Maximum safe daily dose of sulfasalazine

Hi guys and gals,

I'm new to this site. This is my first post, but I've read many of your posts here over the years. As is probably typical for new members, I finally joined because of increasing problems...

So, first, some history: I've have UC since 1992. Luckily it's never been particularly bad - mainly just a nuisance. I've also been fortunate that low doses of sulfasalazine has kept the UC in check since then. For many years I was only taking 500 mg once daily. And every year or so during that time I would try to stop taking it entirely, but my UC symptoms would invariably return after a month or two. And then upping the sulfasalazine and adding Rowasa enemas at night for a month would return me to normal fairly quickly.

Since 2006 however, flare-ups have been harder to control. I've had to remain on increasingly higher doses of sulfasalazine: first 1 gm daily, then 2 gm, then 3 gm. Most recently, I was on 3 gm daily for 8 months, and then had another flare-up. Going to 4 gm daily, along with 6 weeks of nightly Rowasa enemas brought it under control. So, I stopped the Rowasa, and have been on 4 gm sulfasalazine daily alone for the past 6 weeks. But it feels like my symptoms are slowly returning yet again.

Now, my gastro doc was reluctant to even put me on 4 gm daily - ideally he wants me to be on only 3 gm max. If I can't soon return to 3 gm daily, he wants to switch me to either Asacol or generic Colazal, which supposedly have less side effects and so can be taken in higher doses.

The problem is, I've never had any side effects from sulfasalazine all this time, even at 4 gm daily. Also, Asacol is about 12x more expensive and generic Colazal about 7x more expensive then generic sulfasalazine.

Does anyone here have any experience with doses of sulfasalazine higher than 4 gm daily?

John.

Well, I take 4 500MG tablets per day, and have taken as much as 8 per day during bad flares.  Only problem with taking high doses could be headache and increased sensitivity to sun.

But, I'm becoming pretty concerned with crystalization in my urinary system - i.e. build-up.  This has been brought to my attention by several medical pros.  The key, I suppose, is to drink a lot of water.

Are you taking time-released (ET's) or the standard gritty round tabs, which disolve in your stomach?

- To Test Flyer:
Funny you should mention the enteric coated sulfasalazine. I assume this means the same thing as delayed release? I've wondered what type I was taking several times over the years: sometimes my insurance receipt said "enteric coated" and sometimes not. My GI doc's script always specified just "azulfidine". And in fact, the pill I took always looked the same: round, orange, with "G500" on one side, and what looks like a finger nail-like crease on the other. The pill is smooth, but I guess I would call it gritty too: it's easily broken and when it is, it leaves orange "grit" behind.

Does the enteric coated sulfasalazine look much different from the regular sulfasalazine?

My understanding was that the enteric coated tablet is designed for people who have stomach problems caused by the regular sulfasalazine. Since I never had problems, I didn't think it mattered which I took, and my doc probably thought the same. But maybe the enteric coated type allows you to take higher doses?

- To the other repliers:
I'm not poor, and I have insurance (thank heavens!), but I just don't want to throw money away if I don't have to.
But perhaps it is indeed time to try a different treatment, since my UC just does not seem to respond to sulfasalazine well any more.