-3 months.

In any treatment, Sulfasalazine tablets are taken immediately after meals with water.

Possible side effects

Like almost any other antimicrobial drug, Sulfasalazine has side effects. These include:

agranulocytosis;
anaphylactic shock;
hemolytic anemia;
anorexia;
ataxia;
transient infertility;
epigastric pain;
hallucinations;
hepatitis;
headache;
dizziness;
diarrhea;
yellowness of the skin, sclera, urine;
leukopenia;
fever;
flatulence;
kidney dysfunction;
sleep disorders;
peripheral neuropathy;
interstitial nephritis;
oligospermia is transient;
pancreatitis;
interstitial pneumonitis;
vomit;
Stevens-Johnson syndrome;
convulsions;
rash;
nausea;
thrombocytopenia;
fatigue;
photosensitivity;
noise in ears.

There is no specific antidote to this drug, therefore, if necessary, treatment is symptomatic.

Drug overdose

One of the antimicrobial drugs in demand in the treatment of diseases of the joints and gastrointestinal tract is Sulfasalazine. Its use must be prescribed by a specialist and carried out in strict accordance with the dosage and regimen chosen by the attending physician.

In case of overdose or poisoning with this medicine, abdominal pain, dizziness, nausea, and vomiting occur. The patient needs health care, consisting of gastric lavage and forced diuresis. Specific symptomatic therapy is also necessary.

Possible joint treatment

In some cases, the drug "Sulfasalazine" is indicated for rheumatoid arthritis. The patient and the doctor prescribing it for use should remember that it enhances the effect of immunosuppressants, hepato- and nephrotoxic drugs, as well as cytostatics. "Sulfasalazine" inhibits the absorption of digoxin and folic acid, but enhances functional activity anticoagulants, anticonvulsants and oral hypoglycemic drugs.

Some treatment features

Widely applied to therapy joint diseases- "Sulfasalazine." Its analogues, like the drug itself, require the use of large amounts of water during the course of treatment. But alcohol, despite the absence of a strict prohibition, should not be taken, as it is very potential danger serious liver damage.

What do they say about the drug?

Antimicrobial tablets "Sulfasalazine" reviews are mostly quite positive. Experts note effective action medications in the treatment of certain diseases, and patients note that the drug helped them get rid of painful sensations. The only drawback of the medicine that many of those who took these pills talk about is frequent manifestation dyspeptic phenomena - abdominal pain, flatulence, diarrhea. But the quality of treatment compensates for these side effects- notes the majority who left responses about “Sulfasalazine”.

Are there any analogues?

For medicinal antimicrobial agent"Sulfasalazine" analogues can contain both the same active substance and its derivatives, for example, mesalazine. The synonym for the drug is “Salazopyrin”, but its analogues are “Pentasa”, “Asacol”, “Samezil”, “Mesakol” or the generic “Mesalazine”. For the drug "Sulfasalazine", the instructions for use indicate the dosage of the active component contained in the tablets. The same applies to analogues. The specialist treating the patient will decide which specific drug to choose.

Antimicrobial drugs help solve many problems caused by pathogenic inhabitants of the microworld. One of them is Sulfasalazine. The instructions for its use contain all the information necessary for the doctor and the patient, and therefore must be read carefully. Compliance with the recommendations of the instructions and the attending physician will help to carry out adequate and quality treatment existing problem.

Standard treatment for arthritis or Crohn's disease involves the use of anti-inflammatory drugs (NSAIDs). However, there are times when these medications do not work as expected. In these cases, experts advise using the drug Sulfasalazine, instructions for use of which will be given in detail in this publication.

Composition of the product

The drug Sulfasalazine, produced by the Slovenian pharmaceutical company KRKA, can be purchased in the form of yellowish tablets, each of which contains 500 mg of the substance of the same name, sulfasalazine. From auxiliary components attention should be paid to talc, titanium dioxide, colloidal silicon, macrogol and magnesium stearate.

Effect of the drug

Sulfasalazine is a powerful anti-inflammatory drug that, in addition to its main action, is capable of destroying various microbes - gonococci, streptococci, coli, diplococci and other pathogens. Accumulating in the intestinal tissues, the active substance Sulfasalazine is split into two components:

5-aminosalicylic acid ( essential component, preventing the formation of inflammation and eliminating the existing inflammatory process);
sulfapyridine (a substance that prevents the proliferation of microbes and thereby has an antimicrobial effect).

