What are the Different Sulfasalazine Side Effects?

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  • Written By: Maggie J. Hall
  • Edited By: Jenn Walker
  • Last Modified Date: 29 September 2019
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Sulfasalazine, also known as Azulfidine® or Salazopyrin, produces a wide range of side effects, which correlate with the medication’s antibacterial, anti-inflammatory and immunosuppressive properties. Side effects might also be created or enhanced by interactions with certain medications. Some side effects include discolored urine, nausea, an increased likelihood of developing blood disorders, meningitis and hallucinations. Commonly used to treat rheumatoid arthritis and ulcerative colitis, sulfasalazine side effects also include adverse reactions, such as skin reactions, asthma and liver complications, in persons having certain medication sensitivities or preexisting medical conditions.

One of the common and harmless sulfasalazine side effects involves orange-yellowish colored urine; this side effect also may extend to skin discoloration. As with many antibiotics, people who take the medication typically experience abdominal discomfort, nausea, vomiting and diarrhea. Bowel inflammation and rectal bleeding may occur as well. Many individuals also endure anorexia, headaches, oxidized hemoglobin and reduced sperm counts. Some gastric symptoms may be minimized by using enteric-coated tablets. Persons also may see the development of various types of skin rashes.


The anti-inflammatory properties of the medication improve bowel inflammation for those with colitis, but along with immunosuppressive activity, might mask signs of a developing infection until persons experience a sore throat or fever. The immunosuppressive action of the medication might interfere with the chemicals, enzymes and cellular activity that produce natural immune responses. Sulfasalazine side effects in this area may include bone marrow suppression, affecting red and white blood cells and potentially causing numerous types of blood disorders that result in anemia.

Higher concentrations of the medication are typically found in areas of the body containing clear fluid and connective tissue. Elevated concentrations also generally accumulate in the liver and the intestinal tract. Sulfasalazine side effects appearing from central nervous system involvement may include drowsiness, insomnia or depression, convulsions, hallucinations and meningitis. Nervous tissue involvement may produce inflammation and pain along with hearing disturbances, hearing loss or lack of physical coordination. Side effects occurring because of liver involvement include symptoms correlating with hepatitis, liver damage or liver failure.

There are more than 20 medications that may be contraindicated with sulfasalazine. Sulfasalazine typically reduces the absorption of folic acid and digoxin, resulting in anemia and an abnormal pulse. Persons having a sensitivity to sulfa drugs or aspirin may experience sulfasalazine side effects of varying severity in any of the body’s systems. These reactions include asthma and other lung disorders, skin reactions, heart and vascular anomalies and liver symptoms. Persons having various medical conditions may also experience an increased severity in symptoms. It is important to discuss any current medications or conditions with a physician before taking sulfasalazine.

The medication is typically not recommended for individuals with kidney or liver diseases. Sulfasalazine is also generally not used in patients having gastrointestinal or renal blockages, or in pregnant women because of possible birth defects. Persons having blood disorders or glucose-6-phosphate dehydrogenase deficiency, commonly referred to as G6PD, also experience exacerbated symptoms.


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