by Other (see comment). Avoid or Use Alternate Drug. Comment: Myelosuppressive agents can produce additive myelosuppression. Avoid use and monitor patients receiving the combination for effects of excessive myelosuppression.rose hipsMinor (3)rose hips will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. sulfasalazine decreases levels of rose hips by increasing renal clearance. Minor/Significance Unknown. rose hips increases levels of sulfasalazine by decreasing renal clearance. Minor/Significance Unknown.sacubitril/valsartanMonitor Closely (3)sacubitril/valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. sulfasalazine decreases effects of sacubitril/valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. sacubitril/valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.safinamideMonitor Closely (1)safinamide will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Safinamide and its major metabolite may inhibit intestinal BCRP. Monitor BCRP substrates for increased pharmacologic or adverse effects.salicylates (non-asa)Monitor Closely (2)salicylates (non-asa) and sulfasalazine both increase anticoagulation. Use Caution/Monitor. salicylates (non-asa) and sulfasalazine both increase serum potassium. Use Caution/Monitor.Minor (1)salicylates (non-asa) will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.salmeterolMonitor Closely (1)sulfasalazine increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.salsalateMonitor Closely (2)salsalate and sulfasalazine both increase anticoagulation. Use Caution/Monitor. salsalate and sulfasalazine both increase serum potassium. Use Caution/Monitor.Minor (1)salsalate will increase the level or effect of sulfasalazine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.sertralineMonitor Closely (1)sertraline, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.Siberian ginsengMonitor Closely (1)sulfasalazine and Siberian ginseng both increase anticoagulation. Use Caution/Monitor.silodosinMonitor Closely (1)sulfasalazine decreases effects of silodosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.sodium bicarbonateMinor (1)sodium bicarbonate, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).sodium citrate/citric acidMinor (1)sodium citrate/citric acid, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).sodium picosulfate/magnesium oxide/anhydrous citric acidMonitor Closely (1)sulfasalazine, sodium picosulfate/magnesium oxide/anhydrous citric acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May be associated with fluid and electrolyte imbalances.sofosbuvir/velpatasvirMonitor Closely (1)sofosbuvir/velpatasvir will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Velpatasvir is an inhibitor of the drug transporter BCRP. Coadministration may increase systemic exposure of drugs that are BCRP substrates.sotalolMonitor Closely (2)sulfasalazine decreases effects of sotalol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. sotalol and sulfasalazine both increase serum potassium. Use Caution/Monitor.spironolactoneMonitor Closely (1)spironolactone and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.stiripentolMonitor Closely (1)stiripentol will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Stiripentol is a BCRP transport inhibitor. Consider dosage reduction for BCRP substrates if adverse effects are experienced when coadministered.streptomycinMinor (1)sulfasalazine increases levels of streptomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.succinylcholineMonitor Closely (1)sulfasalazine and succinylcholine both increase serum potassium. Use Caution/Monitor.sulfadiazineMinor (1)sulfasalazine increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown.sulfamethoxazoleMinor (1)sulfasalazine increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulfisoxazoleMinor (1)sulfasalazine increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown.sulindacMonitor Closely (2)sulfasalazine and sulindac both increase anticoagulation. Use Caution/Monitor. sulfasalazine and sulindac both increase serum potassium. Use Caution/Monitor.Minor (1)sulfasalazine will increase the level or effect of sulindac by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.tafamidisMonitor Closely (1)tafamidis will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.tafamidis meglumineMonitor Closely (1)tafamidis meglumine will increase the level or effect of sulfasalazine by Other (see comment). Use Caution/Monitor. Tafamidis inhibits breast cancer resistant protein (BCRP) in vitro and may increase exposure of BCRP substrates following tafamidis or tafamidis meglumine administration. Dosage adjustment of these BCRP substrates may be necessary.telmisartanMonitor Closely (3)telmisartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. sulfasalazine decreases effects of telmisartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. telmisartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.temocillinMonitor Closely (2)temocillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. temocillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.teniposideMinor (1)sulfasalazine increases levels of teniposide by unspecified interaction mechanism. Minor/Significance Unknown.terazosinMonitor Closely (1)sulfasalazine decreases effects of terazosin by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis.terbutalineMonitor Closely (1)sulfasalazine increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.ticarcillinMonitor Closely (2)ticarcillin, sulfasalazine. Either increases levels of the other by plasma protein binding competition. Use Caution/Monitor. ticarcillin, sulfasalazine. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.timololMonitor Closely (2)sulfasalazine decreases effects of timolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis. timolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.tisagenlecleucelSerious - Use Alternative (2)sulfasalazine, tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. tisagenlecleucel, sulfasalazine. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.tobramycinMinor (1)sulfasalazine increases levels of tobramycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in preterm infants.tobramycin inhaledMonitor Closely (1)tobramycin inhaled and sulfasalazine both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicitytolazamideMonitor Closely (1)sulfasalazine increases effects of tolazamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)sulfasalazine increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.tolbutamideMonitor Closely (1)sulfasalazine increases effects of tolbutamide by unknown mechanism. Use Caution/Monitor. Risk of hypoglycemia.Minor (1)sulfasalazine increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.tolfenamic acidMonitor Closely (2)sulfasalazine and tolfenamic acid both increase anticoagulation. Use Caution/Monitor. sulfasalazine and tolfenamic acid both increase serum potassium. Use Caution/Monitor.Minor (1)sulfasalazine will increase the level or effect of tolfenamic acid by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.tolmetinMonitor Closely (2)sulfasalazine and tolmetin both increase anticoagulation. Use Caution/Monitor. sulfasalazine and tolmetin both increase serum potassium. Use Caution/Monitor.Minor (1)sulfasalazine will increase the level or effect of tolmetin by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.tolvaptanMonitor Closely (1)sulfasalazine and tolvaptan both increase serum potassium. Use Caution/Monitor.torsemideMonitor Closely (1)sulfasalazine increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.trandolaprilMinor (1)sulfasalazine decreases effects of trandolapril by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis.trazodoneMonitor Closely (1)trazodone, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.triamcinolone acetonide injectable suspensionMonitor Closely (1)sulfasalazine, triamcinolone acetonide injectable suspension. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of GI ulceration.Minor (1)triamcinolone acetonide injectable suspension decreases levels of sulfasalazine by increasing renal clearance. Minor/Significance Unknown.triamtereneMonitor Closely (1)triamterene and sulfasalazine both increase serum potassium. Modify Therapy/Monitor Closely.Minor (2)triamterene, sulfasalazine. Other (see comment). Minor/Significance Unknown. Comment: Risk of acute renal failure. Mechanism: NSAIDs decrease prostaglandin synthesis, which normally protect against nephrotoxicity. sulfasalazine increases toxicity of triamterene by pharmacodynamic antagonism. Minor/Significance Unknown. NSAIDs decrease prostaglandin synthesis, increasing the risk of nephrotoxicity.valganciclovirMinor (1)sulfasalazine will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.valoctocogene roxaparvovecMonitor Closely (1)sulfasalazine and valoctocogene roxaparvovec both increase Other (see comment). Use Caution/Monitor. Medications that may cause hepatotoxicity when combined with valoctogene roxaparvovec may potentiate the risk of elevated liver enzymes. Closely monitor these medications and consider alternative medications in case of potential drug interactions.valsartanMonitor Closely (3)valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. sulfasalazine decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect. valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.vancomycinMinor (1)sulfasalazine