Side effects
Use of sulfasalazine is contraindicated in people with sulfa allergies and in those with urinary tract obstructions, intestinal obstructions, and severe liver or kidney problems.Sulfasalazine metabolizes to sulfapyridine. Serum levels should be monitored every three months, and more frequently at the outset. Serum levels above 50 μg/L are associated with side effects. In rare cases, sulfasalazine can cause severe depression in young males. It can also cause oligospermia and temporary infertility. Immune thrombocytopenia has been reported.Sulfasalazine inhibits dihydropteroate synthase, and can cause folate deficiency and megaloblastic anemia. and various other undesirable effects.Sulfasalazine can cause hemolytic anemia in people with G6PD deficiency.Sulfasalazine can cause kidney stones. Sulfasalazine may cause stomach upset, nausea, vomiting, loss of appetite, headache, dizziness, or unusual tiredness. Skin and urine can become orange, with occasional allergic reactions.Sulfasalazine may cause sulfhemoglobinemia. Pharmacology
Around 90% of a dose of sulfasalazine reaches the colon, where most of it is metabolized by bacteria into sulfapyridine and mesalazine (also known as 5-aminosalicylic acid or 5-ASA). Both metabolites are active; most of the sulfapyridine is absorbed and then further metabolized, but most mesalazine is not, and remains in the colon.A mix of unchanged, hydroxylated, and glucuronidated sulfapyridine is eliminated in urine, as is acetylated mesalazine and unmetabolized sulfasalazine.The mechanism of action is not clear, but it appears that sulfasalazine and its metabolites have immunosuppressive, antibacterial, and anti-inflammatory effects. It also appears to inhibit the cystine-glutamate antiporter. Chemistry
It is a codrug which is a combination of sulfapyridine and 5-aminosalicylic acid coupled with an azo linkage.
Withdrawal symptoms include chest pain and other heart problems. These symptoms may be relieved with re-exposure to nitroglycerin or other suitable organic nitrates.For workers in nitroglycerin (NTG) manufacturing facilities, the effects of withdrawal sometimes include "Sunday heart attacks" in those experiencing regular nitroglycerin exposure in the workplace, leading to the development of tolerance for the venodilating effects. Over the weekend, the workers lose the tolerance, and when they are re-exposed on Monday, the drastic vasodilation produces a fast heart rate, dizziness, and a headache. This is referred to as "Monday disease. "People can be exposed to nitroglycerin in the workplace by breathing it in, skin absorption, swallowing it, or eye contact. The Occupational Safety and Health Administration  has set the legal limit (permissible exposure limit) for nitroglycerin exposure in the workplace as 0.2 ppm (2 mg/m3) skin exposure over an 8-hour workday. The National Institute for Occupational Safety and Health  has set a recommended exposure limit  of 0.1 mg/m3 skin exposure over an 8-hour workday. At levels of 75 mg/m3, nitroglycerin is immediately dangerous to life and health. See also
References
External links
"Nitroglycerine! Terrible Explosion and Loss of Lives in San Francisco". Central Pacific Railroad Photographic History Museum. Retrieved 23 March 2005. – 1866 Newspaper article
WebBook page for C3H5N3O9
CDC - NIOSH Pocket Guide to Chemical Hazards
The Tallini Tales of Destruction Detailed and horrific stories of the historical use of nitroglycerin-filled torpedoes to restart petroleum wells. Dynamite and TNT at The Periodic Table of Videos (University of Nottingham)