A 30-year-old female patient has been treated with Salazopyrin (sulfasalazine) 500 mg two tablets t

Fråga: A 30-year-old female patient has been treated with Salazopyrin (sulfasalazine) 500 mg two tablets twice daily since February of this year because of a rheumatic disease. Psychotic symptoms, observed by her relatives, started to appear in March-April and the patient began treatment with Trilafon (perphenazine) towards the end of April. Trilafon was later replaced by Roxiam (remoxipride). The psychosis is now relatively well controlled with remoxipride and the patient still receives Salazopyrin. Are psychotic symptoms known to occur during treatment with sulfasalazine?

Sammanfattning: There is no documentation in the literature concerning sulfasalazine causing psychosis as a side-effect. A number of cases have been reported to the WHO centre but the possible causal relationship with sulfasalazine treatment remains unclear.

Svar: A similar question concerning psychiatric side-effects during treatment with sulfasalazine has recently been answered (1). This type of side effect is not common, but depression, irritability and mood disturbances may occur, usually within the first 6 months of treatment (2). The few case reports found in the literature have concerned only depression (3). The Swedish Adverse Drug Reactions Advisory Committee (SADRAC) has received reports of 20 cases of psychiatric side-effects during treatment with sulfasalazine (the number of cases is given in parentheses): depression (8), mood disturbances (4), concentration disturbances (3), personality changes (2) and one report each respectively of confusion, hallucination and feelings of unreality.

The WHO centre has received reports of a total of 12 cases of psychosis related to sulfasalazine treatment. In two of the 12 cases the relationship with sulfasalazine treatment was classified as possible and in two cases unlikely. The remaining cases were not classified.