Who is the drug indicated for?

Crohn's disease (mild to moderate);
(if therapy with other NSAIDs does not give the desired effect).

Analogues of the drug

If Sulfasalazine is not available in pharmacies, it can be replaced with drugs containing similar action: Mesacol or Mesalazine, Asacol or Kansalazine, Salofalk or Samezil. As for analogues produced in other forms, these include: Samezil rectal suspension, Pentax suppositories, as well as Salofalk rectal foam.

Dosage regimen

The medication in question should be taken after meals. Its dosage and duration of treatment are determined solely by the doctor.

For Crohn's disease, adolescents over 16 years of age and adults should take 1 pill 4 times a day on the first day, 2 tablets 4 times a day on the second day, and 3-4 tablets 4 times a day starting from the 3rd day. /day. Maintenance therapy involves taking Sulfasalazine one tablet 4 times a day.

In the case of arthritis, adults and adolescents over 16 years old should take one tablet once a day in the first week, one tablet twice a day in the second week, and one tablet three times a day from the third week. If necessary, the doctor may increase daily dosage up to 6 tablets. As a rule, the duration of such treatment is 6 months or more.

The dosage of the drug for children is calculated exclusively by the doctor. It is only important that the daily dose does not exceed 2 g of the drug or 40–50 mg/kg of the child’s weight per day.

Contraindications

Studying the conditions for which experts do not prescribe Sulfasalazine, the instructions for use highlight the following:

liver or kidney failure;
urinary tract diseases;
intolerance to the components of the drug;
congenital phosphodehydrogenase deficiency;
pregnancy and breastfeeding;
child's age up to five years;
intestinal obstruction;
aplastic anemia;
porphyria.

Side effects

We list a number of conditions that may occur under the influence of taking the medication Sulfasalazine. Thus, according to reviews, this drug can cause hematuria and proteinuria, headaches, sleep disturbances, and in exceptional cases, convulsions and hallucinations. In addition, stomach problems and some allergic manifestations. Good health to you!

Sulfasalazine is indicated for rheumatoid arthritis and other inflammatory diseases of an autoimmune nature, incl. helps to resist dangerous intestinal diseases. Instructions for use of Sulfasalazine will tell you in detail about the properties and rules for taking the medicine.

Every year from rheumatoid arthritis Several tens of thousands of people die in the world, in 70% of cases it leads to disability. Moreover, the onset of the disease occurs at 40-50 years of age. Therefore, the treatment for this systemic disease, affecting connective tissue - current problem rheumatology. Used A complex approach, and the primary task of doctors is to reduce inflammation, relieve pain, eliminate swelling around the affected joints and their stiffness. Therapy usually begins with the selection of a drug from the group symptomatic drugs– glucocorticosteroid or anti-inflammatory drug non-steroidal series. Often they are not effective enough. In such cases, they add or completely switch to treatment with Sulfasalazine - this is a basic antirheumatic drug. It not only improves the patient’s condition, but also helps to slow down the development of the disease and ensure high-quality remission.

Pharmacological properties of the drug

This is a drug complex action. It is due to the ability of Sulfasalazine to release active ingredients: antimicrobial substance sulfapyridine and anti-inflammatory substance - mesalazine, a derivative of 5-aminosalicylic acid.

In connection with this unique feature chemical structure and set of properties, the question often arises: is sulfasalazine an antibiotic or not. It cannot be used as a full-fledged analogue of an antibiotic, because the disease itself caused bacterial microflora, does not cure, but only eliminates the pain symptom.

The combination of active compounds that complement each other gives Sulfasalazine the following properties:

anti-inflammatory effect– prevents development inflammatory reaction or suppresses the existing inflammatory process, incl. chronic. Characterized by local action in the intestines, and also eliminates painful symptoms outside the intestines. The effect is based on the binding of those formed in damaged tissue free radicals and on inhibition of the synthesis of prostaglandins and other mediators that mediate the development of inflammation and are responsible for the appearance pain, formation of edema, dysfunction of the joint;
bacteriostatic activity– delays the reproduction and growth of bacteria, suppressing the synthesis of folic acid, which is a growth factor for the development of microorganisms. Has a specific selective antibacterial effect, bacteria from the streptococcus family are sensitive to the drug, different kinds diplococci and Escherichia coli strains.

