Side effects
A therapy with sulfasalazine can have various side effects. For example, diarrhea, dizziness, headache, rash, inflammation of the heart muscle (myocarditis), inflammation of the pancreas (pancreatitis) and kidney problems may occur. Liver enzymes may increase in the blood (transaminase increase) and the blood count may change under therapy.
It is possible that individual blood cell counts are reduced, for example a reduction in red blood cells (anemia) or blood platelets (thrombopenia). In rare cases, this can also lead to agranulocytosis, i.e. a lack of certain white blood cells (the granulocytes), which can be dangerous under certain circumstances. In some cases, sperm production in men under therapy with sulfasalazine may be reduced, which may result in inability to conceive during this period.
However, this condition usually recovers within two to three months after the end of therapy. The fertility of women is not affected by sulfasalazine. Should strong side effects occur, the therapy with Sulfasalazine must be stopped immediately and not repeated in the future.
The effectiveness of Sulfasalazine may be impaired if other drugs are taken at the same time. This applies, for example, to the antibiotics neomycin, rifampicin, ampicillin and ethambutol, since these cause the intestinal bacteria to no longer sufficiently cleave the drug. Thus the full effect is then no longer guaranteed.
If iron preparations against iron deficiency are taken at the same time, the absorption of sulfasalazine in the intestine may be reduced. This also applies to certain lipid-lowering agents (cholestyramine, cholestipol), as these bind sulfasalazine in the intestine and thus hinder its absorption. Therapy with sulfonylureas in type 2 diabetes mellitus can have an increased effect under sulfasalazine, so that excessive blood sugar reduction with hypoglycemia (hypoglycemia) can occur. Sulfasalazine can also reduce the absorption of the drug digoxin (used to treat heart muscle weakness), so that it loses its effectiveness.Digoxin and Sulfasalazine should therefore not be taken at the same time, but at intervals of several hours.
