Drug Interactions with Sulphasalazine: Safety Concerns with Cold Medications and Herbal Remedies

Q: Drug Interactions with Sulphasalazine: Safety Concerns with Cold Medications and Herbal Remedies

Hello： <br>1. <br>Regarding drug interactions with Sulfasalazine, literature indicates that it may interact with NSAIDs commonly found in cold medications (which serve to reduce fever, relieve pain, and provide anti-inflammatory effects), potentially increasing the risk of gastro

Drug interactions, medication consultation, Sulphasalazine?

Hello, I have been taking Sulphasalazine 1g twice daily for ankylosing spondylitis.
I would like to know if this medication has any interactions with common cold medications, vitamin C, or Fangfeng Tongsheng San.
Additionally, is the following information applicable to this medication? Thank you.
Sulfonamide drugs are prone to crystallization in the renal tubules in acidic environments.
This can occur not only with acidic beverages (such as carbonated drinks) but also with certain traditional Chinese medicines.
Sulfonamide drugs (such as sulfadiazine) should not be used in conjunction with traditional Chinese medicines or their compound preparations that are rich in organic acids (such as Wu Mei, Hawthorn, Shan Yao, Schisandra, and formulations like Wu Mei Wan, Shen Mai Yin, Wu Wei Xiao Du Yin, Chuan Xiong Cha Tiao San, etc.), as a large amount of organic acids can reduce the solubility of acetylated sulfonamides, leading to crystallization in the renal tubules, which can obstruct and damage the kidneys, causing hematuria, urinary retention, or even acute renal failure.
Sulfonamide drugs should also not be taken with tannin-containing traditional Chinese medicines (such as Di Yu, Pomegranate peel, Wubeizi, He Zi, Rhubarb, and Polygonum cuspidatum), as tannins can bind to sulfonamide drugs, affecting their excretion and leading to increased concentrations of sulfonamides in the blood and liver, which in severe cases can result in toxic hepatitis.

STEP, 20~29 year old female. Ask Date: 2016/10/19

Dr. Chen Yuemei reply Pharmacology

Hello:
1.
Regarding drug interactions with Sulfasalazine, literature indicates that it may interact with NSAIDs commonly found in cold medications (which serve to reduce fever, relieve pain, and provide anti-inflammatory effects), potentially increasing the risk of gastrointestinal bleeding.
2.
Sulfasalazine has poor solubility in "acidic urine," which can lead to precipitation.
Therefore, it is recommended that (1) during the medication period, intake of foods that may further acidify urine (such as tea, coffee, carbonated beverages, and vitamin C, among others) should be reduced.
(2) It is essential to drink plenty of water during the medication period (at least six to eight glasses of water daily) to prevent the formation of crystals or stones in the urine.
3.
For questions regarding foods that may further acidify urine, consulting a nutritionist is advisable.
4.
Some Western medications should not be taken simultaneously with traditional Chinese medicine.
It is generally recommended to space the intake of Western and Chinese medications by at least two hours to minimize the risk of drug interactions that could affect efficacy or cause adverse reactions.

Reply Date: 2016/10/19

More Info

Sulphasalazine is a medication primarily used to treat inflammatory bowel disease and certain types of arthritis, including ankylosing spondylitis. It is a sulfonamide compound that can interact with various medications and substances, leading to potential safety concerns. Understanding these interactions is crucial for anyone taking Sulphasalazine, especially when considering over-the-counter medications, vitamins, or herbal remedies.

Interactions with Cold Medications
Cold medications often contain ingredients such as acetaminophen, decongestants (like pseudoephedrine), and antihistamines. When combined with Sulphasalazine, there are a few considerations:
1. Gastrointestinal Risks: Some cold medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), can increase the risk of gastrointestinal bleeding when taken with Sulphasalazine. This is particularly concerning for individuals with a history of gastrointestinal issues.

2. Acidic Environment: Sulphasalazine is less soluble in acidic urine, which can lead to crystallization in the kidneys. Cold medications that may increase urine acidity (like vitamin C) should be used cautiously. It is advisable to maintain hydration and monitor urine pH to minimize the risk of crystallization.

Interactions with Vitamin C
Vitamin C (ascorbic acid) is known to acidify urine, which can decrease the solubility of Sulphasalazine. This can lead to crystallization in the renal tubules, potentially causing kidney damage, hematuria (blood in urine), or even acute kidney failure. Therefore, it is recommended to limit the intake of vitamin C while on Sulphasalazine.

Interactions with Herbal Remedies
Herbal remedies can also pose risks when taken with Sulphasalazine. Many traditional Chinese medicines contain organic acids or tannins, which can interact negatively with sulfonamide drugs. For instance:
- Organic Acids: Herbal formulations containing ingredients like hawthorn, sour plum, or other fruits high in organic acids can exacerbate the risk of crystallization in the kidneys.

- Tannins: Herbs that are rich in tannins (such as pomegranate peel or certain types of rhubarb) can bind to Sulphasalazine, impairing its excretion and potentially leading to increased serum levels of the drug. This can heighten the risk of side effects, including hepatotoxicity.

Recommendations
1. Consult Healthcare Providers: Always discuss any new medications, including over-the-counter cold medications, vitamins, or herbal remedies, with your healthcare provider. They can provide guidance tailored to your specific health needs and medication regimen.

2. Hydration: Ensure adequate hydration while taking Sulphasalazine. Drinking plenty of water (at least 6-8 glasses a day) can help dilute the urine and reduce the risk of crystallization.

3. Timing of Medications: If you need to take herbal remedies or other medications, consider spacing them out from Sulphasalazine by at least two hours to minimize potential interactions.

4. Monitoring: Regular monitoring of kidney function and urine analysis may be warranted, especially if you are taking multiple medications or have underlying kidney issues.

In summary, while Sulphasalazine is effective for managing certain inflammatory conditions, it is essential to be aware of its interactions with cold medications, vitamin C, and herbal remedies. By taking precautions and consulting with healthcare professionals, you can help ensure safe and effective use of this medication.

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