O’Dell JR, Haire CE, Erikson N et al. Vender RJ, Spiro HM. Management: Vaccine efficacy may be reduced. If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. See manufacturer's labeling.• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).• Discontinuation of therapy: Withdraw therapy with gradual tapering of dose.• Stress: Patients may require higher doses when subject to stress (ie, trauma, surgery, severe infection).Blood pressure; weight; serum glucose; electrolytes; growth in pediatric patients; presence of infection, bone mineral density; assess HPA axis suppression (eg, ACTH stimulation test, morning plasma cortisol test, urinary free cortisol test); Hgb, occult blood loss, leukopenia and thrombocytopenia (every 6 months when used in combination with azathioprine [Manns 2010]); chest x-ray (at regular intervals during prolonged therapy); IOP with therapy >6 weeks, eye examination (periodically during therapy [Manns 2010]).Prednisone and its metabolite, prednisolone, cross the placenta.In the mother, prednisone is converted to the active metabolite prednisolone by the liver.

Preexisting psychiatric conditions may be exacerbated by corticosteroid use.• Cardiovascular disease: Use with caution in patients with heart failure and/or hypertension; long-term use has been associated with electrolyte disturbances, fluid retention, and hypertension. Management: Concurrent use with antirheumatic doses of methotrexate or nonbiologic disease modifying antirheumatic drugs (DMARDs) is permitted, and this warning seems particularly focused on more potent immunosuppressants.Trastuzumab: May enhance the neutropenic effect of Immunosuppressants.Upadacitinib: Corticosteroids (Systemic) may enhance the immunosuppressive effect of Upadacitinib.

Corticosteroids (Systemic) may decrease the serum concentration of Salicylates.

Sulfasalazine should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.Severe, life-threatening, systemic hypersensitivity reactions such as drug rash with eosinophilia and systemic symptoms have been reported in patients taking sulfasalazine. Hypoadrenalism may occur in newborns following maternal use of corticosteroids in pregnancy; monitor.

Latent or active amebiasis should be ruled out in any patient with recent travel to tropic climates or unexplained diarrhea prior to corticosteroid initiation. Review article: mild to moderate Crohn’s disease defining the basis for a new treatment algorithm. Select one or more newsletters to continue. They are available in the following package sizes: Bottles of 100 NDC 0013-0101-10 Bottles of 100 NDC 0013-0101-01 Bottles of 300 NDC 0013-0101-30 Less common or rare adverse reactions include:The sulfonamides bear certain chemical similarities to some goitrogens, diuretics (acetazolamide and the thiazides), and oral hypoglycemic agents. Specifically, the risk for serious infections may be increased.Desirudin: Corticosteroids (Systemic) may enhance the anticoagulant effect of Desirudin.

103. The pharmacokinetics of a medication are how the drug is absorbed, distributed, metabolized, and eliminated. O’Morain C, Smethurst P, Dore CJ. Management: Consider avoiding Echinacea in patients receiving therapeutic immunosuppressants. Closely monitor patients for the development of signs and symptoms of infection during and after treatment with AZULFIDINE.

Levy N, Roisman I, Teodor I. Ulcerative colitis in pregnancy in Israel. Deaths associated with the administration of sulfasalazine have been reported from hypersensitivity reactions, agranulocytosis, aplastic anemia, other blood dyscrasias, renal and liver damage, irreversible neuromuscular and central nervous system changes, and fibrosing alveolitis.

Baiocco PJ, Korelitz BI. In vivo studies have indicated that the absolute bioavailability of orally administered SSZ is less than 15% for parent drug. Pregnancy in inflammatory bowel disease: effect of sulfasalazine and corticosteroids on fetal outcome. 167.

Sack DM, Peppercorn MA. PredniSONE may increase the serum concentration of CycloSPORINE (Systemic).CYP3A4 Inducers (Strong): May decrease the serum concentration of PredniSONE.CYP3A4 Inhibitors (Strong): May increase the serum concentration of PredniSONE.Deferasirox: Corticosteroids (Systemic) may enhance the adverse/toxic effect of Deferasirox. Patients should be instructed to take AZULFIDINE in evenly divided doses preferably after meals. Consult drug interactions database for more detailed information.• Elderly: Use with caution in elderly patients with the smallest possible effective dose for the shortest duration.• Pediatric: May affect growth velocity; growth and development should be routinely monitored in pediatric patients.• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. Gómez-Reino JJ.