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Sulfasalazine side effects: what 77,779 FDA adverse event reports show

Sulfasalazine · 1,285 reaction terms · 908,319 drug–reaction co-reports · data 2026-09-14
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Drug class

Aminosalicylate

FDA label (Established Pharmacologic Class)

Who reports

77,779 reports · 84% serious · 7,233 with death outcome · 77% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Sulfasalazine delayed release tablets are indicated: a) in the treatment of mild to moderate ulcerative colitis, and as adjunctive therapy in severe ulcerative colitis; b) for the prolongation of the remission period between acute attacks of ulcerative.

FDA label, Indications and Usage

What it is

Sulfasalazine is an azobenzene consisting of diphenyldiazene having a carboxy substituent at the 4-position, a hydroxy substituent at the 3-position and a 2-pyridylaminosulphonyl substituent at the 4'-position.

PubChem CID 5339 (ChEBI)

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 1Labeled (related wording) 1Likely indication confounding 2Reporting / coding artifact 3Lab value / disease marker 11Not in label — unassessed 22
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only (and, for the 300 most-reported drugs, adjusted for age band), and flags pairs whose reports are unusually skewed by sex or come mostly from consumers. Each row also shows the PRR against the other drugs of the same FDA class, which removes most confounding by the condition being treated, and a calibrated p-value: on validation, known non-causes average an ROR of about 2, so significance is judged against that empirical null (✓ = p < 0.05 after calibration). 1,245 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Synovial fluid analysis792,991.0
1,380.9–6,478.6ROR 2,994.0 · calibrated p 2e-18 ✓
230.8 EB05 191.1 · IC025 +6.2
3/3 methods agree
Reporting / coding artifactserious n=79 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Human antichimeric antibody positive3042,598.9
1,796.1–3,760.6ROR 2,609.1 · calibrated p 3e-21 ✓
237.8 EB05 216.2 · IC025 +7.2
3/3 methods agree
Lab value / disease markerserious n=304 · ♀ 100% (drug 77%)no trial arm names this drug
Anti-cyclic citrullinated peptide antibody positive5,5971,046.1
987.3–1,108.4ROR 1,127.1 · calibrated p 6e-18 ✓
212.1 EB05 207.5 · IC025 +7.7
3/3 methods agree
Lab value / disease markerserious PRR 146.3 · ♀ 99% (drug 77%) · 93% clinicianno trial arm names this drug
Red blood cell sedimentation rate212851.3
645.9–1,122.1ROR 853.6 · calibrated p 5e-16 ✓
199.2 EB05 177.7 · IC025 +6.9
3/3 methods agree
Lab value / disease markerserious n=212no trial arm names this drug
Swollen joint count increased2,295775.8
715.6–841.1ROR 799.4 · calibrated p 4e-16 ✓
198.0 EB05 191.3 · IC025 +7.5
3/3 methods agree
Lab value / disease markerserious n=2,293 · ♀ 99% (drug 77%) · 95% clinicianno trial arm names this drug
Anti-cyclic citrullinated peptide antibody487750.4
630.7–892.7ROR 755.1 · calibrated p 1e-15 ✓
195.1 EB05 181.0 · IC025 +7.2
3/3 methods agree
Lab value / disease markerserious n=487 · ♀ 100% (drug 77%) · 95% clinicianno trial arm names this drug
Rheumatoid factor positive4,138704.3
664.8–746.3ROR 743.9 · calibrated p 8e-16 ✓
193.1 EB05 188.2 · IC025 +7.5
3/3 methods agree
Lab value / disease markerserious n=4,136 · ♀ 99% (drug 77%) · 93% clinicianno trial arm names this drug
Lupus vulgaris844675.8
595.2–767.2ROR 683.2 · calibrated p 2e-15 ✓
190.3 EB05 179.7 · IC025 +7.3
3/3 methods agree
Not in label — unassessedserious n=844 · ♀ 100% (drug 77%) · 96% clinicianno trial arm names this drug
Rheumatic fever3,055644.1
603.4–687.6ROR 670.4 · calibrated p 2e-15 ✓
188.3 EB05 182.7 · IC025 +7.5
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=3,053 · ♀ 100% (drug 77%) · 95% clinicianno trial arm names this drug
Hepatic enzyme93547.7
383.7–781.8ROR 548.4 · calibrated p 1e-13 ✓
173.0 EB05 145.4 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=93 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Pemphigus8,068508.9
490.6–527.8ROR 567.6 · calibrated p 1e-14 ✓
174.8 EB05 171.7 · IC025 +7.4
3/3 methods agree
Not in label — unassessedserious PRR 120.6 · ♀ 100% (drug 77%) · 91% clinicianno trial arm names this drug
Duodenal ulcer perforation4,720495.2
472.1–519.5ROR 527.1 · calibrated p 3e-14 ✓
173.2 EB05 169.1 · IC025 +7.4
3/3 methods agree
Not in label — unassessedserious PRR 118.9 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Deep vein thrombosis postoperative1,252485.1
442.1–532.3ROR 493.0 · calibrated p 7e-14 ✓
171.6 EB05 163.8 · IC025 +7.2
3/3 methods agree
Not in label — unassessedserious n=1,252 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
C-reactive protein558437.5
382.3–500.7ROR 440.7 · calibrated p 3e-13 ✓
164.7 EB05 153.6 · IC025 +7.0
3/3 methods agree
Lab value / disease markerserious n=558 · ♀ 100% (drug 77%) · 95% clinicianno trial arm names this drug
Granuloma skin507432.0
375.2–497.5ROR 434.9 · calibrated p 3e-13 ✓
163.9 EB05 152.2 · IC025 +7.0
3/3 methods agree
