Download Sulfasalazine - Wolverhampton Formulary

Royal Wolverhampton
NHS Trust
Wolverhampton City
Clinical Commissioning Group
Wolverhampton Shared
Care Agreement
Black Country Cluster
Sulfasalazine EC (Salazopyrin®) - GP monitored
ESCA: For the treatment of rheumatological conditions in adults
SECONDARY CARE SECTION TO BE COMPLETED BY INITIATING DOCTOR
Patient’s Name:
NHS Number:
Date of Birth:
Date Treatment Started:
(Add Date)
One copy of information leaflet given to patient
One copy of agreement sent to general practitioner
One copy filed in patients notes
Name of Initiating Doctor:
Consultant:
Speciality:
Fax Number:
01902 695736
PRIMARY CARE SECTION TO BE COMPLETED BY GENERAL PRACTITIONER
I agree*/don’t agree* to enter into a shared care arrangement for the treatment of the above patient with
this medicine (*delete as appropriate)
GP Name:
Signature:
Date:
Once signed please detach this sheet and fax to the number shown above.
File copy in patient’s record and add read code 66S2 or XaK6z depending on GP clinical system.
BACK-UP ADVICE AND SUPPORT
Contact details
Telephone No.
Rheumatology Nurse Helpline
01902 695491
Rheumatology Secretaries
01902 695492
01902 695495
Hospital Pharmacy Department
Mrs S. Reed
01902 695136
Email address:
[email protected]
This Shared Care Agreement should be read in conjunction with the Summary of Product Characteristics (SPC) for Sulfasalazine
(Salazopyrin)
Date approved: September 2012
Expiry date: 31/12/2017
Royal Wolverhampton
NHS Trust
Wolverhampton City
Clinical Commissioning Group
Wolverhampton Shared
Care Agreement
Black Country Cluster
Sulfasalazine EC (Salazopyrin®) - GP monitored
ESCA: For the treatment of rheumatological conditions in adults
Patient’s Name:
Date treatment commenced:
AREAS OF RESPONSIBILITY FOR THE SHARING OF CARE
This shared care agreement outlines suggested ways in which the responsibilities for managing the prescribing of ***
disease can be shared between the specialist and general practitioner (GP). GPs are invited to participate. If GPs
are not confident to undertake these roles, then they are under no obligation to do so. In such an event, the total
clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks the
GP to prescribe this drug, the GP should reply to this request as soon as practicable.
Sharing of care assumes communication between the specialist, GP and patient. The intention to share care should
be explained to the patient by the doctor initiating treatment. It is important that patients are consulted about
treatment and are in agreement with it.
The doctor who prescribes the medication legally assumes clinical responsibility for the drug and the
consequences of its use.
RESPONSIBILITIES and ROLES
Specialist responsibilities
1. Discuss the benefits and side effects of treatment with the patient.
2. Dose stabilisation: initial dosage adjustment until stable. Thereafter, during maintenance treatment, advice to
the GP on any further dose adjustments required.
3. Ask the GP whether he or she is willing to participate in shared care, and agree with the GP as to who will
discuss the shared care arrangement with the patient.
4. Monitor liver function tests and blood count (including differential white cell count) every month for three
months. If dose and bloods are stable for 3 months, the general practitioner can monitor the patient as below
5. Communicate promptly with the GP when treatment is changed.
6. Have a mechanism in place to receive rapid referral of a patient from the GP in the event of deteriorating
clinical condition.
7. Advise the GP on stopping treatment (if appropriate).
8. Report serious adverse events to the MHRA.
9. Ensure that clear backup arrangements exist for GPs to obtain advice and support.
General Practitioner responsibilities
1 Reply to the request for shared care as soon as practicable.
2 Prescribe sulfasalazine at the dose recommended.
3 Monitor liver function tests and blood count (including differential white cell count) every 3 months. If the dose
increases, then repeat bloods 1 month after dose increase, if stable revert to usual monitoring.
4 Adjust the dose as advised by the specialist.
5 Report to and seek advice from the specialist on any aspect of patient care that is of concern and may affect
treatment.
6 Refer patient to the specialist if his or her condition deteriorates.
7 Stop treatment on the advice of the specialist or immediately if an urgent need to stop treatment arises.
8 Report adverse events to the specialist and MHRA.
Patient's role
1 Report to the specialist or GP if he or she does not have a clear understanding of the treatment.
2 Share any concerns in relation to treatment with sulfasalazine.
3 Report immediately if he or she develops sore throat, fever, malaise, pallor, purpura, jaundice which may
indicate myelosuppression, haemolysis or Hepatotoxicity.
4 Report any other adverse effects to the specialist or GP whilst taking sulfasalazine.
This Shared Care Agreement should be read in conjunction with the Summary of Product Characteristics (SPC) for Sulfasalazine
(Salazopyrin)
Date approved: September 2012
Expiry date: 31/12/2017
Royal Wolverhampton
NHS Trust
Wolverhampton City
Clinical Commissioning Group
Wolverhampton Shared
Care Agreement
Black Country Cluster
Sulfasalazine EC (Salazopyrin®) - GP monitored
ESCA: For the treatment of rheumatological conditions in adults
SUPPORTING CLINICAL INFORMATION
Indications
Treatment of rheumatoid arthritis which has failed to respond to non-steroidal anti-inflammatory drugs (NSAIDs).
Dosage and Administration
Treatment of rheumatoid arthritis – starting dose is 500mg daily, increased by one tablet each week until a maximum
dose of 4 to 6g is reached.
Adequate fluid intake should be ensured during treatment as sulfasalazine causes crystalluria and kidney stone
formation.
Contraindications

Infant under the age of 2 years.

Patients with a known hypersensitivity to sulfasalazine, its metabolites or any of the excipients as well as
sulfonamides or salicyclates.

Patients with porphyria.
Side Effects
The most common side effects with sulfasalazine are nausea, headache, rash, loss of appetite and raised
temperature. Blood disorders such as leucopenia, thrombocytopenia, agranulocytosis, aplastic anaemia, haemolytic
anaemia, Heinz body anaemia, hypoprothrombinaemia, lymphadenopathy, macrocytosis, megaloblastic anaemia,
methaemoglobinaemina, neutropenia and pancytopenia have been reported.
Insomnia, depression, dizziness, taste disorders, tinnitus, conjunctival and scleral infection. Cough, stomatitis,
pruritis, arthralgia, fever have also been commonly reported
Hepatic failure and hepatitis may occur.
Monitoring
Full blood count (including differential white cell), renal function and liver function tests should be monitored regularly
and drug discontinued if patient develops signs or symptoms of myelosuppression, haemolysis or Hepatotoxicity.
Drug Interactions
Bone marrow suppression may occur when mercaptopurine or its prodrug azathioprine are used in combination with
sulfasalazine.
Vaccination
The use of LIVE vaccine is not recommended during drug treatment with immunosuppressant drugs. This section
may be excluded if the shared care agreement related to a drug which is not an immunosuppressant.
Acknowledgements
This section may be excluded if this document has been created developed without reference to another
organisation’s documentation.
Version Control
Version
Date of Issue
Author/s
Brief Description of Changes
25/06/2013
R Eardley
Removal of pharmacy fax numbers
1.0
1.1
This Shared Care Agreement should be read in conjunction with the Summary of Product Characteristics (SPC) for Sulfasalazine
(Salazopyrin)
Date approved: September 2012
Expiry date: 31/12/2017