increases levels of vancomycin by decreasing renal clearance. Minor/Significance Unknown. Interaction mainly occurs in neonates.varicella virus vaccine liveSerious - Use Alternative (1)sulfasalazine, varicella virus vaccine live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.venlafaxineMonitor Closely (1)venlafaxine, sulfasalazine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of upper GI bleeding. SSRIs inhib. serotonin uptake by platelets.verapamilMinor (1)verapamil increases effects of sulfasalazine by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.vitamin K1 (phytonadione)Monitor Closely (1)sulfasalazine increases and vitamin K1 (phytonadione) decreases anticoagulation. Effect of interaction is not clear, use caution. Use Caution/Monitor.voclosporinMonitor Closely (1)voclosporin, sulfasalazine. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.warfarinMonitor Closely (1)sulfasalazine increases effects of warfarin by anticoagulation. Use Caution/Monitor.willow barkMinor (2)sulfasalazine will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. willow bark increases effects of sulfasalazine by pharmacodynamic synergism. Minor/Significance Unknown. Willow bark contains salicylic acid, which may have additive effects/toxicity with salicylate drugs.zavegepant intranasalSerious - Use Alternative (1)sulfasalazine will increase the level or effect of zavegepant intranasal by Other (see comment). Avoid or Use Alternate Drug. NTCP inhibitors may result in a significant increase in systemic exposure of zavegepant (a NTCP substrate).zotepineMonitor Closely (1)sulfasalazine decreases effects of zotepine by pharmacodynamic antagonism. Use Caution/Monitor. NSAIDs decrease prostaglandin synthesis. >10% Anorexia (~33%) Headache (~33%) Nausea (~33%) Vomiting (~33%) Gastric distress (~33%) Apparently reversible oligospermia (~33%) <1% Skin rash Pruritus Urticaria Fever Heinz body anemia Hemolytic anemia Cyanosis Postmarketing Reports Blood dyscrasias: Pseudomononucleosis Cardiac disorders: Myocarditis Hepatobiliary disorders: reports of hepatotoxicity, including elevated liver function tests (SGOT/AST, SGPT/ALT, GGT, LDH, alkaline phosphatase, bilirubin), jaundice, cholestatic jaundice, cirrhosis, hepatitis cholestatic, cholestasis and possible hepatocellular damage including liver necrosis and liver failure; some of these cases were fatal; 1 case of Kawasaki-like syndrome Immune system disorders: Anaphylaxis Metabolism and nutrition system disorders: Folate deficiency Renal and urinary disorders: Nephrolithiasis Respiratory, thoracic and mediastinal disorders: Oropharyngeal pain Skin and subcutaneous tissue disorders: Angioedema, purpura Vascular disorders: Pallor Hypersensitivity reactions: Erythema multiforme, epidermal necrolysis (SJS/TEN) with corneal damage, exfoliative dermatitis, DRESS, serum sickness syndrome, interstitial lung disease, pneumonitis with or without eosinophilia, vasculitis, fibrosing alveolitis, pleurisy/pleuritis, pericarditis with or without tamponade, allergic myocarditis, polyarteritis nodosa, lupus erythematosus-like syndrome, hepatic necrosis with or without immune complexes, fulminant hepatitis, sometimes leading to liver transplantation, parapsoriasis varioliformis acuta (Mucha-Haberman syndrome), rhabdomyolysis, photosensitization, arthralgia, periorbital edema, conjunctival and scleral injection, and alopecia Contraindications Hypersensitivity to sulfasalazine or its metabolites, to sulfonamides, or to salicylates Intestinal or urinary tract obstruction Porphyria Cautions Serious skin reactions, some of them fatal, including exfoliative dermatitis, Stevens-Johnson syndrome, acute generalized exanthematous pustulosis, and toxic epidermal necrolysis; discontinue at first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity Severe hypersensitivity reported; may include internal organ involvement, such as hepatitis, nephritis, myocarditis, mononucleosis-like syndrome (ie, pseudomononucleosis), hematological abnormalities (including hematophagic histiocytosis), and/or pneumonitis including eosinophilic infiltration; if signs or symptoms are present, the patient should be evaluated immediately; Sulfasalazine drug should be discontinued if an alternative etiology for signs or symptoms cannot be established Administer tablets with caution to patients with severe allergy or bronchial asthma; adequate fluid intake must be maintained in order to prevent crystalluria and stone formation; patients with glucose-6 phosphate dehydrogenase deficiency should be observed closely for signs of hemolytic anemia; reaction is frequently dose-related; if toxic or hypersensitivity reactions occur, the drug should be discontinued