If you suffer from inflammatory bowel disease or rheumatoid arthritis, your doctor may prescribe Sulfasalazine EC 500mg tablets. This medication is an anti-inflammatory drug belonging to a group of medicines called aminosalicylates. Sulfasalazine EC works by lowering the level of inflammation in the digestive tract and joints, which helps to relieve symptoms like abdominal pain and diarrhea, as well as joint pain and stiffness. Treatment with Sulfasalazine EC 500mg tablets usually lasts for several months.
The main forms of inflammatory bowel disease are Ulcerative Colitis and Crohn’s disease. Although the diseases have some features in common, there are some important differences.
Ulcerative Colitis is an inflammatory disease that affects only the large bowel (colon and back passage). The lining of the bowel becomes inflamed (red and swollen) and symptoms include abdominal pain and diarrhoea (which may contain blood and mucus). Sulfasalazine EC Tablets are used to control the flare-ups of ulcerative colitis. They may also be used at lower doses to prevent more flare-ups of ulcerative colitis.
Crohn’s disease is an inflammatory disease that may affect any part of the digestive system
from the mouth to the anus, but it most commonly affects the last part of the small bowel and the
first part of the large bowel. Symptoms include abdominal pain and diarrhoea (which may be
bloody). Sulfasalazine EC Tablets are used to control the flare-ups of Crohn’s Disease.
Rheumatoid arthritis
Sulfasalazine EC Tablets are usually given when a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs e.g. aspirin and ibuprofen) are not working. They help prevent damage to your joints and work slowly to reduce swelling and stiffness in your joints.
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The tablets should be taken with a glass of water and should be swallowed whole. Do not crush, break or chew the tablets. Unless your doctor has told you otherwise, the usual doses for the following conditions are: For Inflammatory bowel disease: Ulcerative Colitis • Adults and the Elderly • Severe Flare-Ups 2-4 tablets four times a day, with other medicines such as steroids. Do not leave more than 8 hours between the evening and following morning dose. • Mild/Moderate Flare-Up 2-4 tablets four times a day, but not always with other medicines. Page 4 of 8 • Maintenance dose to control your flare ups – Once the flare-up is controlled the dose is slowly reduced to 4 tablets each day. Your doctor will tell you how to reduce your dose. This lower dose may be continued for some time to help stop other flare-ups. • Children 2 years of age and over Your doctor will tell you what dose your child will need to use. This will be based on your child’s weight. Crohn’s Disease • Adults and the Elderly • Severe Flare-Ups – 2-4 tablets four times a day, with other medicines such as steroids. Do not leave more than 8 hours between the evening and following morning dose. • Mild/Moderate Flare-Up – 2-4 tablets four times a day, but not always with other medicines. • Children 2 years of age and over – Your doctor will tell you what dose your child will need to use. This will be based on your child’s weight. For Rheumatoid arthritis • Adults and the Elderly – Start on one tablet each day for the first week. Then, increase the dose by one tablet a day each week to a maximum of 6 tablets daily
What you need to know before you take Sulfasalazine EC-tabs
Your doctor will perform complete blood counts and liver function tests before starting Salazopyrin and every second week during the first three months of therapy. During the second three months, the same tests should be done once monthly and thereafter once every three months, and as clinically indicated. Urine analysis and an assessment of kidney function should also be done periodically during treatment with Salazopyrin. Thereafter, monitoring will be performed as your doctor requires. Do not take Sulfasalazine EC-tabs if you • are allergic (hypersensitive) to any of the ingredients of Sulfasalazine EC-tabs (listed in section 6). • are allergic (hypersensitive) to salicylates (e.g. aspirin) or sulfonamides (e.g. a certain type of antibiotic). • have a disease known as porphyria (a rare blood pigment disorder). Your doctor will have already told you if you have this disease. Sulfasalazine EC-tabs are not to be used in children under 2 years of age. Warnings and precautions Tell your doctor if you are taking or have recently taken Sulfasalazine EC-tabs, or any other sulfasalazine containing products, because they may affect results of blood and urine tests. If you answer YES to any of these questions tell your doctor or pharmacist before taking this medicine: • Have you ever had any problems with your liver or kidneys? • Have you been told by your doctor that you have an inherited condition in which the body doesn’t have enough of an enzyme known as glucose-6-dehydrogenase which helps red blood cells function normally? • Have you ever had asthma? • If you are a child and have arthritis? Potentially life-threatening skin rashes (exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis) have been reported with the use of Sulfasalazine EC-tabs, appearing initially as reddish target-like spots or circular patches often with central blisters on the trunk. Additional signs to look for include ulcers in the mouth, throat, nose, genitals and conjunctivitis (red and swollen eyes). These potentially life-threatening skin rashes are often accompanied by flu-like symptoms. The rash may progress to widespread blistering or peeling of the skin. The highest risk for occurrence of serious skin reactions is within the first weeks of treatment. If you have developed exfoliative dermatitis, Stevens-Johnson syndrome or toxic epidermal necrolysis with the use of Sulfasalazine EC-tabs you must not be re-started on Sulfasalazine EC-tabs at any time. If you develop a rash or these skin symptoms, stop taking Sulfasalazine EC-tabs, seek immediate advice from a doctor and tell your doctor that you are taking this medicine. Severe, life-threatening allergic reactions such as Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) have been reported in patients taking various drugs including Sulfasalazine EC-tabs. It is important to note that early signs of severe allergy, such as fever or swollen lymph nodes, may be present even though rash is not evident. If such signs or symptoms are present, you should seek immediate advice from a doctor. Sulfasalazine EC-tabs should be discontinued if an alternative cause for the signs or symptoms cannot be established. Page 3 of 8 Tests on your blood, kidneys, liver