Sulfasalazine drug monitoring in primary care during COVID-19

The following advice is for the management of patients taking DMARDs for rheumatology related conditions. 

General guidance on management of rheumatology patients during COVID-19 is available from the British Society for Rheumatology.

This page gives advice on drug monitoring in primary care during COVID-19 for sulfasalazine when used as a DMARD in stable patients (stable patients defined as those who have been on current treatment for >12 months and at a stable dose for >6 weeks)

Advice on drug monitoring for other medicines during COVID-19 is here

For sulphasalazine, the usual monitoring recommendations are:

  • After 12 months, no routine monitoring required unless patient is at high risk of toxicity in which case monitoring may be more frequent

During the COVID-19 pandemic, recommendations are: 

  • No change to the existing monitoring regimen is recommended

For patients with symptoms of COVID-19, recommendations are:

  • NICE and the BSR recommend to continue sulfasalazine in patients known or suspected to have COVID‑19
  • Refer patients to advice from Versus Arthritis

This page was developed in conjunction with Kalveer Flora, Chair, Rheumatology Pharmacists UK (RPUK); Lead Pharmacist, Specialised Rheumatology CRG for NHS England.  We are hugely grateful for her input.

This advice has been developed quickly in response to the COVID-19 pandemic; if you spot anything that’s wrong report a concern to us.