Sulfasalazine, a compound containing a sulfa drug and a salicylate that is broken down to its active components by the gut flora, is widely used in the treatment of inflammatory bowel disease and has been shown to impair the absorption of folic acid, polyglutamyl folate, and methyl-tetrahydrofolic acid in patients with these disorders. However, oral sulfasalazine inhibits the absorption and metabolism of folic acid which may interfere with folic acid supplementation and diminish the effect of periconceptional folic acid supplementation that has been shown to decrease the risk of NTDs. Liver failure, pancreatitis, and kidney failure also have been associated with sulfasalazine. That includes folic acid to prevent spina bifida and other neural tube birth defects. Patients should take a folic acid supplement. 1990 Nov;126(11):1516-7. This is because sulfasalazine can reduce levels of folic acid in the body. Trimetrexate was a gift from Dr. D. Fry (Park-Davis, Ann Arbor, MI). It is possible, but certainly not inevitable ,that a child of a parent with IBD will have it too. Sulfasalazine contains salicylate and the sulfa antibiotic. Sulfasalazine is used to treat bowel inflammation, diarrhea (stool frequency), rectal bleeding, and abdominal pain in patients with ulcerative colitis, a condition in which the bowel is inflamed. SSZ, 5 -aminosalicylic acid (5 -ASA), sulfa-pyridine, and folic acid were purchased from Sigma (St. Louis, MO). Reduced absorption of folic acid and digoxin have been reported when those agents were administered concomitantly with sulfasalazine. Folic acid supplementation is required whilst trying to conceive and during pregnancy, and should be discussed with your doctor Breast-feeding is not advisable when taking sulfasalazine Young men should be aware that although sulfasalazine lowers the sperm count, contraception is still recommended to prevent an unplanned pregnancy. This is because sulfasalazine can reduce levels of folic acid in the body. If you do go on it, try the enteric-coated tablets, drink plenty of water daily, and also ask your gastro to Rx a folic acid supplement-- because steady sulfa can interfere with the body's absorption of folic acid. This article discusses folic acid, its … taking before becoming pregnant. Sulfasalazine is considered safe to use while you are breastfeeding, … Reduced absorption of folic acid and digoxin have been reported when those agents were administered concomitantly with sulfasalazine. This may, however, be counter-productive for patients who are also taking methotrexate, which is a folic acid inhibitor. Heredity . 1. Sulfasalazine delayed-release (Azulfidine EN-tabs) is also used to treat rheumatoid arthritis in adults and children whose disease has not responded well to other medications. Manufacturer advises caution. Folic acid, digoxin, and warfarin are medicines that may cause drug interactions with sulfasalazine. Sulfasalazine decreases the absorption of folic acid. Commonly these include loss of appetite, nausea, headache, and rash. You should also take folic acid tablets (5 mg daily) as sulfasalazine can reduce levels of folic acid in the body. Sulfasalazine is in a class of medications called anti-inflammatory drugs. Sulfasalazine is considered safe to use if you're breastfeeding unless your baby is premature or at risk of jaundice Aching of joints 2. fever 3. headache (continuing) 4. increased sensitivity of the skin to sunlight 5. skin rash or itching 6. vomiting Folic acid (2 mg daily) is particularly important for women taking sulfasalazine, which inhibits folic acid absorption. Folic acid reduces heart risk in arthritis. Sulfasalazine as folic acid inhibitor in psoriasis. Sulfasalazine is considered safe to use while you are breastfeeding, … Some patients complain of headache, fatigue, and feeling “wiped out” (also called methotrexate “fog”). Hi everyone, I posted here 2 years ago, after starting sulfasalazine and folic acid. It is taken by mouth. Folic acid is a synthetic form of vitamin B9 that's often added to processed foods and used in supplements. To the Editor.— The findings that sulfasalazine inhibits folate transport, 1 inhibits the hydrolysis of polyglutamyl folate, and decreases the absorption of both polyglutamyl and monoglutamyl folates suggest, as recently reported by Halstead et al, 2 that folate deficiency may be prevented by increasing folate intake while the patient receives sulfasalazine. Folic acid is needed for the normal healthy replication of cells. Leucovorin was obtained from Eprova (Schaffhausen, Switzerland). 