Sulfasalazine

Sulfasalazine (Azulfidine®) is used in the induction and maintenance of remission of mild to moderate inflammatory bowel disease.  Sulfasalazine is a 5-aminosalicylic acid conjugated to a sulfapyridine. Sulfapyridine is thought to be responsible for the drug's adverse side effects, which include nausea, vomiting and hepatitis (Connell and Miller, 1999 and Connell and   Sandborn 1999).  (CONTINUE)

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Volume 10, Issue 2

Aminosalicylates

ITIS

Corticosteroids

Corticosteroids are frequently used in the treatment of Crohn's disease, with prednisolone    being the most common choice.  Prednisolone in doses of 40mg or more resulted in an overall remission in 67% of patients whereas doses of 60mg yielded remission in 83% of patients.  This medication, however, can aggravate pregnancy complications, such as glucose              intolerance, hypertension, sodium retention and peripheral oedema.  Abrupt cessation of high dose, or prolonged use of prednisolone may induce maternal adrenal insufficiency and         supplemental treatment may be needed during labor (Connell and Miller, 1999). 

In humans, the concentration of prednisolone in the fetus has been found to be approximately 10% of that in maternal circulation.  This is comparatively different from other corticosteroids; for example, dexamethasone crosses the placenta freely and is used in the treatment of        congenital adrenal hyperplasia.  This small amount of prednisolone is unlikely to cause fetal adrenal suppression (Connell and Miller, 1999).  However, there are case reports of neonatal adrenal insufficiency. Thus, it is recommended that prednisolone be used with caution in    pregnancy. 

The Motherisk Teratogen Information Service documented a slight increased risk of cleft     palate in association with prednisolone (Park-Wyllie L, et al., 2000).  In most studies,         prednisolone was not found to be associated with an increase in congenital anomalies (Reprotox #1359).  However, early studies found that it may be associated with fetal growth retardation, stillbirth, placental insufficiency, reduced neonatal birth weight and fetal distress. It is unclear if these complications are due to the medication or to the underlying condition, and subsequent studies have not confirmed these findings  (Connell and Miller, 1999 and Illinois Teratogen Information Service, 2000).  The Crohn's and Colitis Foundation of America has stated that prednisolone is appropriate to use as treatment in pregnant women (Connell and Sandborn, 1999).