Not in label — unassessedserious n=507no trial arm names this drug
Musculoskeletal deformity138385.0
296.5–499.9ROR 385.7 · calibrated p 2e-12 ✓
154.2 EB05 133.8 · IC025 +6.4
3/3 methods agree
Not in label — unassessedserious n=138 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Hand deformity7,498367.0
354.6–379.8ROR 406.0 · calibrated p 5e-13 ✓
154.4 EB05 151.5 · IC025 +7.2
3/3 methods agree
Not in label — unassessedserious PRR 115.3 · 91% clinicianno trial arm names this drug
C-reactive protein abnormal3,578345.3
328.7–362.7ROR 361.9 · calibrated p 2e-12 ✓
150.4 EB05 146.3 · IC025 +7.1
3/3 methods agree
Lab value / disease markerserious n=3,573no trial arm names this drug
Rheumatoid factor negative98337.3
250.3–454.6ROR 337.7 · calibrated p 8e-12 ✓
144.8 EB05 122.3 · IC025 +6.1
3/3 methods agree
Reporting / coding artifactserious n=98no trial arm names this drug
Swollen joint count135331.3
257.2–426.6ROR 331.9 · calibrated p 7e-12 ✓
144.8 EB05 125.4 · IC025 +6.3
3/3 methods agree
Not in label — unassessedserious n=135 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Facet joint syndrome1,686313.3
292.1–336.1ROR 320.3 · calibrated p 5e-12 ✓
143.9 EB05 138.2 · IC025 +7.0
3/3 methods agree
Not in label — unassessedserious n=1,684 · ♀ 100% (drug 77%) · 95% clinicianno trial arm names this drug
Grip strength123307.5
237.2–398.7ROR 308.0 · calibrated p 2e-11 ✓
139.8 EB05 120.3 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=123 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Synovitis9,222284.5
276.5–292.8ROR 322.7 · calibrated p 5e-12 ✓
137.7 EB05 135.4 · IC025 +7.1
3/3 methods agree
Not in label — unassessedserious PRR 98.8no trial arm names this drug
X-ray abnormal888269.3
245.3–295.5ROR 272.4 · calibrated p 3e-11 ✓
133.7 EB05 126.5 · IC025 +6.9
3/3 methods agree
Lab value / disease markerserious n=888 · 95% clinicianno trial arm names this drug
Body height below normal315255.3
218.7–298.0ROR 256.3 · calibrated p 5e-11 ✓
129.5 EB05 117.9 · IC025 +6.6
3/3 methods agree
Reporting / coding artifactserious n=315 · ♀ 100% (drug 77%)no trial arm names this drug
Dislocation of vertebra1,073253.2
233.0–275.2ROR 256.8 · calibrated p 4e-11 ✓
129.7 EB05 123.3 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=1,073 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Adjustment disorder with depressed mood969251.5
230.4–274.6ROR 254.7 · calibrated p 5e-11 ✓
129.2 EB05 122.5 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=969 · ♀ 100% (drug 77%) · 96% clinicianno trial arm names this drug
Presbyacusis147243.5
194.7–304.6ROR 244.0 · calibrated p 1e-10 ✓
125.3 EB05 109.2 · IC025 +6.2
3/3 methods agree
Not in label — unassessedserious n=147 · ♀ 100% (drug 77%)no trial arm names this drug
Helicobacter infection4,755237.5
228.5–246.8ROR 252.9 · calibrated p 5e-11 ✓
125.7 EB05 122.7 · IC025 +6.9
3/3 methods agree
Not in label — unassessedserious PRR 91.3 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Red blood cell sedimentation rate abnormal1,073232.3
214.1–252.1ROR 235.6 · calibrated p 1e-10 ✓
124.0 EB05 117.9 · IC025 +6.8
3/3 methods agree
Lab value / disease markerserious n=1,069no trial arm names this drug
Retinitis743217.6
197.5–239.7ROR 219.7 · calibrated p 2e-10 ✓
119.6 EB05 112.5 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious n=743 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Sleep disorder due to general medical condition, insomnia type2,798208.5
198.5–218.9ROR 216.2 · calibrated p 2e-10 ✓
117.0 EB05 113.4 · IC025 +6.8
3/3 methods agree
Not in label — unassessedserious n=2,795 · ♀ 98% (drug 77%) · 94% clinicianno trial arm names this drug
Seronegative arthritis483204.8
181.9–230.6ROR 206.1 · calibrated p 3e-10 ✓
115.4 EB05 107.1 · IC025 +6.5
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=480 · 92% clinicianno trial arm names this drug
Muscle injury3,407192.4
184.2–200.9ROR 201.1 · calibrated p 4e-10 ✓
111.8 EB05 108.7 · IC025 +6.7
3/3 methods agree
Not in label — unassessedserious PRR 83.3 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Bone erosion1,423181.8
170.0–194.5ROR 185.2 · calibrated p 8e-10 ✓
108.1 EB05 103.5 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious n=1,420no trial arm names this drug
Blood parathyroid hormone decreased593178.8
161.1–198.4ROR 180.2 · calibrated p 1e-9 ✓
106.8 EB05 99.8 · IC025 +6.5
3/3 methods agree
Lab value / disease markerserious n=593no trial arm names this drug
Hypocholesterolaemia122177.7
141.3–223.4ROR 177.9 · calibrated p 2e-9 ✓
105.0 EB05 90.3 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=122 · ♀ 100% (drug 77%) · 100% clinicianno trial arm names this drug
Folliculitis3,905164.5
158.2–171.1ROR 173.2 · calibrated p 1e-9 ✓
101.8 EB05 99.2 · IC025 +6.6
3/3 methods agree
Not in label — unassessedserious PRR 82.3 · ♀ 100% (drug 77%) · 94% clinicianno trial arm names this drug
Pericarditis5,998152.1
147.5–156.9ROR 164.8 · calibrated p 2e-9 ✓
97.0 EB05 94.9 · IC025 +6.5
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 67.2 · ♀ 99% (drug 77%) · 93% clinicianno trial arm names this drug

