If you have ulcerative colitis (UC), your doctor might suggest treatment with Azulfidine or Azulfidine EN-tabs.

Azulfidine and Azulfidine EN-tabs are medications prescribed to treat UC in adults and some children. Your doctor might have you take either drug by itself as treatment for mild or moderate UC. Or you might take one of them in combination with other medications for treating severe UC.

Azulfidine EN-tabs are also prescribed to treat the following conditions when other medications have not worked to reduce symptoms:

To learn more about the uses of these drugs, see the “What are Azulfidine and Azulfidine EN-tabs used for?” section below.

Azulfidine and Azulfidine EN-tabs basics

Azulfidine and Azulfidine EN-tabs come as tablets that you swallow. Azulfidine EN-tabs are delayed-release tablets, which slowly release the medication over time.

Both medications contain the active drug sulfasalazine. (An active drug is the ingredient that makes a medication work.) Sulfasalazine is also the generic for these medications.

Keep reading to learn more about Azulfidine and Azulfidine EN-tabs, including their side effects, dosage, uses, and more.

Like most drugs, Azulfidine and Azulfidine EN-tabs may cause mild or serious side effects. The lists below describe some of the more common side effects of Azulfidine and Azulfidine EN-tabs. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

For additional information on the side effects of these medications, see this article. Your doctor or pharmacist can also tell you more about the potential side effects of Azulfidine and Azulfidine EN-tabs. And they can suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Azulfidine and Azulfidine EN-tabs can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read the prescribing information for these drugs.

Mild side effects of Azulfidine and Azulfidine EN-tabs that have been reported include:

* For more information about this side effect, see the “Side effect focus” section below.

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Azulfidine and Azulfidine EN-tabs can occur, but they aren’t common. If you have serious side effects from either drug, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Azulfidine and Azulfidine EN-tabs that have been reported include:

* For more information about this side effect, see the “Side effect focus” section below.

Side effect focus

Learn more about some of the side effects Azulfidine and Azulfidine EN-tabs may cause.

Severe skin reactions

Azulfidine and Azulfidine EN-tabs may cause severe skin reactions that can be life threatening.

It’s not known exactly how often these side effects occurred in studies of these drugs. They’re thought to be rare.

These reactions are most common during the first month of treatment. But they may occur at any time while taking Azulfidine or Azulfidine EN-tabs.

Severe skin reactions reported with Azulfidine and Azulfidine EN-tabs include:

Symptoms of a severe skin reaction can include:

  • blisters on your eyes, lips, mouth, or skin
  • fever
  • flu-like symptoms
  • rash that continues to get worse
  • reddened or discolored skin
  • severe rash
  • skin burning or pain
  • skin peeling

What might help

Severe skin reactions such as DRESS, SJS, and TEN can be life threatening and may require treatment in the hospital. If you think you’re having a severe skin reaction, stop taking Azulfidine or Azulfidine EN-tabs and contact your doctor immediately. If your symptoms feel life threatening, seek emergency medical attention right away. Dial 911 or go to the closest emergency room.

If your doctor confirms you’ve had a severe skin reaction to Azulfidine or Azulfidine EN-tabs, they’ll have you stop taking the medication. They can discuss with you other treatment options for your condition.

Kidney problems

While rare, kidney problems may occur from treatment with Azulfidine or Azulfidine EN-tabs. Kidney problems reported by people taking the drugs in studies include nephritis (inflammation in the kidneys) and kidney failure.

Symptoms of kidney problems caused by Azulfidine or Azulfidine EN-tabs can include:

If you already have kidney problems, such as chronic kidney disease, these drugs could worsen your condition.

What might help

Before you take Azulfidine or Azulfidine EN-tabs, tell your doctor if you have kidney problems. The drug may not be safe for you to take. Your doctor can discuss other treatment options with you.

While you’re taking Azulfidine or Azulfidine EN-tabs, your doctor may order kidney function tests to check your kidney health. These tests can help detect kidney problems before they start causing symptoms.

If you notice symptoms of kidney problems while taking Azulfidine or Azulfidine EN-tabs, contact your doctor right away. If they confirm you’re having kidney problems, they’ll likely have you stop taking Azulfidine or Azulfidine EN-tabs.

Low sperm count and infertility

Low sperm count and infertility have been reported in males* taking Azulfidine or Azulfidine EN-tabs. Exactly how often this side effect occurred in the studies of these drugs isn’t known. Low sperm count is one of the more common side effects caused by these drugs. But this side effect also tends to go away once you stop taking the drug.

