Shared Care Policy and Prescribing Information for General Practitioners for
SULFASALAZINE (Adults only, non-renal patients)
Please keep this document in the patient's notes
PATIENT NAME
UNIT NUMBER
CHI NUMBER

WARD
TELEPHONE NO
CONSULTANT (print name)
ADDRESS
DATE OF BIRTH

Insert
HOSPITAL

patient sticker here
THERAPEUTIC INDICATION FOR THIS PATIENT:
DATE
SIGNATURE
(to be completed by consultant)
DOSAGE/PREPARATION/ROUTE/FREQUENCY OF ADMINISTRATION: (to be completed by consultant)
SAFE PRACTICE IS THAT THE CLINICIAN WHO ORDERS THE TEST MUST ACT ON THE RESULT
CARE WHICH IS THE RESPONSIBILITY OF
THE HOSPITAL CONSULTANT
Baseline:
Full Blood Count (FBC), U&E and LFTs.
Initiation of therapy and recommendations for
dose increments. Decision on final dose
required.
Monitoring clinical response to treatment.
Patients should be advised to report
immediately if sore throat, fever, malaise,
inexplicable bruising or bleeding.
CARE WHICH IS THE RESPONSIBILITY OF THE
GENERAL PRACTITIONER
1. Prescribing of medication.
2. The General Practitioner should check before
prescribing medication that the monitoring is up to date
and that results are within the normal range.
3. The GP should be aware that the drug can cause blood
dyscrasias, rashes.
 Patients should be asked about the presence of sore
throat, rash, fever, abnormal bruising or bleeding at
each visit.
When the patient has an intercurrent illness a FBC, U&E
and LFTs should be done and any abnormal results
including those noted above should be reported to the
consultant.
4. The General Practitioner has primary responsibility for
monitoring therapy according to the schedule below
 FBC and LFTs (incl. ALT and Alk Phos) every 4
weeks for the first 6 months.
 FBC and LFTs (including ALT and Alk Phos) every 3
months for the next 6months.
 If during the first year of treatment blood results have
been stable then 6 monthly tests will suffice.
When writing laboratory request forms always include
details of the patient’s medication
NOTE: in addition to absolute values for haematological
indices a rapid fall or a consistent downward trend in any
value should prompt caution and extra vigilance.
If something unexpected occurs Contact Consultant.
Notify the consultant if the drug is stopped.
Version 1. April 2005, Review date: April 2007
Page 1 of 2
Shared Care Policy and Prescribing Information for General Practitioners for
SULFASALAZINE (Adults only, non-renal patients continued)
MONITORING: - Action to be taken if:

WBC <4.0x109/L

Neutrophils <2x109/L

Platelets <150x109/L

>2-fold rise in ALT or Alk Phos (from upper limit of reference range, note that Alk Phos can sometimes
rise as part of the rheumatoid process)
withhold until discussed with consultant

MCV>105fl



Rash or oral ulceration
Abnormal bruising or sore throat
Nausea, dizziness, headache

Discolouration of urine
investigate and if B12 or folate low start appropriate
supplementation
withhold until discussed with consultant
withhold until FBC result available
if possible continue, may have to reduce dose or stop if
symptoms severe.
reassure and continue treatment.
FOR SPECIFIC PRODUCT INFORMATION PLEASE CONSULT THE CURRENT SUMMARY OF
PRODUCT CHARACTERISTICS AND THE BNF
OTHER INFORMATION



The enteric coated formulation is the only preparation of sulfasalazine licensed for rheumatoid arthritis and
is better tolerated than uncoated tablets.
Some types of soft contact lenses may be stained in patients taking sulfasalazine.
When considering prescribing a new drug please refer to Summary of Product Characteristics,
BNF.
PREGNANCY
Discuss with consultant. Theoretical risk of neonatal haemolysis, see SPC/BNF.
BREAST-FEEDING
Discuss with Aberdeen Maternity Hospital. Small amounts in milk. Theoretical risk of neonatal haemolysis –
see SPC.
RESPONSIBILITIES OF GPS UNDERTAKING MONITORING
A GP agreeing to monitor sulfasalazine should:
 Ensure that the relevant monitoring requirements are undertaken at the correct frequency,
 Ensure that the test results are checked for any abnormality as soon as the results are available,
 Ensure abnormal results are acted upon,
 Only continue to prescribe sulfasalazine if it is being satisfactorily monitored,
 Contact the consultant in the event of a drug reaction or monitoring abnormality or anything you are
unhappy about,
 Be alert for any of the known adverse reactions.
The patient should be encouraged to ensure blood tests are taken at the correct intervals.
Version 1. April 2005, Review date: April 2007
Page 2 of 2