Composition, release forms

Holder registration certificate Sulfasalazine – KRKA group of companies, Slovenia/Russia. Underneath this trade name the only one produced dosage form– tablets coated with a protective film shell. Appearance tablets: round, convex on both sides, chamfered, the color of the tablets varies from light yellow to brownish. The core is the same color, there are small inclusions. The tablets are sealed in a 10-cell blister. An individual pack with instructions contains 5 blister packs. The content of the active component in Sulfasalazine tablets is 500 mg. It's covered aqueous solution povidone, slowing down the rate and degree of absorption of the composition from the gastrointestinal tract.

The following are used as auxiliary ingredients:

pregelatinized starch – filler;
magnesium stearate – lubricant;
anhydrous silicon dioxide powder in the form of colloidal particles – enterosorbent.

Composition of the protective film:

hypromellose – filler;
propylene glycol is a solvent.

How does Sulfasalazine work?

On what mechanisms is the effectiveness of Sulfasalazine in treatment based? various forms inflammatory arthritis has not been fully established, but it is included in the group of essential drugs basic therapy. Medicine cannot completely cure the disease, but it can slow down the development of the pathological process. To enhance the therapeutic effect, it is often combined with analgesics or other anti-inflammatory and antirheumatic drugs. Practice shows that the drug helps only in 60-70% of cases.

Such patients note that thanks to the use of Sulfasalazine:

manages to stop chronic inflammation, delay relapse of the disease;
pain and stiffness in the joints go away;
after a long rest, the joints take less time to move apart and begin to work in normal mode;
Remission time for UC is achieved faster and the time of remission increases; reviews for colitis indicate the ability of Sulfasalazine to relieve abdominal discomfort, diarrhea with blood and mucus, relieve swelling of the intestinal mucosa, inflammation, and also have a healing effect. With limited damage to the rectum, the use of rectal suppositories is effective;
manages to suppress education pathological cells and reduce the severity autoimmune process. The medication helps in severe cases when other drugs are powerless.

The first result is noticeable after a month of use. The result of 3 months regular use becomes stable positive dynamics and a marked reduction in disease activity. To achieve the full therapeutic effect, a six-month course is usually enough. If no reduction in pain symptoms is observed within 1.5-3 months, then the medication should be replaced or an additional small dose of glucocorticosteroid should be administered. If there is no improvement, discontinue Sulfasalazine and select another, more effective therapy.

Reviews indicate that the achieved positive effect persists for several months after completion of the course. The duration of the remission period can be increased if you continue to take minimal doses of NSAIDs during breaks. Knowledge of the principles and patterns of processes occurring with medicinal composition, after its introduction into the body, helps determine the effective safe dosage drug.

The main pharmacokinetic parameters are given in the instructions:

Suction: after oral administration Sulfasalazine is poorly absorbed from the gastrointestinal tract, in the walls small intestine Only about 30% of the incoming dose is absorbed. The remaining amount passes into the large intestine, where, under the influence of normal microflora, it breaks down into its constituent active components, of which 60-80% (bioavailability level) is sulfapyridine, 25% is 5-aminosalicylic acid. Peak concentrations of Sulfasalazine taken in the form of film-coated tablets are observed after 3-12 hours.
Distribution: The 5-ASA metabolite is poorly absorbed in the blood; sulfapyridine has higher absorption (up to 30%), which causes various unwanted effects. In the systemic circulation, substances circulate mainly in the form associated with plasma proteins. The complex with proteins forms 99% of absorbed Sulfasalazine, 50% of sulfapyridine, 43% of 5-ASA. Some compounds have a therapeutic effect in the intestine (mainly 5-ASA), and some are transported and accumulate in connective tissue, liver, fluid serous cavities. Up to 30% of active compounds reach the synovial bursa. The drug is secreted into mother's (breast) milk.
Metabolism: the active substances, in turn, are transformed under the influence of liver enzymes, forming inactive metabolites.
Excretion: metabolites and unchanged sulfasalazine are excreted mainly by the kidneys. WITH feces About 5% of sulfapyridine and 67% of 5-ASA are removed. To reduce the concentration in the body by half it will take: 5-10 hours for sulfasalazine, 6-14 hours for sulfapyridine, 35-85 minutes for 5-ASA. In elderly patients, the elimination rate is halved.

Indications for use

As an independent, sole treatment, it is rarely used, Sulfasalazine is an important basic element complex therapy. The instructions provide an exhaustive list of diseases for which it is advisable to use this medicine.