* In this article, we use the term “males” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

What might help

If you’re concerned about low sperm count and infertility caused by Azulfidine or Azulfidine EN-tabs, talk with your doctor. Stopping treatment with the drug appears to reverse low sperm count. Your doctor can suggest other treatments for your condition as well, including drugs that may not cause sexual side effects.

Allergic reaction

Some people may have an allergic reaction to Azulfidine and Azulfidine EN-tabs. It’s not known exactly how often these reactions occurred in studies.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Azulfidine and Azulfidine EN-tabs. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Your doctor will recommend the dosage of Azulfidine and Azulfidine EN-tabs that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

For details about the dosage of these drugs, see this article.

Forms and strengths

Azulfidine and Azulfidine EN-tabs come as tablets that you swallow. They’re available in one strength: 500 milligrams (mg).

Azulfidine EN-tabs are delayed-release tablets. This means the tablets slowly release the medication over time, which may lower the risk of side effects. Azulfidine EN-tabs also have a special coating that stops the tablets from breaking down until they reach your intestines. This helps prevent the tablets from irritating your digestive tract.

Recommended dosages

You’ll likely take Azulfidine or Azulfidine EN-tabs one to four times a day. This can vary depending on the condition you’re taking the drug to treat. It’s recommended that you take each dose after a meal.

Your doctor can tell you more about how often you’ll take your dose.

Questions about the dosages of Azulfidine and Azulfidine EN-tabs

Below are some common questions about the dosage for these two drugs.

  • What if I miss a dose of Azulfidine or Azulfidine EN-tabs? If you miss a dose of Azulfidine or Azulfidine EN-tabs, try to take it as soon as you remember. But if it’s almost time for your next dose, skip the missed dose. Take your next dose at the regularly scheduled time. Don’t take two doses to make up for the missed dose. This may raise your risk of side effects.
  • Will I need to use Azulfidine and Azulfidine EN-tabs long term? If you and your doctor agree that Azulfidine or Azulfidine EN-tabs is working well for you, you’ll likely take the medication long term.
  • How long do Azulfidine and Azulfidine EN-tabs take to work? These drugs begin working as soon as you take a dose. But it may take a few weeks before you notice your symptoms decreasing.

Azulfidine and Azulfidine EN-tabs are prescribed to treat ulcerative colitis (UC) in adults and children ages 6 years and older. Your doctor might have you take either drug by itself as treatment for mild or moderate UC. Or you might take one of them in combination with other medications for treating severe UC.

Azulfidine EN-tabs are also prescribed to treat the following when other medications haven’t worked to reduce symptoms:

UC is a type of inflammatory bowel disease (IBD). It causes inflammation in your colon and rectum. It’s not exactly known what causes UC. It’s a type of autoimmune condition, which means your body’s immune system mistakenly attacks your own body.

Like UC, RA and JIA are autoimmune conditions.

It’s not fully understood how Azulfidine and Azulfidine EN-tabs work to treat autoimmune conditions. But it’s thought their anti-inflammatory properties help reduce inflammation in your body. This may be what helps relieve symptoms of UC, RA, and JIA. These drugs may also weaken your immune system, which helps stop it from attacking your own body.

Other uses

Azulfidine or Azulfidine EN-tabs may also be used off-label for other conditions. With off-label use, a drug that’s approved by the Food and Drug Administration (FDA) for certain conditions is used for another purpose. Talk with your doctor for more information.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. You can also find current prices for Azulfidine EN-tabs on this website.

Azulfidine and Azulfidine EN-tabs are available as sulfasalazine, which is the generic form of the drug. Generics usually cost less than brand-name drugs. Talk with your doctor if you’d like to know about taking sulfasalazine.

Financial assistance to help you pay for Azulfidine and Azulfidine EN-tabs may be available. Medicine Assistance Tool and NeedyMeds are two websites that provide resources to help reduce the cost of these drugs.

You can also check out this article to learn more about saving money on prescriptions.

Find answers to some commonly asked questions about Azulfidine and Azulfidine EN-tabs.

How do Azulfidine and Azulfidine EN-tabs work?

The mechanism of action for Azulfidine and Azulfidine EN-tabs isn’t fully understood. Mechanism of action refers to how a drug works to treat a condition. But it’s believed to be related to their anti-inflammatory properties.

