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Updated: Oct 28 2019


  • Snapshot
    • A 25-year-old man with a history of ulcerative colitis presents to his gastroenterologist. His ulcerative colitis had been calm but recently he developed rectal bleeding and increasingly frequent stools. A colonoscopy shows diffuse inflammatory changes localized to the rectum. He is started on topical mesalazine as well as oral sulfasalazine, which contains both an anti-inflammatory and anti-bacterial component.
  • Introduction
    • Drugs
      • sulfasalazine
    • Mechanism of action
      • activated by gut bacteria and metabolized into sulfapyridine and 5-aminosalicylic acid (5-ASA)
      • 5-ASA
        • anti-inflammatory (COX inhibitor)
        • inhibits leukotriene synthesis and lipoxygenase
      • sulfapyridine
        • anti-bacterial
    • Clinical use
      • inflammatory bowel disease
        • ulcerative colitis
        • Crohn disease
      • juvenile rheumatoid arthritis
    • Adverse effects
      • gastrointestinal upset
      • drug rash
      • hemolytic anemia in those with G6PD deficiency
      • malaise
      • reversible oligospermia
      • contraindications
        • allergy to sulfa medicines
        • porphyria
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