Indications for use are:

Instructions for use Sulfasalazine

The tablets are intended for oral use, they are taken orally after meals and must be swallowed whole without violating the integrity of the film coating. The treatment regimen and dosage should be selected by the doctor individually in each specific case. Sulfasalazine is a slow-acting drug intended for long-term course use, often for many years.

Before starting therapy, it is recommended to first study and evaluate the body’s reaction to the administration of the drug in order to exclude the possibility of developing negative effects. side effects. To do this on initial stage treatment is carried out in small doses. If the drug is well tolerated, go to the maximum dosage, which is reduced after achieving the expected positive result. The calculation takes into account the type and course of the disease, the severity of symptoms, the age and body weight of the patient.

for rheumatoid arthritis: therapeutic dose – 1.5-3 g, for children no more than 2 g (40-50 mg per unit of weight). The course of therapy lasts 6 months or longer. The scheme is as follows: in the first week - 1 tablet, in the 2nd - 2, then - 3-4 per day after equal intervals time. The maximum dosage depends on the age and body weight of the child: 6-8 years (weight 20-29 kg) – 1 g, divided into 2 doses, 8-12 years (weight 30-39 kg) – 1-1.5 g per day for 2-3 doses, 12-16 years (40-50 kg) – 1.5-2 g for 2-3 doses (it is acceptable to take 2 tablets at the same time). Weakening clinical symptoms felt after 6-10 weeks regular intake;
for intestinal diseases: maximum daily allowance adult dose– 8 g, at the age of 10-16 years – 2 g. It is achieved gradually, on the first day take 1 tablet 4 times a day, on the 2nd – 2, on the 3rd and subsequent days, until it subsides painful symptoms– 3-4 tablets (per day – 12-16 tablets). The maximum dosage for children 10-16 years old (weighing 35-50 kg) is 4 tablets. When the acute stage of the disease has passed, they switch to maintenance therapy, which usually lasts several months. Maintenance dose – 1.5-2 mg of sulfasalazine, divided into 3-4 doses. It is recommended only for patients over 16 years of age and weighing over 65 kg.

During long-term treatment, regular (weekly in the first month of treatment, then 1-2 times a month) monitoring of the body’s condition is necessary - donating blood for kidney and liver tests, monitoring blood and urine test parameters.

An overdose of the drug may be indicated by dizziness, abdominal discomfort, and vomiting. High doses Sulfasalazine can cause convulsions, anuria, and the appearance of traces of blood or salt crystals in the urine. Having discovered such signs of poisoning, you should urgently free the stomach and intestines from drug residues - induce vomiting, artificially stimulate urination.

Sulfasalazine during pregnancy accepted in minimum dosage and only with the permission and under the supervision of a doctor. IN last trimester It is prohibited to use the medicine. The risk group also includes patients with a tendency to an allergic reaction, inflammatory skin lesions, and bronchial asthma.

According to the instructions, contraindications for use are:

intolerance to drug components or active metabolites;
porphyrin disease;
renal, hepatic dysfunction;
diseases circulatory system, anemia caused by deficiency of the enzyme g-6-PDG;
period breastfeeding;
childhood 0-5 years.

Side effects

The instructions warn that in addition to therapeutic effect, Sulfasalazine can provoke some undesirable effects.

They are mainly due to malfunctions internal organs and increased plasma concentrations of sulfapyridine.

Possible side effects:

headache, loss of coordination of movements, ringing in the ears, convulsions, muscle weakness, sleep problems, impaired perception, hallucinogenic effect;
temporary shortage renal function, inflammatory damage to interstitial tissue (renal nephritis, interstitial pneumonia), cough, shortness of breath, other lung diseases;
change in blood picture;
vomiting, loss of appetite, abdominal pain, diarrhea, inflammation of the pancreas, drug-induced hepatitis;
masculine and female infertility;
icteric skin color, yellowing contact lenses, tears, sweat, unusual coloration of urine;
allergic reaction in the form of skin rash, erythema, drug fever, anaphylaxis.

Attention!

Sulfasalazine and alcohol are unacceptable compatibility, especially regular drinking of alcohol, because in this case, the load on the kidneys and liver increases significantly. If necessary, simultaneous or sequential use of tablets with other medications You should first consult with a specialist; he will help you adjust the administered doses of the medication and eliminate unacceptable combinations.

Cost of the drug, analogues

Pharmacies dispense Sulfasalazine only after presenting a doctor's prescription. Tablets should be stored in their original packaging at a temperature not exceeding 25 degrees. When stored this way, they remain good for 5 years.