These drugs decrease the inflammation caused by the autoimmune conditions they treat. An autoimmune condition is when a person’s immune system mistakenly attacks their own body. Both drugs are used to treat ulcerative colitis (UC). Azulfidine EN-tabs are also used to treat rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). This anti-inflammatory action helps ease symptoms of these conditions.

These drugs may also weaken your immune system to stop it from attacking your own body.

If you’d like to learn more about how Azulfidine and Azulfidine EN-tabs work, talk with your doctor or pharmacist.

What should I know about Azulfidine and Azulfidine EN-tabs vs. the alternative drug sulfasalazine?

Sulfasalazine is the active drug in both Azulfidine and Azulfidine EN-tabs. An active drug is the ingredient that makes a medication work. Sulfasalazine is also the generic for these drugs.

Doctors prescribe sulfasalazine to treat the same conditions that Azulfidine and Azulfidine EN-tabs treat. And they can cause very similar side effects.

If you’d like to know more about sulfasalazine as an alternative to Azulfidine or Azulfidine EN-tabs, talk with your doctor or pharmacist.

Will Azulfidine or Azulfidine EN-tabs cure my condition?

No. Neither drug cures the autoimmune conditions they’re used to treat. There currently isn’t a known cure for these conditions.

But drugs such as Azulfidine and Azulfidine EN-tabs can help treat symptoms of these conditions. This can make it easier for you to go about your daily activities.

Talk with your doctor or pharmacist if you’d like to learn more about treatment options for your condition.

Your doctor will explain how you should take Azulfidine and Azulfidine EN-tabs. They will also explain how much to take and how often. Be sure to follow your doctor’s instructions.

Taking Azulfidine and Azulfidine EN-tabs

Azulfidine and Azulfidine EN-tabs are tablets that you swallow. You’ll likely take Azulfidine or Azulfidine EN-tabs one to four times a day.

Accessible medication containers and labels

If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that:

  • have large print
  • use braille
  • contain a code you can scan with a smartphone to change the text into audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put Azulfidine and Azulfidine EN-tabs in an easy-open container. Your pharmacist may also recommend tools to help make it simpler to open the drug’s container.

Taking Azulfidine and Azulfidine EN-tabs with other drugs

Depending on the severity of your condition, your doctor may have you take Azulfidine or Azulfidine EN-tabs on their own as treatment. Or you may take them along with other medications to treat your condition.

Questions about taking Azulfidine and Azulfidine EN-tabs

Below are some common questions about taking Azulfidine and Azulfidine EN-tabs.

  • Can Azulfidine and Azulfidine EN-tabs be chewed, crushed, or split? No, you shouldn’t crush, chew, or split Azulfidine or Azulfidine EN-tabs. If you’re having trouble swallowing pills, see the tips in this article. Your doctor or pharmacist may also have advice about how to take your dose.
  • Should I take Azulfidine and Azulfidine EN-tabs with food? It’s recommended that you take each dose after a meal.
Questions for your doctor

You may have questions about Azulfidine and Azulfidine EN-tabs and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Azulfidine and Azulfidine EN-tabs affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So don’t be afraid to ask questions or offer feedback on your treatment.

Before you start taking Azulfidine or Azulfidine EN-tabs, it’s important that you tell your doctor about any medical conditions you may have. You should also tell them about all medications you may take. This helps them determine whether Azulfidine or Azulfidine EN-tabs is the right treatment option for you.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Azulfidine and Azulfidine EN-tabs, be sure to tell your doctor about all medications you take, including prescription and over-the-counter types. Also, describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Azulfidine and Azulfidine EN-tabs.

Interactions with drugs or supplements

Azulfidine and Azulfidine EN-tabs can interact with several types of drugs. These drugs include:

This list does not contain all types of drugs that may interact with Azulfidine and Azulfidine EN-tabs. Your doctor or pharmacist can tell you more about these interactions and any others that may occur when taking Azulfidine and Azulfidine EN-tabs.

Warnings

Azulfidine and Azulfidine EN-tabs may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before taking Azulfidine and Azulfidine EN-tabs. Factors to consider include those in the list below.

