Pendahuluan Sulfasalazine

Oleh :

dr.Eveline Yuniarti

Sulfasalazine merupakan obat antiinflamasi yang digunakan dalam penanganan kolitis ulseratif dan rheumatoid arthritis. Sulfasalazine juga digunakan secara off label pada penyakit Crohn. Sulfasalazine adalah pro-drug golongan disease modifying drug (DMARD), dengan kandungan aminosalisilat, yang bermanfaat mengendalikan respon inflamasi.[1-3]

Sulfasalazine bekerja dengan menghambat berbagai molekul inflamasi. Penelitian telah menemukan bahwa sulfasalazine dan metabolitnya, mesalazine dan sulfapyridine, dapat menghambat leukotrien dan prostaglandin dengan menghalangi jalur siklooksigenase dan lipoksigenase.[1,2]

Peringatan yang diperlukan pada penggunaan sulfasalazine adalah adanya laporan kematian terkait dengan agranulositosis, anemia aplastik, atau diskrasia darah lain. Manifestasi klinis seperti sakit tenggorokan, demam, pucat, purpura, atau ikterus mengindikasikan myelosupresi, hemolisis, atau hepatotoksisitas.[1]

Di Indonesia, sulfasalazine beredar dalam merek dagang Sulcolon®, Lazafin®, dan Sulfitis®.[5]

Tabel 1. Deskripsi Singkat Sulfasalazine

Perihal	Deskripsi
Kelas	Obat untuk saluran cerna[4]
Subkelas	Obat untuk antiinflamasi[4]
Akses	Resep[4]
Wanita hamil	Kategori FDA: B[1] Kategori TGA: A[6]
Wanita menyusui	Dikeluarkan ke ASI[1]
Anak-anak	Efikasi dan keamanan pada anak berusia di bawah 2 tahun belum diketahui[1]
Infant
FDA	Approved[1]

Referensi

1. American Society of Health-System Pharmacists. Sulfasalazine. Drugs.com, 2022. https://www.drugs.com/monograph/sulfasalazine.html
2. Mushtaq S, Sarkar R. Sulfasalazine in dermatology: A lesser explored drug with broad therapeutic potential. Int J Womens Dermatol 2020;6:191–8. https://doi.org/10.1016/j.ijwd.2020.01.009.
3. Yasukochi S, Kusunose N, Matsunaga N, Koyanagi S, Ohdo S. Sulfasalazine alleviates neuropathic pain hypersensitivity in mice through inhibition of SGK-1 in the spinal cord. Biochem Pharmacol 2021;185. https://doi.org/10.1016/j.bcp.2021.114411.
4. Kementerian Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/813/2019 tentang Formularium Nasional. 2020.
5. BPOM. Cek BPOM. 2023. https://cekbpom.pom.go.id/search_home_produk
6. TGA. Prescribing medicine in pregnancy database. 2023. https://www.tga.gov.au/products/medicines/find-information-about-medicine/prescribing-medicines-pregnancy-database
7. Stamatiades GA, Echouffo-Tcheugui JB, Garber JR. Sulfasalazine-Induced Hypoglycemia in a Patient with Type 2 Diabetes and End-Stage Renal Disease. AACE Clin Case Rep 2018;4:e493–6. https://doi.org/10.4158/ACCR-2018-0067.
8. Forcato S, de Oliveira Aquino AB, de Moura Camparoto N, Lens HHM, Guarnier FA, Kiss ACI, et al. Sulfasalazine exposure during pregnancy and lactation induces alterations in reproductive behavior in adult female rat offspring. Life Sci 2022;293.
9. Brownfoot FC, Hastie R, Hannan NJ, Cannon P, Nguyen T V., Tuohey L, et al. Combining metformin and sulfasalazine additively reduces the secretion of antiangiogenic factors from the placenta: Implications for the treatment of preeclampsia: Treating preeclampsia with combination metformin and sulfasalazine. Placenta 2020;95:78–83. https://doi.org/10.1016/j.placenta.2020.04.010.
10. Binder NK, Brownfoot FC, Beard S, Cannon P, Nguyen T V., Tong S, et al. Esomeprazole and sulfasalazine in combination additively reduce sFlt-1 secretion and diminish endothelial dysfunction: potential for a combination treatment for preeclampsia. Pregnancy Hypertens 2020;22:86–92. https://doi.org/10.1016/j.preghy.2020.07.013.
11. Yousefi‐Ahmadipour A, Ebrahimi‐Barough S, Niknia S, Allahverdi A, Mirzahosseini-pourranjbar A, Tashakori M, et al. Therapeutic effects of combination of platelet lysate and sulfasalazine administration in TNBS-induced colitis in rat. Biomedicine and Pharmacotherapy 2020;125. https://doi.org/10.1016/j.biopha.2020.109949.
12. Negi M, Baek HJ, Park DW, So R, Kwon JE, Jeon H, et al. Elaeocarpus sylvestris extract (ESE) inhibits inflammatory mediators and increases the efficacy of sulfasalazine in rheumatoid arthritis. Phytomedicine Plus 2022;2. https://doi.org/10.1016/j.phyplu.2021.100207.
13. Nunokawa T, Chinen N, Shimada K, Kimura M, Tateishi M, Chen FY, et al. Efficacy of sulfasalazine for the prevention of Pneumocystis pneumonia in patients with rheumatoid arthritis: A multicentric self-controlled case series study. Journal of Infection and Chemotherapy 2023;29:193–7.
14. Finelli R, Finocchi F, Leisegang K, Damiani G. The Impact Of Sulphasalazine-Based Treat-Ment On Semen Quality In Patients With In-Flammatory Bowel Disease, ASRM Abstracts; 2021.
15. Durando M, Tiu H, Kim JS. Sulfasalazine-Induced Crystalluria Causing Severe Acute Kidney Injury. American Journal of Kidney Diseases 2017;70:869–73. https://doi.org/10.1053/j.ajkd.2017.05.013.
16. Cao Y, Khan A, Soltani A, Erfani-Moghadam V, Lup ANK, Aghaei M, et al. Spectroscopic, density functional theory, cytotoxicity and antioxidant activities of sulfasalazine and naproxen drugs combination. Arabian Journal of Chemistry 2021;14. https://doi.org/10.1016/j.arabjc.2021.103190.
17. Brownfoot FC, Hannan NJ, Cannon P, Nguyen V, Hastie R, Parry LJ, et al. Sulfasalazine reduces placental secretion of antiangiogenic factors, up-regulates the secretion of placental growth factor and rescues endothelial dysfunction. EBioMedicine 2019;41:636–48. https://doi.org/10.1016/j.ebiom.2019.02.013.
18. National Center for Biotechnology Information. PubChem Compound Summary for CID 5339, Sulfasalazine. https://pubchem.ncbi.nlm.nih.gov/compound/Sulfasalazine. Accessed May 11, 2023.
19. Nadarajan P, Fabre A, Kelly E. Sulfasalazine: A rare cause of acute eosinophilic pneumonia. Respir Med Case Rep 2016;18:35–6. https://doi.org/10.1016/j.rmcr.2016.03.006.

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