First-lineSalazopyrin
Sulfasalazine
DMARD / aminosalicylate
Compatible in pregnancy — give with folic acid.
Oral
First-line for
- RA / IBD maintenance in pregnancy when methotrexate unsuitable
Mechanism
Cleaved by gut bacteria to sulfapyridine (systemically absorbed) + 5-ASA (local anti-inflammatory action in gut/joints).
Sulfasalazine in pregnancy
- Compatible — continue if controlling disease
- Always co-prescribe folic acid (sulfapyridine impairs folate absorption)
- Men: reversible oligospermia — resolves 2–3 months after stopping
Dosing
- Maintenance
- 500 mg PO BD, titrate to 2–3 g/day in divided doses
Contraindications
- AbsoluteSulfonamide or salicylate hypersensitivity
- CautionG6PD deficiency (haemolysis risk)
Side effects
- GI upset
- Rash
- Reversible oligospermia (male)
- Rare agranulocytosis
Fetal & maternal notes
- • Compatible in pregnancy and breastfeeding.
- • Give folic acid 5mg/day throughout — sulfapyridine competes with folate absorption.
Key interactions
Methotrexate
Caution↑ MTX toxicity via folate antagonism
Clinical pearls
- 💡 A useful methotrexate-sparing DMARD when disease control is needed through pregnancy.
Content last reviewed: REPLACE_ME (e.g. 2026-07) · Sources: Rheumatology Secrets 5th ed. Table 78.2
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