  • Blockage in your intestinal tract or urinary tract. If you have an intestinal tract or urinary tract blockage, your doctor likely will not prescribe Azulfidine or Azulfidine EN-tabs. These drugs may cause side effects that can affect digestion and urination. This could worsen the blockage. In such a case, your doctor will discuss other treatments that may be safer for you.
  • Blood disorder. Blood disorders are a possible side effect of Azulfidine or Azulfidine EN-tabs. If you already have a blood disorder, such as anemia, these medications may worsen your condition. Your doctor will let you know whether Azulfidine or Azulfidine EN-tabs are safe for you to take.
  • Porphyria. If you have porphyria, a rare, inherited blood disorder, your doctor likely won’t prescribe Azulfidine or Azulfidine EN-tabs. Taking either medication could cause an acute porphyria attack. Your doctor will discuss treatments that may be safer for you instead.
  • Kidney problems. It’s possible to have kidney problems from taking Azulfidine or Azulfidine EN-tabs. If you already have a kidney problem, such as chronic kidney disease, either medication may worsen it. Tell your doctor if you have any kidney problems. This will help them determine whether Azulfidine or Azulfidine EN-tabs are safe for you.
  • Liver problems. Azulfidine and Azulfidine EN-tabs can cause liver problems. Taking either medication can worsen liver problems that already exist. If you have liver problems, your doctor will determine whether Azulfidine or Azulfidine EN-tabs are safe for you to take.
  • Allergic reaction. If you’ve had an allergic reaction to Azulfidine, Azulfidine EN-tabs, or any of their ingredients, your doctor will likely not prescribe Azulfidine or Azulfidine EN-tabs. Ask your doctor what other medications are better options for you.
  • Sulfonamide or salicylate allergy. If you have an allergy to salicylate or sulfonamide medications, your doctor will likely not prescribe Azulfidine or Azulfidine EN-tabs. Your doctor will instead discuss treatments that are safer for you.

Azulfidine and Azulfidine EN-tabs and alcohol

There’s no direct interaction between alcohol and Azulfidine or Azulfidine EN-tabs.

But alcohol may worsen or raise your risk of certain side effects these medications can cause, including:

  • headache
  • kidney problems
  • liver problems
  • nausea

Talk with your doctor about how much alcohol is safe for you to drink during treatment with Azulfidine or Azulfidine EN-tabs.

Pregnancy and breastfeeding

It isn’t known whether taking Azulfidine or Azulfidine EN-tabs while pregnant or breastfeeding is safe.

If you’re pregnant or breastfeeding or planning to become pregnant or breastfeed, talk with your doctor. They can recommend safe treatment options for you.

Don’t take more Azulfidine or Azulfidine EN-tabs than your doctor prescribes. Using more than this can lead to serious side effects.

Symptoms of overdose

Symptoms caused by an overdose can include:

What to do in case you take too much Azulfidine and Azulfidine EN-tabs

Call your doctor if you think you’ve taken too much Azulfidine and Azulfidine EN-tabs. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

Talk with your doctor or pharmacist if you’re considering treatment with Azulfidine or Azulfidine EN-tabs. Ask questions that help you feel comfortable about the risks and benefits.

Some examples to help you get started are:

  • What should I know about treatment alternatives to Azulfidine and Azulfidine EN-tabs for my condition?
  • Are there different doses I can try if I experience side effects from Azulfidine or Azulfidine EN-tabs?
  • How will I know if Azulfidine or Azulfidine EN-tabs are working for me?

You can learn more about treatments for conditions these drugs are used to treat by checking out these articles:

If you’re looking to connect with a supportive online group of people who share your condition, visit Bezzy.com. There you’ll find online communities for rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), such as ulcerative colitis.

For news about treatments and advice on managing your condition, sign up for Healthline’s IBD newsletter or RA newsletter.

Q:

Will I need to have blood work while taking Azulfidine or Azulfidine EN-tabs?

Anonymous

A:

Yes, it’s likely you’ll have blood work done regularly while taking Azulfidine or Azulfidine EN-tabs.

Monitoring through blood tests can help your doctor check for certain side effects before they cause symptoms.

While taking Azulfidine or Azulfidine EN-tabs, your doctor will likely order the following lab tests:

  • Complete blood count. A complete blood count helps monitor for blood disorders, like anemia or low white blood cell levels. You’ll likely have this test before you start treatment and regularly during treatment.
  • Liver function tests. To check for liver damage, you’ll likely have liver function tests before treatment with Azulfidine or Azulfidine EN-tabs. Your doctor will also regularly order these tests during treatment.
  • Kidney function tests, including urinalysis. Kidney function tests, which include urinalysis and blood tests, help check for kidney damage and infection. Your doctor may order these tests to monitor your kidney function regularly while you’re taking Azulfidine or Azulfidine EN-tabs.

Your doctor can provide more information about the specific tests they’ll order for you. They’ll also let you know how often you’ll need to have blood work while taking Azulfidine or Azulfidine EN-tabs.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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