and urine Your doctor will be taking blood tests to check your blood and your kidneys before you start treatment and regularly during treatment. They will also measure substances produced by your liver known as enzymes (liver function tests) before you start treatment and at regular intervals. They may also test your urine for protein and blood. Other medicines and Sulfasalazine EC-tabs Tell your doctor or pharmacist if you are taking the following medicines as they may interact with Sulfasalazine EC-tabs: • any medicine for high blood sugar/diabetes, • methenamine, an antibiotic for treating urinary tract infections, • digoxin, used to treat heart failure, • folate, sometimes taken during the first few weeks of pregnancy to reduce the risk of neural tube defects, e.g. Spina Bifida, • azathioprine and mercaptopurine – drugs used to help to suppress your body’s immune response in organ transplantation and certain chronic inflammations such as rheumatoid arthritis. • methotrexate, used to treat rheumatoid arthritis Please tell your doctor or pharmacist if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. Pregnancy and breast-feeding If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, you MUST ask your doctor for advice before taking this medicine. The doctor will advise you on whether you may take or continue to take this medicine. You should avoid breast-feeding while taking this medicine. There have been reports of diarrhoea or blood in the stools of babies of breast-feeding mothers taking Sulfasalazine EC-tabs. Driving and using machines Sulfasalazine EC-tabs is unlikely to affect your ability to drive or use machinery. Sulfasalazine EC-tabs contains propylene glycol This medicine contains 5 mg propylene glycol in each tablet
Possible side effects
Like all medicines, Salazopyrin EN-tabs can cause side effects, although not everybody gets them. Stop taking Salazopyrin EN-tabs and tell your doctor immediately if you experience any of the following symptoms after taking this medicine. Although they are very rare, these symptoms can be serious. • An allergic reaction such as sudden wheeziness, difficulty in breathing, swelling of eyelids, face or lips, rash or itching (especially affecting the whole body). • If you develop a severe skin rash that causes blistering, (this can affect the mouth and tongue). Potentially life-threatening skin rashes (exfoliative dermatitis, Stevens Johnson Syndrome, or toxic epidermal necrolysis) have been reported very rarely (see section 2 for a list of some of the possible symptoms). Your doctor will stop your treatment in these cases. • If you have a serious skin condition with a rash (sometimes confined to the cheeks and bridge of the nose) peeling skin or blistering. It may be triggered or aggravated by sunlight. Should this occur, stop taking this medicine, avoid strong sunlight and contact your doctor promptly. • If you are generally feeling unwell, have a fever, have pains in your joints, hives, swollen glands, rash and itching. These may be signs of a condition known as serum sickness. Your doctor will stop your treatment in these cases. • If you are breast feeding stop taking this medicine, once you notice blood in stools or diarrhoea in newborn. Tell your doctor immediately if you experience any of the following symptoms after taking this medicine as they will stop treatment in these cases: • If you notice any unexplained bleeding. • If you notice bruising, fever, rash, pallor (paleness), a severe sore throat or tiredness. These may be the first signs of an abnormality of the blood, including decreases in the number of red cells, white cells or platelets. Your doctor may take regular blood samples to test for these effects. Discontinue treatment with Salazopyrin while awaiting the results of blood tests. Other side-effects that may occur are: Very common side-effects which may affect more than 1 person in 10 are listed below: • Indigestion, heartburn • Feeling sick (nausea) Common side-effects which may affect more than 1 person in 100 are listed below: • Dizziness • Difficulty sleeping Page 6 of 8 • Headache • Changes in taste • Abdominal pains • Diarrhoea • Being sick • Ringing in the ears • Blood shot eyes • Inflamed mouth (stomatitis) • Cough • Itching of the skin • Joint pain • Protein in urine • Fever Uncommon side-effects which may affect more than 1 person in 1000 are listed below: • Depression • Fits, jerky, uncontrolled movements • Loss of balance • Shortness of breath • Hair loss • Hives • Puffiness around the eyes and face Since introduction to the market the following side-effects have been reported: • Inflammation of the lining of the brain • Severe diarrhoea • Other blood disorders including anaemia, enlarged glands (lymph nodes) • Blood vessel inflammation • Loss of appetite • Hallucinations • Changes in mental state • Changes in smell • Inflammation of the sac surrounding the heart (pericarditis) • Inflammation of the heart muscle (myocarditis) • Bluish tint to skin due to poor circulation • Lung complications with breathlessness • Inflammation of the salivary glands on either side of the face • Kidney inflammation and kidney pain, • Liver disease (hepatitis) • Yellowing of the skin or whites of the eyes (jaundice) • Inflammation of pancreas, which causes severe pain in the abdomen and face • Rash, reddening or blistering of the skin, eczema, • Tingling, numbness, pain in hands and feet • Blood in urine • Urine or motions may become a yellow/orange colour which is normal and harmless. (See section 6 General Advice for further information) • Temporary infertility in men. Fertility returns when treatment is stopped. Normal contraception should still be used. Page 7 of 8 Very rarely sulfasalazine has caused permanent staining of extended wear soft contact lenses. (See section 6 General Advice for further information). Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.
What Sulfasalazine EC-tabs contain The active substance is sulfasalazine. Each tablet contains 500mg of sulfasalazine. Other ingredients are maize starch, povidone, magnesium stearate, colloidal silicon dioxide. The tablet enteric coating contains cellulose acetate phthalate, PVP (propylene glycol (E1520) see section 2 (Sulfasalazine EC-tabs contains propylene glycol), bees wax, carnauba wax, self emulsifying glyceryl monostearate and talc.
Keep out of the sight and reach of children. Do not use Sulfasalazine EC-tabs after the expiry date which is stated on the bottle. The expiry date refers to the last day of that month. Store in a dry place. Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.
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