Clinical concept groups

MedDRA splits one clinical problem across several terms (e.g. "neutropenia", "neutrophil count decreased", "agranulocytosis"), which dilutes term-level signals. These rows count reports with any term in a concept group (an exact union, not a sum), compared with all other drugs. Groups are hand-built and listed in the methods.

ConceptReportsPRR 95% CIReading
Liver injury11,56410.710.5–10.9signal
Interstitial lung disease3,54310.310.0–10.6signal
Tendon disorder6474.64.3–5.0signal
Serious infection11,6094.14.0–4.2signal
Hyperglycaemia / diabetes4,6713.73.6–3.8signal
Opportunistic infection1,7783.63.4–3.7signal
Depression2,8082.72.6–2.8signal
Anaphylaxis / angioedema1,1492.52.3–2.6signal
Pancreatitis6232.11.9–2.3raised
Severe cutaneous reaction5732.11.9–2.3raised
Malignancy2,6811.91.9–2.0raised
Venous thromboembolism1,4701.81.7–1.9raised
Fall / fracture2,4081.71.6–1.8raised
Gi bleeding1,1391.71.6–1.8raised
Anaemia1,5101.41.3–1.4raised
Rhabdomyolysis / myopathy3941.31.2–1.4raised

Trial evidence (ClinicalTrials.gov)

