Azulfidine, or sulfasalazine by generic name, belongs to the group of medications known as sulfa drugs. The first experiments with this class of medicines were initiated in the distant 1930^th. At those times sulfa drugs were mainly used as antimicrobial agents, and, in fact, sulfa drugs are often mentioned as the pioneers of the antibiotic revolution in medicine.

It is not the scope of this article to cover the history of sulfa drugs, but it is worth mentioning that there were many bright episodes with thousands of patients saved by sulfa drugs during World War II, and, on the other hand, there were also some rather disastrous events, for example, Elixir Sulfanilamide disaster or mass poisoning with sulfa drugs in 1937, when more than 100 people died in the USA.

Nowadays, the popularity of sulfa drugs seems to decline because of the potential adverse reactions associated with the use of this class of medications, and, definitely, because of the new generations of medicines. However, there are still medical conditions, where using sulfa drugs, such as Azulfidine, remains among the first-line officially-approved treatments.

The example is Crohn’s disease, one of the types of inflammatory bowel disease (IBD), which manifests itself through such symptoms as abdominal pain and cramping, fatigue, diarrhea, blood in the stool, weight loss or loss of appetite, fever and even anemia. Modern science has not yet discovered the causes of IBD, as well as modern medications, which would be both effective and safe against this disorder. Under such circumstances, Azulfidine is commonly prescribed to patients, suffering from Crohn’s disease. By the way, ulcerative colitis, urinary infections, different forms of arthritis and psoriasis may also be treated with sulfa drugs.

How can Azulfidine help in case of Crohn’s disease?

The key problem of Crohn’s disease, as well as ulcerative colitis, is the chronic inflammation of the human gastrointestinal tract. And it is the inflammation, which is targeted by Azulfidine.

In fact, the medication itself is considered to be a prodrug. It means that it is not active in the form it is taken by humans. Unlike other sulfa drugs, only about 30% of Azufidine is absorbed into the bloodstream. The rest of medication goes into the colon, where it is broken down into two specific substances - 5-aminosalicylic acid (5ASA), and sulfapyridine. It is now known that these are the very substances, which relieve the inflammation of the colon tissues. Besides, Azulfidine is known to have some immune-suppressing effect, which is another benefit in the treatment of Crohn’s disease.

How to take Azulfidine?

The general recommendation for adult patients is 1-4g daily taken in even doses in 6-hours or 12-hours intervals. In cases of mild to moderate Crohn’s disease it is recommended to start the treatment with 1 or 2 tablets (500mg) daily, which should be divided into 4 even doses. The daily dose is gradually increased afterwards. However, the daily dose should not exceed 4 g per day, because the occurrence of adverse reactions, associated with Azulfidine, is dose related.

To avoid upset stomach, Azulfidine can be taken with food. To avoid heartburn, which may appear after taking sulfa drugs, one may try taking Azulfidine EN tablets with the special coating to minimize heartburn risks.

What side effects may develop after taking Azulfidine?

Nausea and headache are, perhaps, the earliest and the most common side effects, associated with Azulfidine use. Besides, certain skin reactions may develop, such as itching, rash, and sensitivity to sunlight. General feeling unwell, hallucinations, diarrhea, ringing in the ears, and chills have also been reported as the adverse reactions of Azulfidine.

It is necessary to underline that men taking Azulfidine may temporally become infertile because of the significant drop of sperm count. However, this effect is reversible, when the treatment with Azulfidine is stopped.

Besides, people on Azulfidine should not be frightened if their urine turns orange-yellow. This is a harmless reaction, which poses no threat to human health.

Severe side effects, such as drop in white blood cell count or specific anemia, are considered to be rare (in about 6 persons among 10 thousands). However, in case of fever, pale skin, sore throat, fatigue and unusual bleeding or bruising, one should be taken to emergency room to exclude severe adverse reactions of Azulfidine.

What to do to minimize the side effects of Azulfidine?

-         In order to avoid allergic reactions, such as skin rash, itching and fever, a patient can be desensitized (the initial dose should 1/8-1/4 of a tablet daily for one weak with subsequent gradual increasing of the dose until the necessary therapeutic dose is reached);

-         To avoid heartburn – take Azulfidine EN tablets, and to avoid nausea - take the medication with food;

-         Wear protective clothing or use sunscreens if you suffer from the increased sun sensitivity, caused by Azulfidine;

-         Take folic acid supplements, since Azulfidine may contribute to folic deficiency;

-         Maintain adequate fluid intake to reduce the risk of kidney stones formation;

-         Be very careful with taking Azulfidine with other medications because of possible interactions, and always follow the regimen prescribed by a doctor.

To sum it up, it is necessary to admit that Azulfidine as any other medication can definitely have both positive and negative effects on the human health. However, when it goes about such disorders as Crohn’s disease, where there is a very limited range of treatment options, it is necessary to choose the lesser among two evils.