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Sulphasalazine (SSZ) Sulphasalazine (SSZ) is composed of 5-amino salicylic acid and sulphapyridine. The usual dose is 2-3g daily taken in divided doses. It may be used as monotherapy, especially in young females considering pregnancy, or in combination with other DMARDs.
Monitoring Baseline: CBC, LFT. Monitoring: CBC, LFT every 4 weeks initially, increasing to 12 weeky once stable.
Clinical AEs 1. Rash – This can signify an allergy to sulpha compounds and in most cases should result in immediate discontinuation of SSZ. A severe hypersensitivity syndrome manifest by rash, fever, lymphadenopathy and abnormal LFTs can occur if SSZ is not discontinued. 2. Nausea – This occurs frequently on initiation and often improves over a few days if the SSZ is continued.
Laboratory AEs 1. LFT abnormalities. See guidance under MTX.
2. Haematologic abnormalities. A severe idiosyncratic cytopenia is described rarely with SSZ. This can develop suddenly, typically around 6 weeks after starting, so may not be detected by routine monitoring. SSZ should be discontinued immediately and the rheumatologist notified should this arise. For less severe abnormalities, see guidance for MTX above.
3. Oligozoospermia – this is a reversible complication of treatment with SSZ.
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