ClinicalTrials.gov returned results-bearing trials mentioning Sulfasalazine only as a background or rescue medication (NCT00259610, NCT00720798); no trial listing it as the tested intervention was cached, so no trial cross-check is shown.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Drug ineffective (drug did not work)29,3566.1
6.1–6.2ROR 9.2 · calibrated p 0.042 ✓
6.0 EB05 6.0 · IC025 +2.6
3/3 methods agree
Reporting / coding artifactage-adj. PRR 6.7 · serious PRR 10.6no trial arm names this drug
Rheumatoid arthritis19,52956.2
55.5–57.0ROR 74.7 · calibrated p 9e-7 ✓
46.6 EB05 46.0 · IC025 +5.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
age-adj. PRR 45.2 · serious PRR 38.6no trial arm names this drug
Pain15,9477.1
7.0–7.2ROR 8.7 · calibrated p 0.050
7.0 EB05 6.9 · IC025 +2.8
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 6.6 · serious PRR 7.3no trial arm names this drug
Drug intolerance13,76244.9
44.2–45.7ROR 54.3 · calibrated p 8e-6 ✓
38.5 EB05 38.0 · IC025 +5.2
3/3 methods agree
Reporting / coding artifactage-adj. PRR 46.8 · serious PRR 42.3no trial arm names this drug
Arthralgia (joint pain)13,4819.0
8.9–9.2ROR 10.7 · calibrated p 0.025 ✓
8.8 EB05 8.6 · IC025 +3.1
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 7.9 · serious PRR 10.5no trial arm names this drug
Fatigue (tiredness)13,3184.7
4.6–4.8ROR 5.4 · calibrated p 0.191
4.6 EB05 4.6 · IC025 +2.2
3/3 methods agree
Not in label — unassessedage-adj. PRR 3.8 · serious PRR 5.8no trial arm names this drug
Joint swelling12,74431.8
31.3–32.4ROR 37.9 · calibrated p 7e-5 ✓
28.5 EB05 28.1 · IC025 +4.8
3/3 methods agree
Not in label — unassessedage-adj. PRR 26.5 · serious PRR 33.1no trial arm names this drug
Off label use (used outside approved label)11,1293.5
3.4–3.6ROR 3.9 · calibrated p 0.396
3.5 EB05 3.4 · IC025 +1.8
3/3 methods agree
Reporting / coding artifactage-adj. PRR 3.3 · serious PRR 4.3no trial arm names this drug
Rash10,9877.0
6.9–7.1ROR 8.0 · calibrated p 0.067
6.8 EB05 6.7 · IC025 +2.7
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 6.3 · serious PRR 10.0no trial arm names this drug
Abdominal discomfort10,04517.2
16.9–17.5ROR 19.6 · calibrated p 0.002 ✓
16.2 EB05 15.9 · IC025 +4.0
3/3 methods agree
Not in label — unassessedage-adj. PRR 14.5 · serious PRR 24.4no trial arm names this drug
Contraindicated product administered9,681127.7
124.8–130.7ROR 145.7 · calibrated p 6e-9 ✓
86.5 EB05 85.1 · IC025 +6.4
3/3 methods agree
Reporting / coding artifactage-adj. PRR 104.7 · serious PRR 73.6no trial arm names this drug
Condition aggravated9,5938.8
8.6–9.0ROR 9.9 · calibrated p 0.033 ✓
8.6 EB05 8.4 · IC025 +3.1
3/3 methods agree
Reporting / coding artifactage-adj. PRR 7.9 · serious PRR 8.7no trial arm names this drug
Alopecia (hair loss)9,47413.6
13.3–13.9ROR 15.3 · calibrated p 0.006 ✓
13.0 EB05 12.8 · IC025 +3.7
3/3 methods agree
Labeled adverse reaction
exact term
age-adj. PRR 10.3 · serious PRR 18.7 · ♀ 97% (drug 77%)no trial arm names this drug
Synovitis9,222284.5
276.5–292.8ROR 322.7 · calibrated p 5e-12 ✓
137.7 EB05 135.4 · IC025 +7.1
3/3 methods agree
Not in label — unassessedserious PRR 98.8no trial arm names this drug
Arthropathy9,21653.3
52.2–54.4ROR 60.3 · calibrated p 4e-6 ✓
44.5 EB05 43.8 · IC025 +5.4
3/3 methods agree
Not in label — unassessedage-adj. PRR 45.4 · serious PRR 37.2no trial arm names this drug

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Sulfasalazine?

In FDA FAERS, the most frequently co-reported reaction terms for Sulfasalazine are rheumatoid arthritis, pain, arthralgia, fatigue, joint swelling, rash. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Sulfasalazine have an FDA boxed warning?

No. The FDA label retrieved for Sulfasalazine has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Sulfasalazine causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-14. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.