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Sulphasalazine - What is it for

Sulphasalazine belongs to a group of medicines called aminosalicylate which is used to reduce pain and swelling in joint conditions e.g. rheumatoid arthritis.

It is one of the disease-modifying-anti-rheumatic drugs (DMARDs) which can modify the progress of clinical disease by reducing permanent damage to joints caused by continuing inflammation.

It may be combined with other DMARDs or biologic agents to control the disease.​

Sulphasalazine - Side Effects, Precautions, and Contraindications

What side effects can Sulphasalazine cause?

​In general, most patients can take sulfasalazine with few side effects.

The tablets may cause your urine to turn an orange colour and if you are wearing contact lenses, it may get stained. DO NOT be alarmed by these signs.

Common side effects

  • Nausea
  • Vomiting
  • Dizziness
  • Headache

Rare side effects

  • Allergy
  • Hepatitis
  • Inflammation of the blood vessels of the heart lining and muscles.
  • Drop in blood counts
  • Ringing in the ears
  • Disturbed sleep

Before taking Sulphasalazine, what precautions must I follow?

Come back to the hospital for regular blood test as instructed by your doctor.

Because adverse effects can happen at any time during the course of treatment and some side effects may not cause symptoms, it is really important that you have your regular blood test. 

Avoid prolonged exposure to sun and use sunscreen as this medicine may cause the skin to be more sensitive to sunlight.

Sulphasalazine can lower sperm counts and motility may be lowered. These go back to normal within 2 months after the drug is stopped. Do inform your doctor or pharmacist if intending to start a family.

What food or medicine must I avoid when I take Sulphasalazine?

Sulphasalazine - Dosage and How to Use

How should Sulphasalazine be used?

It is given orally, after food to prevent stomach upset, usually once, twice or even up to three times a day.

A typical dose will range from 500mg to 3g a day, varying for each person depending upon factors such as activities of your disease and your response to the treatment.

Sulphasalazine tablets should be swallowed whole, with a glass of water. The tablets should not be crushed or chewed.

What should I do if I miss a dose?

Take a missed dose as soon as you think about it. If it is close to the time for your next dose, skip the missed dose and go back to your normal time.

DO NOT double the dose to make up for the missed dose.

What should I do if I overdose?

Sulphasalazine - Handling and Storage

How should I handle Sulphasalazine safely?

How should I store Sulphasalazine?

Keep away from children;#Keep in a cool, dry place, away from direct sunlight;#

How should I dispose of Sulphasalazine safely?

​Sulphasalazine  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.

Sulphasalazine - Additional Information

How LONG does it take for the medicine to be EFFECTIVE?

  • It usually takes between 1 and 3 months to notice any improvement in symptoms after starting sulfasalazine.

When do I seek medical attention IMMEDIATELY?

  • Come back to the hospital if you have:

    • Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
    • A temperature that exceeds 38°C or other symptoms of infection such as chills, cough or painful urination.
    • Feeling very tired or weak.
    • If you see tablet bits in the stool.
    • Excessive diarrhea and/or vomiting despite taking medicine.
    • Very bad skin irritation.
    • Jaundice (eyes or skin turn yellow).
    • Breathlessness.


  • Your doctor may prescribe pain-relieving treatments since methotrexate is not a pain killer.
  • DO NOT take iron within 2 hours after taking sulphasalazine.
  • Always check with the doctor or pharmacist first before self-treatment with any over-the-counter medicines.
  • DO NOT take any supplements, alternative or herbal medicines without informing your doctor or pharmacist.

What special DIETARY instructions should I follow?

  • Maintain adequate hydration (2-3 liters of fluid a day, unless otherwise advised by your doctor) and nutrition (small, frequent meals are preferred).
  • Alcohol should be avoided if possible or kept to a minimum as suggested by your rheumatologist because alcohol may increase the risk of liver toxicity associated with sulphasalazine.


  • Although sulphasalazine is not known to harm fetus growth and development, do inform your doctor if you are pregnant or preparing for pregnancy or breast-feeding.

In SUMMARY… what you need to know about sulphasalazine?​

  • Take sulphasalazine approximately at the same time every day, unless instructed otherwise by your doctor.
  • Always come for your BLOOD TESTS on the scheduled date.
  • Beware of the SIDE EFFECTS and when to get immediate medical attention.
  • Never take medicines, supplements or herbal treatments OVER-THE-COUNTER without checking with your doctor or pharmacist first.
  • If you (both genders) intent to start a family, please inform your doctor as sulphasalzine may affect your fetus and sperm count.
  • If you have further questions about Sulphasalazine, please call ______________________ (office number) to discuss with your doctor / pharmacist / specialty nurse (please circle as appropriate).
  • Updated on Friday, June 12, 2015
  • Article contributed by Pharmacy, Rheumatology & Immunology Singapore General Hospital

    The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth


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