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Crohn’s Disease, Folate and Sulfasalzine

January 31, 2013

Digestive SystemAn inflammatory bowel disorder, Crohn’s disease causes abdominal cramping and diarrhea and, in more severe cases, malnutrition, narrowing of the digestive tract, ulcers and fistulas. No cure exists for Crohn’s disease, but several types of medications, including antibiotics, can control the symptoms. Doctors commonly prescribe the antibiotic sulfasalazine to treat Crohn’s disease, but as with any medication, both positive and negative effects can occur.

Folate Deficiency

Patients with Crohn’s disease have a high risk for malnutrition and vitamin deficiency because their digestive systems process food so inefficiently. Compared to a healthy digestive tract, the digestive tract of a patient with Crohn’s disease absorbs less nutrients from the same food intake. In particular, the absorption of folate is a problem, because the body relies on a constant influx of dietary folate to replenish the supply needed to make enough red blood cells.

Medline Plus lists Crohn’s disease as a risk factor for folate-deficient anemia, a condition in which the body has too few red blood cells. Treatment of Crohn’s disease with sulfasalzine exacerbates the problem because it interferes with the ability of the intestines to absorb folate. Medline Plus lists the use of sulfasalazine as an independent risk factor for developing folate-deficiency anemia. The Merck Manual says sulfasalazine can trigger folate deficiency, especially in patients who do not make it a point to get enough folate in their diets. Symptoms of folate-deficiency anemia include constant fatigue, headache, pale skin and sore mouth and tongue.

Allergic Reaction

The National Institute of Diabetes and Digestive and Kidney Disorders says that most doctors prescribe anti-inflammatory drugs containing mesalamine for the initial treatment of their patients with Crohn’s disease. Sulfasalazine is the most commonly prescribed member of this group. However, sulfasalazine is a sulfonamide, or sulfa drug, and a derivative of a chemical called 5-aminosalicylic acid, a salicylate. Anyone with an allergy to sulfa drugs or salicylates cannot take sulfasalazine because of the risk of a potentially life-threatening allergic reaction.

Symptoms of an allergic reaction include a skin rash, hives and wheezing; in more serious cases, the patient shows signs of anaphylactic shock, including a sharp decrease in blood pressure and dangerous swelling in the airways. In addition, the Merck Manual says that sulfasalzine is closely related to other classes of drugs, including sulfonylureas, carbonic anhydrase inhibitors and some diuretics. Anyone with allergies to those medications should also not take sulfasalazine.

Stomach, Head and Reproductive Problems

Like other antibiotics, sulfasalazine can upset the stomach, causing abdominal pain, nausea, vomiting and diarrhea. According to the Merck Manual, other common side effects that occur in more than 10 percent of patients who take sulfasalazine include headache and a rash. More than 10 percent of men develop temporary oligospermia, or low sperm count, that recovers when they stop taking sulfasalazine.


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