Shared Care Policy and Prescribing Information for General Practitioners
for Sulfasalazine (Adults only, non-renal patients)
Publish public / Applies to: NHS Grampian / Version 2 /
Coordinator / Authorised for issue by / Document no: NHSG/SCPa/Sulf/MGPG347
Medicines Information pharmacist / Medicines Guidelines
and Policies Group / Effective date:
August 2010
Signature:
I Mweemba / Signature:
C Hind / Review Date: August 2012
Supersedes: Version 1
Please keep this document in the patients notes

UNCONTROLLED WHEN PRINTEDReview Date August 2012 (sooner if recommendations change)NHSG/SCPa/Sulf/MGPG347- 1 -

SCP and Prescribing Information for GPs for MYCOPHENOLATE MOFETIL – Version 2, August 2010

Shared Care Policy and Prescribing Information for General Practitioners
for Sulfasalazine (Adults only, non-renal patients)
PATIENT NAME 
UNIT NUMBER
CHI NUMBER
ADDRESS
DATE OF BIRTH
 Insert patient sticker here  / HOSPITAL
TELEPHONE NO
CONSULTANT (print name)
SIGNATURE / WARD
DATE
THERAPEUTIC INDICATION FOR THIS PATIENT: (to be completed by consultant)
DOSAGE/PREPARATION/ROUTE/FREQUENCY OF ADMINISTRATION:(to be completed by consultant)

UNCONTROLLED WHEN PRINTEDReview Date August 2012 (sooner if recommendations change)NHSG/SCPa/Sulf/MGPG347- 1 -

SCP and Prescribing Information for GPs for MYCOPHENOLATE MOFETIL – Version 2, August 2010

Shared Care Policy and Prescribing Information for General Practitioners
for Sulfasalazine (Adults only, non-renal patients)
SAFE PRACTICE IS THAT THE CLINICIAN WHO ORDERS THE TEST MUST ACT ON THE RESULT
CARE WHICH IS THE RESPONSIBILITY OF THE HOSPITAL CONSULTANT
1.Baseline
Full blood count (FBC); urea,creatinineand electrolytes (U&E);liver function tests(LFTs).
2.Copy of results to be sent to GP.
3.Initiation of therapy and recommendationsfor dose increments.
4.Decision on final dose required forpatient.
5.Monitoring clinical response totreatment.
6.Advise patient to report immediately anysigns or symptoms of bone marrow suppression, e.g. sore throat, fever, malaise, inexplicable bruising or bleeding. / CARE WHICH IS THE RESPONSIBILITY OF
THE GENERAL PRACTITIONER(GP)
1.Prescribing of medication under guidance of consultant.
2.Check before prescribing medication that the monitoring is up to date and that results are within the normal range.
3.The GP should be aware that the drug can cause blood dyscrasias, rashes.
4.Patients should be asked about the presence of sore throat, rash, fever, abnormal bruising or bleeding at each visit.
When the patient has an intercurrent illness a FBC, U&E and LFTs should be done and any abnormal results including those noted above should be reported to the consultant.
5.The General Practitioner has primary responsibility for monitoring therapy according to the schedule below:
FBC and LFTs (incl. ALT and Alk Phos) monthly for three months. If dose and results stable, three monthly thereafter.
Repeat bloods after one month of dose increase.
If during the first year of treatment blood results have been stable then six monthly tests will suffice.
Monitoring can be discontinued after two years of therapy. To be confirmed by consultant.
When writing laboratory request forms always include details of the patient’s medication
NOTE: in addition to absolute values for haematological indices a rapid fall or a consistent downward trend inany value should prompt caution and extra vigilance.
If something unexpected occurs contact consultant.
Notify the consultant if the drug is stopped.

UNCONTROLLED WHEN PRINTEDReview Date August 2012 (sooner if recommendations change)NHSG/SCPa/Sulf/MGPG347- 1 -

SCP and Prescribing Information for GPs for MYCOPHENOLATE MOFETIL – Version 2, August 2010

Shared Care Policy and Prescribing Information for General Practitioners
for Sulfasalazine (Adults only, non-renal patients)
Abnormal Monitoring Result / Action To Be Taken
WBC <4.0 x109/L / Withhold until discussed with consultant
Neutrophils <2.0 x109/L / Withhold until discussed with consultant
Platelets <150x109/L / Withhold until discussed with consultant
2-fold rise in ALT or Alk Phos
(from upper limit of reference range) / Withhold until discussed with consultant
MCV>105fl / Investigate and if B12 or folate low start appropriate supplementation
Abnormal bruising or severe sore throat / Withhold until FBC result available
Acute wide spread rash or oral ulceration / Withhold until discussed with consultant
Nausea, dizziness, headache / Continue if possible, may have to reduce dose or stop if severe
Discolouration of urine / Reassure and continue treatment
For specific product information please consult the current summary of product characteristics ( and the BNF (
Other information
  • The enteric coated formulation is the only preparation of sulfasalazine licensed for rheumatoid arthritis and is better tolerated than uncoated tablets.
  • Some types of soft contact lenses may be stained in patients taking sulfasalazine.
  • There are a number of drug interactions that must be considered. When a new drug is prescribed please refer to Summary of Product Characteristics, BNF or contact Medicines Information.
    Some important interactions to consider include the following:
Concomitant administration of sulfasalazine with digoxin or folic acid may reduce their absorption.
Sulfasalazine may increase risk of leucopenia when given with azathioprine.
Pregnancy
Discuss with consultant. Theoretical risk of neonatal haemolysis, see SPC/BNF.
Breast-feeding
Discuss with AberdeenMaternityHospital. Small amounts in milk. Theoretical risk of neonatal haemolysis - see SPC/BNF.
Responsibilities of GPs undertaking monitoring
A GP agreeing to monitor sulfasalazine should:
  • Ensure that the relevant monitoring requirements are undertaken at the correct frequency.
  • Ensure that the test results are checked for any abnormality as soon as the results are available.
  • Ensure abnormal results are acted upon.
  • Only continue to prescribe sulfasalazine if it is being satisfactorily monitored.
  • Contact the consultant in the event of a drug reaction or monitoring abnormality or anything you are unhappy about.
  • Be alert for any of the known adverse reactions.
** The patient should be encouraged to ensure blood tests are taken at the correct intervals.**

UNCONTROLLED WHEN PRINTEDReview Date August 2012 (sooner if recommendations change)NHSG/SCPa/Sulf/MGPG347- 1 -

SCP and Prescribing Information for GPs for MYCOPHENOLATE MOFETIL – Version 2, August 2010