Mesalamine 5 ASA

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

  1. abdominal pain
  2. acne vulgaris
  3. agranulocytosis
  4. alopecia
  5. anaphylactoid reactions
  6. anemia
  7. angioedema
  8. anorexia
  9. aplastic anemia
  10. arthralgia
  11. back pain
  12. chest pain (unspecified)
  13. cholangitis
  14. cholecystitis
  15. cholestasis
  16. colitis
  17. conjunctivitis
  18. constipation
  19. cough
  20. depression
  21. diabetes insipidus
  22. diaphoresis
  23. diarrhea
  24. dizziness
  25. drowsiness
  26. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  27. dyspepsia
  28. dysphagia
  29. dyspnea
  30. ecchymosis
  31. edema
  32. elevated hepatic enzymes
  33. eosinophilia
  34. eructation
  35. erythema nodosum
  36. esophageal ulceration
  37. fatigue
  38. fecal incontinence
  39. fever
  40. flatulence
  41. gastritis
  42. GI bleeding
  43. Guillain-Barre syndrome
  44. headache
  45. hematuria
  46. hemorrhoids
  47. hepatic failure
  48. hepatic necrosis
  49. hepatitis
  50. hyperamylasemia
  51. hypertension
  52. hypotension
  53. increased intracranial pressure
  54. increased urinary frequency
  55. infection
  56. influenza
  57. insomnia
  58. interstitial lung disease
  59. interstitial nephritis
  60. jaundice
  61. leukopenia
  62. lupus-like symptoms
  63. lymphadenopathy
  64. malaise
  65. melena
  66. menorrhagia
  67. migraine
  68. myalgia
  69. myelitis
  70. myocarditis
  71. nausea
  72. nephrotic syndrome
  73. nephrotoxicity
  74. neutropenia
  75. oligospermia
  76. oral ulceration
  77. palpitations
  78. pancreatitis
  79. pancytopenia
  80. paresthesias
  81. pericardial effusion
  82. pericarditis
  83. peripheral neuropathy
  84. peripheral vasodilation
  85. pharyngitis
  86. photosensitivity
  87. pneumonitis
  88. proctitis
  89. proteinuria
  90. pruritus
  91. psoriasis
  92. pulmonary fibrosis
  93. rash
  94. renal failure (unspecified)
  95. rhinitis
  96. sinus tachycardia
  97. sinusitis
  98. Stevens-Johnson syndrome
  99. stool discoloration
  100. syncope
  101. tenesmus
  102. thrombocytopenia
  103. tremor
  104. urticaria
  105. vomiting
  106. weakness
  107. 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
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