1. The mechanism of action of sulfasalazine remains uncertain. Jansen G(1), van der Heijden J, Oerlemans R, Lems WF, Ifergan I, Scheper RJ, Assaraf YG, Dijkmans BA. I was taking sulfasalazine whilst trying to conceive and my rheumatologist did recommend folic acid, as with anyone trying to conceive. Am I supposed to be taking folic acid as well as I heard it inhibits folic acid uptake? Significant side effects occur in about 25% of people. When previously taking methotrexate (and not TTC) I took a large dose of folic acid weekly because of how the meds affected levels. Tell your doctor if you are pregnant. Sulfasalazine (salicylazosulfapyridine), an agent widely used for the treatment of ileitis and colitis, is also a competitive inhibitor of intestinal folate transport (1, 2). Stock solutions of 25 mM Thrombocytopenia has occasionally been attributed to mesalazine [ 73–75] and olsalazine [ 76 ]. Talk to your doctor as soon as possible if you are planning a family, or if you become pregnant while taking sulfasalazine. Biochemical evidence of depletion of folic acid has been reported in people taking this drug, although available evidence remains mixed. Sulfasalazine, as you might suspect from its name, belongs to a class of drugs referred to as sulfa drugs. Sulfasalazine (SSZ), sold under the trade name Azulfidine among others, is a medication used to treat rheumatoid arthritis, ulcerative colitis, and Crohn's disease. Folic acid given at a dose of 1mg daily does not diminish the efficacy of methotrexate and is routinely given with methotrexate to decrease these side effects. Halasz CL. I tried sulfasalazine early in my UC career, but … This eMedTV article discusses these interactions in more detail and describes the side effects that may occur as a result of mixing the drugs. For example, Franklin and Rosenberg2 in 1973 found that orally administered sulfasalazine interfered with folic acid absorption both in patients with inflammatory bowel disease and in normal subjects. Sulfasalazine is also classified as a DMARD(disease-modifying antirheumatic drug). It has been seen that rheumatoid arthritis is linked with … Provides a summary of interactions with vitamins, herbs, and food Reduced digoxin absorption may reduce the effectiveness of digoxin. Sulfonamides increase blood levels of methotrexate, resulting in … Definitely discuss it with your doctor! MTX was a generous gift from Pharmachemie (Haarlem, The Netherlands). Folic acid is the synthetic version of folate that is found in many fortified foods (such as breads and cereals) and as a supplement. Talk to your doctor as soon as possible if you are planning a family, or if you become pregnant while taking sulfasalazine. I recently started on sulfasalazine and have increased dose gradually. Drug/Laboratory Test Interactions: The presence of sulfasalazine or its metabolites in body fluids has not been reported to interfere with laboratory test procedures. The sulfasalazine has been a god send and, having had debilitating flare ups since I was 7 years old, I’m now going to be 33 this week and haven’t had a flare up since starting the medication. Patients on high dose sulfasalazine require folic supplementation (1 mg/day) (1000 µg/day) to maintain normal cell division. Sulfasalazine reduces folic acid absorption, but rarely to a clinically significant extent, although megaloblastic anemia has rarely been documented [ 70, 71 ]. Comment on Arch Dermatol. 2 … Methemoglobinemia can occur in slow acetylators of sulfapyridine [ 72 ]. Sulfasalazine is a potent inhibitor of the reduced folate carrier: implications for combination therapies with methotrexate in rheumatoid arthritis. Reduced absorption of folic acid and digoxin have been reported when those agents were administered concomitantly with sulfasalazine. It is considered by some to be a first line treatment in rheumatoid arthritis. Am I supposed to be taking folic acid as well as I heard it inhibits folic acid uptake? Sulfasalazine is predicted to decrease the absorption of folic acid. 1  People with inflammatory bowel disease (IBD) are at risk for folate deficiency, especially those who are taking methotrexate or sulfasalazine. Taking sulfasalazine can make it harder for your body to absorb folic acid, and folic acid helps prevent major birth defects of the baby's brain or spine. According to my gastro, who subspecializes in IBD treatment, everyone taking sulfasalazine should also take a folic acid supplement daily-- because the sulfa component interferes with the absorption of folic acid so one needs to compensate for that with the supplement. Reduced folic acid absorption may cause folic acid deficiency and result in anemia. Arch Dermatol. 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