Azulfidine (Sulfasalazine) and Alcohol

Sulfasalazine is an anti-inflammatory medication used to treat arthritic conditions, such as rheumatoid arthritis and autoimmune disorders, including inflammatory bowel disease.

Using alcohol while taking sulfasalazine can potentially lead to liver injury in people who have liver disease, hypersensitivity, or a drug allergy to the medication. Allergic reactions tend to occur soon after starting the medication, and acute liver failure is possible. Sulfasalazine has, in some cases, been shown to cause liver disease—with or without concurrent use of alcohol.

Alcohol and opioids a deadly combination - stock photo


Mixing Alcohol and Medications

Using alcohol while taking certain medications regularly can be dangerous. Some interactions may be acute, potentially causing an immediate life-threatening reaction and some interactions can lead to gradual health issues.

Azulfidine and Alcohol

There is no specific mention of avoiding alcohol on the FDA label for sulfasalazine.

Heavy alcohol use while taking the medication can have adverse effects on the body, and there are rare reports of liver damage that has been attributed to using sulfasalazine with heavy alcohol use.

In one case report, a 57-year-old man who had a history of alcoholism and had just started taking sulfasalazine was hospitalized with signs of liver injury. When the medication was stopped, his liver functions significantly improved, which suggested that the liver injury was drug-induced and was not solely caused by his prior alcohol misuse.

How Much Can You Drink While on Sulfasalazine

Although the exact amount of alcohol that is safe to consume with sulfasalazine has not been definitively established, one or two alcoholic drinks a week are unlikely to cause a problem. More than four drinks on one occasion, even if infrequently, is discouraged for people who are taking sulfasalazine.

Liver toxicity from heavy alcohol use while on sulfasalazine can include:

The risk of liver toxicity with alcohol and sulfasalazine is associated with the breakdown of sulfasalazine into sulfapyridine and 5-aminosalicylic acid. Sulfapyridine undergoes a chemical reaction, and is then absorbed in the gut and eliminated. The speed of this process can vary based on a genetic predisposition. People who have a slower process of breaking down and absorbing sulfapyridine can be more predisposed to sulfasalazine-induced liver toxicity.

Liver Toxicity

In rare instances, sulfasalazine can lead to liver toxicity if alcohol is consumed.

Liver injury can be an adverse effect of sulfasalazine. When taking sulfasalazine, it is recommended to have liver function tests on a regular basis to monitor for possible liver damage.

Alcohol can also cause liver injury, and using two substances that can damage the liver may increase the likelihood of this effect.

Guideline for Alcohol Consumption

According to the Centers for Disease Control and Prevention, if alcohol is consumed, it should be consumed in moderation—up to one drink per day for women and two drinks per day for men.This is a guideline for people who do not have any risk factors for liver damage.

A Word From Verywell

Moderate consumption of alcohol is generally safe if you are using sulfasalazine. However, it is best to check with your healthcare provider, as you could have additional health issues that may make this combination unsafe for you. Be sure to tell your practitioner and pharmacist about any vitamins, supplements, and herbs that you take—they can also interact with alcohol or with medications such as sulfasalazine.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Sulfasalazine.

  2. Food and Drug Administration. Azulfidine label.

  3. Masood U, Sharma A, Nijjar S, Krenzer B. Unusual Case of an Alcoholic with Liver Injury from Sulfasalazine Use. J Basic Clin Pharm. 2016 Dec;8(1):38-39. doi: 10.4103/0976-0105.195126

  4. Australian Rheumatology Association. Patient Information on Sulfasalazine.

  5. Centers for Disease Control and Prevention. Dietary Guidelines for Alcohol.

By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.