Talk:Sulfasalazine

NSAID?
The mode of action of sulfasalazine is through release of a metabolite, 5-amminosalicylic acid (5-ASA), which is an NSAID.

Aspirin (commonly abbreviated as "ASA") is acetylsalicylic acid, whereas 5-ASA is aminosalicylic acid. This may be your point of confusion.--69.180.214.43 18:57, 21 June 2007 (UTC) Sulfasalazine does not have an analgesic effect. M dorothy

Drugbox doesn't work. Why?

Mechanism of action
Just some general mechanism/proposed mechanism info. Sulfasalazine, as discussed, has no inherent anti-inflammatory properties, but its metabolite, 5-ASA, does. Salicylates and other NSAIDS act via prostaglandin synthesis blockage, but aminosalicylates like 5-ASA vary in their inhibition of PG, so this isn't a complete explanation. A widely accepted theory is that 5-ASA attenuates the inflammatory products of the cyclooxygenase and lipoxygenase pathways. Another prominent theory is that 5-ASA appears to inhibit leukotriene and other inflammatory cytokine production, and has been proven to inhibit nuclear fcator kappa B, a primary transcription factor for inflammatory cytokines. Finally, 5-ASA may inibit functions of natural killer cells, mucosal lymphocytes, and macrophages (which release large quantities of inflammatory cytokines), and may scavenge oxygen radicals. These theories make sense in that ulcerative colitis and Crohn's disease are inflammatory diseases, and inflammation is caused by a response by the immune system. That is not to say that these diseases are autoimmune in nature; it's very possible that the disease are caused by an abnormally high production of proinflammatory cells, or that those cells produce abnormally large amounts of cytokines (I'm not putting that in the article because that's my own proposition based on my own research). This would also explain why patients presenting with ulcerative colitis can also have arthritic symptoms (arthritis is an inflammatory joint disorder). It is important to note that sulfasalazine, being a "prodrug" is not an analgesic, as M Dorothy stated, but 5-ASA can exhibit indirect analgesic properties (meaning it does not directly stop pain signals or reduce pain perception, but can decrease inflammation that is causing pain). There's a difference between the two. I hope this information is useful. It was taken primarily (not verbatim) from Basic and Clinical Pharmacology, 10th edition by Bertram G. Katzung, MD, PhD, with the particular chapter written by Kenneth R. McQuaid, MD. Just giving credit where it's due! I'm gonna bust out some randomized trials and then I'll make some edits. If anyone has any good trial info to contribute, that'd be helpful. Thanks! Ohnoitsthefuzz 05:32, 2 October 2007 (UTC)

Thought this section could use a cleanup: "Talk to your doctor if you have ulcerative colitis, as some patients that have both sets of symptoms of ulcerative colitis and arthritis may have ankylosing spondylitis, which is a genetic condition, often associated with the antigen HLA-B27. This is a genetic marker, and there is a test available for it. Sulfasalazine is also good for this." 152.133.7.130 (talk) 20:10, 30 March 2009 (UTC)

whole thing needs work
1. the indication section should be brief and not contain complex trial data. The trial data should be referenced 2. sulfasalazine is considered first line treatment for rheumatoid arthritis. "it is also effective" is a bit weak considering the importance of this drug to rheumatologists. 3. "it is surprising" - surprising is a personal adjective 4. "Most often we find " - who is WE? Articles should be written in third person 5. "Sulfasalazine in rare cases can cause severe depression in young males." - interesting to put this in considering how far down the list this particular side effect is. I do believe even something as random as ataxia is a more common side effect. 6. "but should you wish to become pregnant, you should discuss this with your rheumatologist." and "If however you develop a sore mouth, mouth ulcers, easy bruising, nosebleeds or bleeding gums, your doctor should be notified immediately." and others like these - wikipedia articles are ideally objective, peer reviewed, cited, balanced and third party. They are NOT patient leaflets or advice centres.

Hope these ideas help. PhatRita (talk) 23:24, 24 November 2008 (UTC)

additional recommendation. the article says that there is no immunosuppression. this may be true, but, according the the Lexi-Comp drug monograph, it can cause blood dyscrasias such as apslatic anemia and agranulocytosis. this are severe impairments of the immune system.

can this be reworded.

also about 1. above: why no trial data? if it is merely pointing out a trial, its outcome, and a reference is provided, we, the wiki-community, should welcome it with open arms. it adds a layer. i think the layers are a good thing since in my education, wikipedia is regarded as not-peer-reviewed. i think people are protecting their jobs because we, the reviewers, the users, the editors, the educated, are reviewing and improving; some people improve immediately and daily. —Preceding unsigned comment added by Friendlyrph (talk • contribs) 18:18, 13 September 2010 (UTC)

Structure
As it's an azo compound, 5-([p-(2-pyridylsulfamoyl)phenyl]azo) salicylic acid, there should be a double bond between the salicylic acid nitrogen and the sulfa moeity. Also, the salicylic acid moeity should have a hydroxy group (not a keto) at carbon 2... Mike Zinkievich (talk) 20:27, 20 April 2009 (UTC)
 * Changed the name to diazenyl or azo as well. --kupirijo (talk) 10:16, 14 January 2011 (UTC)

Indications
Does that section really need so much information on a possible toxicity? It looks a bit odd as it is...ChillyMD (talk) 22:50, 3 May 2009 (UTC)

Copyright problem removed
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Also used to treat
My doctors prescribed sulfasalazine when Jacobus Pharmaceutical stopped making sulfapyridine available around January 2011. The doctors prescribed supfasalazine to treat (the symptoms of) dermatitis herpetiformis (DH - an allergy to gluten which causes skin rashes). Doctor reference: Dr. Andrew Scheman, Dr. Todd Johnson (dermatologists) of Northbrook & Chicago IL. (Another drug prescribed for DH was dapsone (used to treat leprosy).) Please incorporate what you want from my input. I'm not a doctor. PReinie (talk) 15:42, 25 January 2011 (UTC)

Immunosuppression or no?
The article contradicts itself saying sulfasalazine has no immunosuppressive effect but it can cause agranulocytosis, which seems to be major suppression of the immune system. Which is it? — Preceding unsigned comment added by 72.24.31.36 (talk) 12:33, 25 December 2011 (UTC)

I think its pretty clear that it is an immunosuppressant particularly in regard to rheumatoid arthritis. On the NHS Choices website it states it is an immunosuppressant: http://www.nhs.uk/Conditions/Arthritis/Pages/MedicineOverview.aspx?condition=Rheumatoid%20arthritis&medicine=Sulfasalazine — Preceding unsigned comment added by Antimonos (talk • contribs) 12:57, 23 April 2013 (UTC)

Why does "salicylazosulfapyridine" redirect here?
Not mentioned in article. 86.159.197.174 (talk) 19:31, 25 August 2014 (UTC)