Sulfasalazine
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Sulfasalazine
Has anyone had any experience with this drug? My doctor switched me to this after Lialda failed. I have improved somewhat but I feel terrible, tired, nauseated.
Hi Gayle,
You may not be able to tolerate sullfa drugs — many people can't. IMO, Lialda is a far superior mesalamine-based drug than sulfasalazine (both more effective and safer), so if Lialda didn't work for you, then switching from Lialda to sulfasalazine is the equivalent of jumping from the frying pan into the fire. Your doctor must have had his or her brain disengaged when he or she wrote that prescription. Obviously she or he is lost. Here's why:
Not many members have used Sulfasalazine, because it's a very old drug, and many people react adversely to it. It's not very popular these days, because many people are sensitive to sulfa drugs, and also because many people suffer adverse effects from one of the active moieties of sulfasalazine, (sulfapyradine), after the gut bacteria break down the drug, to activate it.
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since so many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine, to further confuse the matter), in the treatment of IBDs.
The active ingredient in Lialda is mesalamine. Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid, but it does not contain sylfapyradine, thus making it a much more effective and generally safer drug. Mesalamine is a derivative of salicylic acid, which means that it is related to NSAIDs. For many people who have an inflammatory bowel disease, NSAIDs have been shown to stimulate leukotriene production, which can cause inflammation and diarrhea.
Therefore, virtually anyone who is known to suffer an MC flare because of NSAIDs, will also react adversely to mesalamine and/or sulfasalazine. That means that any of the mesalamine-based drugs (including, but not limited to, Asacol, Lialda, Colazal, Pentasa, Rowasa, Canasa, Apriso, Salofalk, etc.) can make our symptoms worse, if we happen to be one of the many patients who have MC, and who react adversely to NSAIDs
Unless you have rheumatoid arthritis, sulfasalazine offers absolutely no benefits over Lialda (mesalamine), other than cost. Mesalamine is a much safer drug to use, with regard to side effect risks, because of the fact that so many people with MC cannot tolerate sulfa drugs. However, because sulfasalazine has been around for a long time, and is cheap to manufacture, it's priced much lower than mesalamine.
IMO, (and this is strictly my unprofessional opinion), Entocort EC (budesonide) is far more effective, and generally safer for treating MC (especially after the dosage is tapered down to a low maintenance dose), than either sulfasalazine or mesalamine, (and it's certainly much, much safer to take than predisone). Mesalamine has been known to cause pancreatitis in a few cases, especially with long-term use, and the pancreas is not a good organ to inflame, because of it's vital digestive system functions. MC itself tends to cause pancreatic inflammation for some of us (which resolves after we get our MC symptoms under control), so we certainly don't need to take a drug that can cause additional inflammation of the pancreas. It's definitely not common for mesalamine to cause pancreatic inflammation, but for those few who are unlucky enough to experience it, it can be a rather serious issue.
Many GI docs are afraid of Entocort, because it is classed as a corticosteroid, but unlike the other corticosteroids, only up to 19% of the active ingredient, (budesonide), is ever absorbed into the bloodstream, so it is nowhere near as likely to cause the side effect risks of the other corticosteroids. Also, most GI docs are unaware of the risks of mesalamine causing pancreatitis, because that risk only becomes apparent if one does a lot of research on the internet, something that most GI docs seem loathe to do, for some unknown reason.
As far as price is concerned, though, sulfasalazine can't be beat, because it is cheap, and Entocort is expensive. I hope this helps.
Tex
You may not be able to tolerate sullfa drugs — many people can't. IMO, Lialda is a far superior mesalamine-based drug than sulfasalazine (both more effective and safer), so if Lialda didn't work for you, then switching from Lialda to sulfasalazine is the equivalent of jumping from the frying pan into the fire. Your doctor must have had his or her brain disengaged when he or she wrote that prescription. Obviously she or he is lost. Here's why:
Not many members have used Sulfasalazine, because it's a very old drug, and many people react adversely to it. It's not very popular these days, because many people are sensitive to sulfa drugs, and also because many people suffer adverse effects from one of the active moieties of sulfasalazine, (sulfapyradine), after the gut bacteria break down the drug, to activate it.