The average selling price of a pack of tablets (50 pcs.) with a dosage of 500 mg is:

Sulfasalazine, Russia – 220 rubles;
Sulfasalazine-EN, Slovenia – 350 rub.

There are no complete analogues of the active substance. If replacement is necessary, you can choose a combination of several drugs that have similar pharmacological effects.

Candles are produced under other brands, their healing effect based on the presence of one of the active ingredients Sulfasalazine.

The analogue usually includes Mesalazine.

Most Popular:

Pentasa - suppositories, tablets and bags of granules;
Salofalk – rectal suppositories, foam or rectal suspension, granules, tablets;
Cansalazine, Mezavant, Mesacol - tablets.

They often compare: Sulfasalazine or Salofalk - which is better. They are the same in purpose, Sulfasalazine is well studied and proven by many years of experience, Salofalk is a modern drug, considered safer and more effective. But only a doctor can decide what is best for a particular patient.

The drug Sulfasalazine has powerful antimicrobial and anti-inflammatory effects. The medicine can also be used for diseases of the musculoskeletal system (for example, arthritis or ankylosing spondylitis).

Without strict indications, taking the drug is strictly prohibited: Sulfasalazine can have serious side effects, even with a short course of treatment. Before taking Sulfasalazine, you should always consult your doctor.

1 What is Sulfasalazine: general description

The drug Sulfasalazine belongs to the group of anti-inflammatory and antimicrobial drugs. It can be used in the treatment of various diseases of the musculoskeletal system (mostly severe).

It is also used for various autoimmune diseases, occurring with pronounced inflammatory phenomena. For example, with nonspecific ulcerative colitis or proctitis, with some forms of arthritis (including rheumatoid).

Composition of Sulfasalazine:

main active ingredient – Sulfasalazine (500 mg in one tablet);
colloidal anhydrous silicon;
propylene glycol;
gelatinized starch;
hypromellose;
magnesium stearate;
titanium dioxide;
dyes with code E172 (iron oxide yellow 10).

During treatment with Sulfasalazine it is required constant control(monitoring) the patient's condition. The fact is that the drug quite often produces unwanted side effects, especially with long-term therapy.

1.1 Release form

There are two versions of Sulfasalazine: classic and with the prefix “EN”. Both versions of the drug have only one release form: tablets.

Regular Sulfasalazine tablets are film-coated and contain 500 mg of active ingredient. One package contains 50 yellow-brown tablets. The tablets are round, biconvex, and have beveled edges. There may be inclusions on the fracture.

Sulfasalazine EH tablets are coated with an enteric soluble coating and contain 500 mg of active ingredient. One package contains 50 tablets of yellow-brown or simply yellow color. The tablets are round, biconvex, have beveled edges and bad smell. The mass of the tablet at the break has a brownish-orange or orange color.

The tablets should be stored in their packaging, without removing them from the blisters, out of the reach of children and sun rays place. The optimal storage temperature is no more than 25 degrees.

1.2 How does it affect the body?

The drug represents its therapeutic effect and chemical structure a combination of sulfapyridine and 5-aminosalicylic acid. The smallest part of the drug is absorbed from the lumen of the colon and then evenly distributed throughout the connective tissues.

The tablet is coated with a film that dissolves under the influence of normal intestinal microflora. After the tablet film disintegrates, sulfapyridine and 5-aminosalicylic acid are released.

It is these substances that create a powerful anti-inflammatory and antimicrobial effect. In terms of anti-inflammatory activity, sulfapyridine is much better, since it has better absorption (about 30% of the dose taken is absorbed by the body).

Half-life products of components are excreted, including by the kidneys. This means that people with kidney disease (including acute jade) the drug either cannot be taken at all, or must be taken with caution.

1.3 Where is Sulfasalazine sold and how much does it cost?

You can purchase Sulfasalazine either on specialized medical Internet portals or in pharmacies. The drug is available only with a prescription.

How much does Sulfasalazine cost? A standard package of 50 tablets (500 mg) costs 600-700 rubles. Sulfasalazine EH has a slightly higher cost: on average it is 670-750 rubles.

1.4 Sulfasalazine analogues: what can be replaced?

What can replace Sulfasalazine? There are a huge number of replacement medications, but Mesacol and Methotrexate have proven themselves to be the best. These are the best and most similar in price/effect analogues.

