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Mesalamine 5 ASA Brand Names
Apriso | Asacol | Asacol HD | Canasa | Delzicol | Lialda | Pentasa | Rowasa | sfRowasa
What is Mesalamine 5 ASA
Mesalamine is a 5-aminosalicylate (5-ASA).
Mesalamine is used, either orally or rectally, as an anti-inflammatory agent in treating ulcerative colitis (UC).
The clinical response to 5-ASA is believed to be due to a local effect. The guidelines support the use of high to standard-dose oral mesalamine (2 to 3 grams/day) or diazo-bonded 5-ASAs (balsalazide or olsalazine) for induction and maintenance of remission in patients with extensive mild to moderate UC.
Fewer patients on the high-to-standard doses of 5-ASA experienced relapse of their quiescent disease compared with those on lower doses (RR of relapse, 0.79; 95% CI, 0.64 to 0.97).
Those with moderate symptoms of UC may benefit from early use of combination oral and rectal 5-ASA; use of combined oral and rectal 5-ASA in patients with extensive disease may improve rates of induction of remission.
Escalation to high-dose (i.e., more than 3 grams/day) oral with rectal 5-ASA in patients with suboptimal response to standard-dose therapy may also be beneficial. In patients with inadequate response to optimized 5-ASA, consider oral prednisone or budesonide MMX 9 mg/day to induce remission instead of changing to an alternate 5-ASA formulation.
Systemic corticosteroids should not be used for maintenance of remission in patients with UC.
In patients with mildly active ulcerative proctitis, rectal 5-ASA at a dose of 1 gram/day should be used to maintain remission rather than oral 5-ASA. Those patients with suboptimal response or intolerance to rectal mesalamine may opt to use rectal corticosteroid enemas or foams.
Oral mesalamine has not been consistently been demonstrated to be effective compared with placebo for induction of remission and achieving mucosal healing in patients with active Crohn’s disease (CD) and should not be used to treat patients with active CD.
Mesalamine is ineffective for fistulizing CD. The drug is is a safe but minimally effective medication to prevent postoperative CD recurrence; 5-ASA is of limited beneit in preventing postoperative CD but is an option (vs. no treatment) for patients with an isolated ileal resection and no risk factors for CD recurrence, or if immunosuppressive therapy (e.g., thiopurine treatment) is not warranted or is contraindicated
Indications
- proctitis
- ulcerative colitis
For the treatment of ulcerative colitis
for induction of remission of mild to moderate active ulcerative colitis
Side Effects
- abdominal pain
- acne vulgaris
- agranulocytosis
- alopecia
- anaphylactoid reactions
- anemia
- angioedema
- anorexia
- aplastic anemia
- arthralgia
- back pain
- chest pain (unspecified)
- cholangitis
- cholecystitis
- cholestasis
- colitis
- conjunctivitis
- constipation
- cough
- depression
- diabetes insipidus
- diaphoresis
- diarrhea
- dizziness
- drowsiness
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
- dyspepsia
- dysphagia
- dyspnea
- ecchymosis
- edema
- elevated hepatic enzymes
- eosinophilia
- eructation
- erythema nodosum
- esophageal ulceration
- fatigue
- fecal incontinence
- fever
- flatulence
- gastritis
- GI bleeding
- Guillain-Barre syndrome
- headache
- hematuria
- hemorrhoids
- hepatic failure
- hepatic necrosis
- hepatitis
- hyperamylasemia
- hypertension
- hypotension
- increased intracranial pressure
- increased urinary frequency
- infection
- influenza
- insomnia
- interstitial lung disease
- interstitial nephritis
- jaundice
- leukopenia
- lupus-like symptoms
- lymphadenopathy
- malaise
- melena
- menorrhagia
- migraine
- myalgia
- myelitis
- myocarditis
- nausea
- nephrotic syndrome
- nephrotoxicity
- neutropenia
- oligospermia
- oral ulceration
- palpitations
- pancreatitis
- pancytopenia
- paresthesias
- pericardial effusion
- pericarditis
- peripheral neuropathy
- peripheral vasodilation
- pharyngitis
- photosensitivity
- pneumonitis
- proctitis
- proteinuria
- pruritus
- psoriasis
- pulmonary fibrosis
- rash
- renal failure (unspecified)
- rhinitis
- sinus tachycardia
- sinusitis
- Stevens-Johnson syndrome
- stool discoloration
- syncope
- tenesmus
- thrombocytopenia
- tremor
- urticaria
- vomiting
- weakness
- xerosis
Monitoring Parameters
- CBC
- LFTs
- serum creatinine
Contraindications
- 5-aminosalicylates hypersensitivity
- breast-feeding
- children
- colitis
- eczema
- geriatric
- GI obstruction
- hemochromatosis
- hepatic disease
- infants
- laboratory test interference
- neonates
- phenylketonuria
- pregnancy
- pyloric stenosis
- renal disease
- renal failure
- renal impairment
- salicylate hypersensitivity
- skin photosensitivity disorder
- sulfite hypersensitivity
- sunlight (UV) exposure
Interactions
- Aluminum Hydroxide
- Aluminum Hydroxide; Magnesium Carbonate
- Aluminum Hydroxide; Magnesium Hydroxide
- Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
- Aluminum Hydroxide; Magnesium Trisilicate
- Amlodipine; Celecoxib
- Amoxicillin; Clarithromycin; Lansoprazole
- Amoxicillin; Clarithromycin; Omeprazole
- Antacids
- Aspirin, ASA; Citric Acid; Sodium Bicarbonate
- Aspirin, ASA; Omeprazole
- Azathioprine
- Calcium Carbonate
- Calcium Carbonate; Magnesium Hydroxide
- Calcium Carbonate; Risedronate
- Calcium Carbonate; Simethicone
- Celecoxib
- Cimetidine
- Dexlansoprazole
- Diclofenac
- Diclofenac; Misoprostol
- Diflunisal
- Digoxin
- Diphenhydramine; Ibuprofen
- Diphenhydramine; Naproxen
- Esomeprazole
- Esomeprazole; Naproxen
- Etodolac
- Famotidine
- Famotidine; Ibuprofen
- Fenoprofen
- Flurbiprofen
- H2-blockers
- Hydrocodone; Ibuprofen
- Ibuprofen
- Ibuprofen; Oxycodone
- Ibuprofen; Pseudoephedrine
- Indomethacin
- Ketoprofen
- Ketorolac
- Lansoprazole
- Lansoprazole; Naproxen
- Magnesium Hydroxide
- Meclofenamate Sodium
- Mefenamic Acid
- Meloxicam
- Mercaptopurine, 6-MP
- Nabumetone
- Naproxen
- Naproxen; Pseudoephedrine
- Naproxen; Sumatriptan
- Nizatidine
- Nonsteroidal antiinflammatory drugs
- Omeprazole
- Omeprazole; Amoxicillin; Rifabutin
- Omeprazole; Sodium Bicarbonate
- Oxaprozin
- Pantoprazole
- Piroxicam
- Porfimer
- Proton pump inhibitors
- Rabeprazole
- Ranitidine
- Rofecoxib
- Sodium Bicarbonate
- Sulindac
- Thioguanine, 6-TG
- Tolmetin
- Valdecoxib
- Verteporfin
- Warfarin
