The safety of sulfasalazine: the gastroenterologists' experience.

Although the incidence of side effects associated with sulfasalazine is in the range of 20%, most of the common side effects, including gastrointestinal reactions and headache, can be managed by dosage adjustment. In patients who experience allergic reactions of rash, fever, and arthralgia, therapy can usually be resumed after a program of desensitization. The risks associated with chronic low-grade hemolysis can be avoided by careful monitoring and, when necessary, folic acid supplementation. Certain idiosyncratic reactions to sulfasalazine do, however, represent absolute contraindications to further use of the drug. Sulfasalazine may cause reversible male infertility, but it is entirely safe for use during pregnancy and lactation. Overall, sulfasalazine has a long and impressive safety record, provided the drug is used with an awareness and appreciation of its potential pitfalls.