Other analogues of Sulfasalazine:

Tablets Salazopyrin En-Tabs 500 mg.
Asacol tablets 800 mg.
Long-acting granules and Pentas tablets.
Gastro-resistant granules and Salofalk suppositories 250 and 500 mg.
Rectal suspension and enteric tablets Samezil 400 and 800 mg.

Methotrexate is one of the best analogues Sulfasalazine

Prohibited independent choice Sulfasalazine and its replacement with analogues without consulting your doctor. In particular, you cannot replace the drug even in cases where the analogue is a drug with almost identical composition and dosage of use.

It is also impossible to replace the classic Sulfasalazine with a subtype with the prefix “EN” without consulting a doctor.

2 Indications: when is Sulfasalazine used?

The use of Sulfasalazine is justified in cases inflammatory diseases, occurring with symptoms of microbial invasion, or the risk of joining infectious complications. Using the product as an analogue of an antibiotic is inappropriate and in some cases extremely dangerous.

Indications for use:

nonspecific ulcerative colitis or nonspecific ulcerative proctitis, occurring with mild or average degree severity (the drug is used to relieve exacerbations and as maintenance therapy in the remission phase of the disease);
Crohn's disease (only moderate or moderately severe forms of the disease during exacerbation, for full treatment of this disease the drug is not suitable);
rheumatoid arthritis with severe inflammatory processes that are not controlled by non-steroidal anti-inflammatory drugs (you can read about the use separately);
juvenile idiopathic chronic polyarthritis with resistance to treatment with non-steroidal anti-inflammatory drugs.

Sulfasalazine can be used in combination with various corticosteroid drugs and some antimicrobials (for example, the drug good compatibility with Metronidazole).

2.1 Contraindications

Using Sulfasalazine correctly means making sure in advance that there are no contraindications. It is almost impossible to do this yourself; a comprehensive examination by doctors is necessary (at least at the level of studying biochemical parameters blood and urine).

Contraindications to Sulfasalazine:

Individual intolerance to one or more components of the drug (presence of allergies).
Acute form of porphyria and/or granulocytopenia.
Severe deficiency of the enzyme glucose-6-phosphate dehydrogenase.
The medication is prohibited for use by children under 5 years of age.
Severe liver and/or kidney dysfunction, chronic renal or liver failure.
Various types of anemia (including severe iron deficiency anemia), various diseases blood.
Intestinal obstruction or compression of the urinary tract.
Lactation period (breastfeeding). During pregnancy, the drug is used, but only under the strictest indications.
The medication should be used with caution in case of systemic juvenile idiopathic-chronic polyarthritis (the development of serum-like reactions is possible).

Treating arthritis is a complex, lengthy process. The modern pharmacological industry offers a number of drugs to combat rheumatic and. Two drugs commonly used are sulfasalazine and methotrexate.

These drugs have a pronounced antirheumatic effect. Everyone has strengths and disadvantages.

To get an idea about pharmacological effect sulfasalazine and its overall influence on the body, we will carefully study the mechanism of action on organs and systems, we will understand the indications and undesirable effects.

Sulfasalazine - complex drug, which has bactericidal and anti-inflammatory effects. Refers to the drugs of choice in the treatment of chronic arthritis.

The drug does not dissolve in water and, therefore, is not absorbed in the stomach and small intestine. A significant part of the active substance passes unchanged through the stomach and small intestine, reaching the colon, where, under the influence of colon flora, it breaks down into its constituent components.

The distinctive property of sulfasalazine is: high ability to bind to body proteins. It is well excreted through the kidneys and bile ducts. Maximum amount the drug accumulates in the blood plasma 5 hours after administration.

Third active substance excreted through the kidneys with urine, half is excreted with bile into the large intestine. The accumulation of the active substance occurs in the connective tissue, synovial membranes of the joints and pleural fluid.

Effect of the drug on joints

Researchers have not yet fully answered the question of how sulfasalazine affects the affected joints. A number of experiments have revealed anti-inflammatory and immunomodulatory effects. This is due to the suppression of lymphocyte activity in the small intestine.

Mechanisms of action of the drug sulfasalazine on joints:

Suppression of the synthesis of inflammatory mediators - prostaglandins.
Suppression of free radical synthesis.
Inhibition of the activity of lymphocytes and neutrophils involved in the autoimmune reaction to joint tissue.
Deprivation of interleukins production.
Sulfasalazine has pronounced antimicrobial activity.

Sulfasalazine is available in tablets. Pills round shape, painted in yellowish color. The tablet contains 0.5 grams of active substance and has a film coating. In addition to tablets, the drug is presented on the pharmacological market in the form of a suspension and suppositories for administration into the rectum. To familiarize yourself with the effect of the drug, detailed instructions are attached to each package.

How to use the medicine

For rheumatoid arthritis drug treatment carried out according to doctor's prescriptions. Sulfasalazine should be taken orally after meals.

During the research, the dosage of the drug was determined - 2-3 grams of the active substance, distributed per day.

Doctors recommend starting treatment with 0.5 grams of the drug per day. Gradually increase the dose until it reaches the average therapeutic dose. It will take a month to increase the dose. You will notice the effect of taking the drug no earlier than 1.5 months after you start taking it.

The instructions for use of the drug provide a clear dosage scheme. For treatment with sulfasalazine to be effective, you must adhere to the instructions.

Adults start taking it with a dose of 500 mg per day, dividing it into 4 equal doses.
On the second day, the daily dose was increased to 1000 mg. It is also distributed into 4 doses.
On the third and fourth days, it is recommended to take tablets of 1000 – 1500 mg per day.
Next, you should maintain the dose until it subsides. acute manifestations arthritis.
Upon passing acute stage disease, the dose is gradually reduced to 500 mg. General course treatment lasts several months.

In adults maximum dose the drug should not exceed 16 tablets per day.

Features of treatment for children

In pediatric practice, sulfasalazine is used to treat juvenile rheumatoid arthritis. The use of the drug has features associated with age-related anatomical and physiological characteristics and the course of the pathological process.

A number of studies have shown that sulfasalazine has been effective in best side in the treatment of single articular lesions with juvenile rheumatoid arthritis and with multiple joint damage.

Long course of admission medicinal product reliably eliminates symptoms and keeps the child’s condition satisfactory for many years when the drug is discontinued.

Taking sulfasalazine suppresses the development of pathological processes in the joints, which can be detected x-ray.

Features of treatment with sulfasalazine

Studies have been conducted on the effects of sulfasalazine and placebo in rheumatoid arthritis. The effectiveness of sulfasalazine exceeds the effect of placebo several times. The effectiveness of the drug exceeds other drugs prescribed for the treatment of articular syndrome. Tolerability of the drug is superior to others pharmacological groups. When compared with basic drugs for the treatment of rheumatoid arthritis, therapeutic effect received much faster.

Sulfasalazine reduces the risk of hidden hemorrhage and inflammatory processes in the walls small intestine- a significant difference from gold or plaquenil preparations.

In patients who were resistant to the prescription of metatrexate, the use of sulfasalazine in the treatment regimen led to an improvement in the condition after 3-4 months.

Treatment with sulfasalazine leads to normalization of parameters peripheral blood, a decrease in the content of C-reactive protein in plasma and a number of immunoglobulins. This is direct evidence of the ability to suppress the inflammatory process.

While taking pills morning stiffness when decreased. The frequency and intensity of pain decreased. There was a significant improvement in the patients' condition.

Side effects

When using sulfasalazine in the treatment of arthritis, remember that it has side effects.

The appearance of unpleasant effects from use is associated with increased individual sensitivity to the components of the drug. These may be salicylic acid derivatives or sulfapyridine. The instructions for use warn that when the rate of destruction of the active substance decreases, undesirable phenomena occur.

Complaints about headache, tinnitus, dizziness, seizures, insomnia, auditory or visual deceptions.
Urinary dysfunction.
Digestive disorders inflammatory processes in the liver and pancreas.
Lesions of lung tissue.
The amount of hemoglobin, platelets, and leukocytes decreases. Long-term treatment is carried out under mandatory and regular monitoring of the blood picture.
Development of infertility.

Contraindications and precautions

The main contraindication to the prescription is individual intolerance or hypersensitivity to the components of the drug.

Sulfasalazine is contraindicated in pregnant women and children under 5 years of age. The active substances penetrate into the female breast milk, it is not recommended to prescribe it while breastfeeding. Contraindications for use include liver and kidney failure.

Most reviews about it high efficiency and good tolerance.

However, do not take it without consulting your doctor first. Before prescribing sulfasalazine, your doctor will order blood and urine tests.

The instructions for use will explain the rules of use and dosage, interactions with other medicinal substances. Studying the instructions is necessary along with consulting a specialist.

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