the Side Effects of Salazopyrin in Ankylosing Spondylitis Patients

Q: the Side Effects of Salazopyrin in Ankylosing Spondylitis Patients

Hello： Approximately 3% of individuals taking Salazopyrin may experience hair loss as a side effect, although this varies from person to person. <br>In my experience, I have seen many patients in the hospital taking this medication with few reports of this side effect. <br>You ma

Ankylosing Spondylitis

Hello! I was diagnosed with stage 2 ankylosing spondylitis in March of this year, and since then, I have been taking Salazopyrin (sulfasalazine) as an immunomodulatory medication.
Recently, in September, I noticed that my hair has been falling out frequently, and there is a noticeable patch of scalp on the top of my head.
I am wondering if this could be related to the medication I am taking.
Could you please explain whether the side effects of this drug might be involved?

Mr. Chen, 10~19 year old female. Ask Date: 2009/09/20

Dr. Hou Fangmin reply Pharmacology

Hello: Approximately 3% of individuals taking Salazopyrin may experience hair loss as a side effect, although this varies from person to person.
In my experience, I have seen many patients in the hospital taking this medication with few reports of this side effect.
You may want to discuss this with your physician.

Here is an introduction to the medication: Sulfasalazine is converted by intestinal microbiota into sulfapyridine and 5-aminosalicylic acid (or mesalamine), which produce anti-inflammatory and immunomodulatory effects.
Initially, a maintenance dose of 1/3 to 1/4 of the total dose is given, with a maximum of 2g per day and a maximum total dose of 3g per day.
The main side effects include headache and photosensitivity.
Caution is advised for patients with hepatic or renal impairment, urinary tract obstruction, or G6PD deficiency.

Salazopyrin® should not be crushed and must be swallowed whole, taken on an empty stomach, and should not be used concurrently with antacids as this may affect absorption.
Long-term use can lead to folate deficiency anemia, so it is important to supplement folic acid appropriately, generally at a dose of 1mg per day, not exceeding 5mg per day.

Wishing you peace and happiness.

Reply Date: 2009/09/20

More Info

Salazopyrin, also known as Sulfasalazine, is a medication commonly used to treat inflammatory conditions such as ankylosing spondylitis (AS). It functions as an immunomodulator and anti-inflammatory agent, primarily by being converted in the gut to sulfapyridine and 5-aminosalicylic acid (mesalamine), which help reduce inflammation and modulate the immune response. While it is effective for many patients, it is essential to be aware of its potential side effects, especially in the context of your concerns regarding hair loss.

Hair loss, or alopecia, is a recognized side effect of Sulfasalazine, though it is relatively uncommon, occurring in approximately 3% of patients. The mechanism behind this side effect is not entirely understood, but it may be related to the drug's impact on folate metabolism. Sulfasalazine can interfere with the absorption of folic acid, which is crucial for the synthesis of DNA and the production of new cells, including hair follicles. A deficiency in folate can lead to hair thinning or loss, among other symptoms.

In addition to hair loss, other common side effects of Sulfasalazine include gastrointestinal disturbances (such as nausea, vomiting, and diarrhea), headache, and hypersensitivity reactions. More serious but less common side effects can include liver toxicity, renal impairment, and blood dyscrasias (such as leukopenia or thrombocytopenia). It is crucial to monitor for these effects, especially if you have pre-existing conditions affecting your liver or kidneys.

Given your experience of hair loss since starting the medication, it would be prudent to discuss this with your healthcare provider. They may recommend a few strategies to mitigate this side effect:
1. Folic Acid Supplementation: Since Sulfasalazine can lead to folate deficiency, your doctor might suggest taking folic acid supplements. The typical recommendation is 1 mg per day, but this can be adjusted based on your specific needs and blood work results.

2. Monitoring: Regular blood tests can help monitor your liver function and blood counts, ensuring that any potential side effects are caught early.

3. Alternative Treatments: If the hair loss becomes significant or bothersome, your physician may consider adjusting your treatment regimen. There are alternative medications for ankylosing spondylitis, such as non-steroidal anti-inflammatory drugs (NSAIDs) or biologics, which might be more suitable for you without the risk of hair loss.

4. Dermatological Consultation: If hair loss persists, consulting a dermatologist could provide additional insights and treatment options, such as topical treatments or therapies aimed at stimulating hair growth.

In conclusion, while hair loss can be a side effect of Sulfasalazine, it is essential to evaluate all potential causes, including the medication itself and other factors such as stress, nutritional deficiencies, or underlying health conditions. Open communication with your healthcare provider is key to managing your treatment effectively and ensuring that you maintain both your physical health and quality of life.

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