Sulfasalazine is a prodrug, that is to say, it does not become active in the digestive system until it is broken down by bacteria in the colon, into 5-aminosalicylic acid, (5-ASA), and sulfapyridine. While sulfapyradine has a therapeutic effect for rheumatoid arthritis, no beneficial effect from sulfapyradine has been observed for treating inflammatory bowel disease. Since so many people tend to react adversely to sulfa drugs, sulfasalazine has mostly been replaced with mesalamine, (sometimes referred to as mesalazine, to further confuse the matter), in the treatment of IBDs.
The active ingredient in Lialda is mesalamine. Mesalamine contains the active moiety of sulfasalazine, known as 5-aminosalicyclic acid, but it does not contain sylfapyradine, thus making it a much more effective and generally safer drug. Mesalamine is a derivative of salicylic acid, which means that it is related to NSAIDs. For many people who have an inflammatory bowel disease, NSAIDs have been shown to stimulate leukotriene production, which can cause inflammation and diarrhea.
Therefore, virtually anyone who is known to suffer an MC flare because of NSAIDs, will also react adversely to mesalamine and/or sulfasalazine. That means that any of the mesalamine-based drugs (including, but not limited to, Asacol, Lialda, Colazal, Pentasa, Rowasa, Canasa, Apriso, Salofalk, etc.) can make our symptoms worse, if we happen to be one of the many patients who have MC, and who react adversely to NSAIDs
Unless you have rheumatoid arthritis, sulfasalazine offers absolutely no benefits over Lialda (mesalamine), other than cost. Mesalamine is a much safer drug to use, with regard to side effect risks, because of the fact that so many people with MC cannot tolerate sulfa drugs. However, because sulfasalazine has been around for a long time, and is cheap to manufacture, it's priced much lower than mesalamine.
IMO, (and this is strictly my unprofessional opinion), Entocort EC (budesonide) is far more effective, and generally safer for treating MC (especially after the dosage is tapered down to a low maintenance dose), than either sulfasalazine or mesalamine, (and it's certainly much, much safer to take than predisone). Mesalamine has been known to cause pancreatitis in a few cases, especially with long-term use, and the pancreas is not a good organ to inflame, because of it's vital digestive system functions. MC itself tends to cause pancreatic inflammation for some of us (which resolves after we get our MC symptoms under control), so we certainly don't need to take a drug that can cause additional inflammation of the pancreas. It's definitely not common for mesalamine to cause pancreatic inflammation, but for those few who are unlucky enough to experience it, it can be a rather serious issue.
Many GI docs are afraid of Entocort, because it is classed as a corticosteroid, but unlike the other corticosteroids, only up to 19% of the active ingredient, (budesonide), is ever absorbed into the bloodstream, so it is nowhere near as likely to cause the side effect risks of the other corticosteroids. Also, most GI docs are unaware of the risks of mesalamine causing pancreatitis, because that risk only becomes apparent if one does a lot of research on the internet, something that most GI docs seem loathe to do, for some unknown reason.
As far as price is concerned, though, sulfasalazine can't be beat, because it is cheap, and Entocort is expensive. I hope this helps.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Gayle, speaking from personal experience, the stuff is poison. I took it for a couple of weeks while I was waiting to get into see my GI doc. My primary care physician had prescribed Prednisone but once I stopped it I flared again, so she suggested Sulfasalazine. With LC I had nausea and light headedness in the morning. On Sulfasalazine I had those symptoms 24/7. I was much worse off and the longer I took it the more intense the side effects became (as expected). I titrated myself off and decided I take my chances with my LC instead.
When I went into to see my GI doc she said 'there are meds that can help' and I asked "are you thinking about sulfasalazine?' and she said- with a shocked look on her face-- "Oh no. We don't ever use that stuff. There are much better medications out there", and then she prescribed me Entocort which really helped me get back on my feet. I took it for 4 months.
so that's my 2 cents worth. It's awful stuff and there are docs that refuse to use it. And IMO, its poisonous.
Carol
When I went into to see my GI doc she said 'there are meds that can help' and I asked "are you thinking about sulfasalazine?' and she said- with a shocked look on her face-- "Oh no. We don't ever use that stuff. There are much better medications out there", and then she prescribed me Entocort which really helped me get back on my feet. I took it for 4 months.
so that's my 2 cents worth. It's awful stuff and there are docs that refuse to use it. And IMO, its poisonous.
Carol
“.... people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou
