chemistry

Sulfasalazine

Sulfasalazine is a chemistry topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Sulfasalazine rather than just read about it. In short: Sulfasalazine, sold under the brand name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease. It is considered by some to be a first-line treatment in rheumatoid arthritis.

Key takeaways

Sulfasalazine belongs to chemistry; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Sulfasalazine to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Sulfasalazine from memory before moving on to harder problems.

Reference excerpt

Sulfasalazine, sold under the brand name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease. It is considered by some to be a first-line treatment in rheumatoid arthritis. It is taken by mouth or can be administered rectally. Significant side effects occur in about 25% of people. Commonly these include loss of appetite, nausea, headache, and rash. Severe side effects include bone marrow suppression, liver problems, Stevens–Johnson syndrome, and kidney problems. It should not be used in people allergic to aspirin or sulfonamide. Use during pregnancy appears to be safe for the baby. Sulfasalazine is in the disease-modifying antirheumatic drugs (DMARDs) family of medications. It is unclear exactly how it works. One proposed mechanism is the inhibition of prostaglandins, resulting in local anti-inflammatory effects in the colon. The medication is broken down by intestinal bacteria into sulfapyridine and 5-aminosalicylic acid. Sulfasalazine was approved for medical use in the United States in 1950. It is on the World Health Organization's List of Essential Medicines. Sulfasalazine is available as a generic medication. In 2020, it was the 284th most commonly prescribed medication in the United States, with more than 1 million prescriptions.

Medical uses Sulfasalazine is used in the treatment of inflammatory bowel disease, including ulcerative colitis and Crohn's disease. It is also indicated for use in rheumatoid arthritis and used in other types of inflammatory arthritis (e.g. psoriatic arthritis and reactive arthritis). It is usually not given to children under two years of age.

Side effects Use of sulfasalazine is contraindicated in people with sulfa allergies and in those with urinary tract obstructions, intestinal obstructions, and severe liver or kidney problems. Sulfasalazine metabolizes to sulfapyridine. Serum levels should be monitored every three months, and more frequently at the outset. Serum levels above 50 μg/L are associated with side effects. In rare cases, sulfasalazine can cause severe depression in young males. It can also cause oligospermia and temporary infertility. Immune thrombocytopenia has been reported. Sulfasalazine inhibits dihydropteroate synthase, and can cause folate deficiency and megaloblastic anemia. and various other undesirable effects. Sulfasalazine can cause hemolytic anemia in people with G6PD deficiency. Sulfasalazine can cause kidney stones. Sulfasalazine may cause stomach upset, nausea, vomiting, loss of appetite, headache, dizziness, or unusual tiredness. Skin and urine can become orange, with occasional allergic reactions. Sulfasalazine may cause sulfhemoglobinemia.

Pharmacology Around 90% of a dose of sulfasalazine reaches the colon, where most of it is metabolized by bacteria into sulfapyridine and mesalazine (also known as 5-aminosalicylic acid or 5-ASA). Both metabolites are active; most of the sulfapyridine is absorbed and then further metabolized, but most mesalazine is not, and remains in the colon. A mix of unchanged, hydroxylated, and glucuronidated sulfapyridine is eliminated in urine, as is acetylated mesalazine and unmetabolized sulfasalazine. The mechanism of action is not clear, but it appears that sulfasalazine and its metabolites have immunosuppressive, antibacterial, and anti-inflammatory effects. It also appears to inhibit the cystine-glutamate antiporter, as well as sepiapterin reductase.

Chemistry It is a codrug which is a combination of sulfapyridine and 5-aminosalicylic acid coupled with an azo linkage.

Cost In people with rheumatoid arthritis, the cost-effectiveness of sulfasalazine is improved by combining it with other drugs. It is commonly used in treating inflammatory bowel disease in part due to its cost effectiveness.

Research Sulfasalazine has been studied in cirrhosis, psoriasis, idiopathic urticaria, and amyloidosis.

References

Illustrations

Worked examples

Example 1 — a first encounter with Sulfasalazine

Start with the simplest possible case. Write down what Sulfasalazine claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In chemistry, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Sulfasalazine before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Sulfasalazine ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Sulfasalazine

In research: Sulfasalazine appears in chemistry research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Sulfasalazine in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Sulfasalazine is common in secondary-school and first-year university syllabi. It links to neighbouring topics 2-Pyridyl compounds, Azo compounds, Codrugs, so understanding it makes those chapters shorter.
In everyday life: Look for Sulfasalazine outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Sulfasalazine in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Sulfasalazine means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Sulfasalazine out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Sulfasalazine in simple terms?

Why does Sulfasalazine matter?

Because it connects several chemistry ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Sulfasalazine?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Sulfasalazine.