1. Introduction
Mesalazine, also known as mesalamine or 5-aminosalicylic acid (5-ASA), is an anti-inflammatory medication primarily used to treat inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease. It works by reducing inflammation in the lining of the intestines, targeting the affected areas directly.
2. Indications
- Ulcerative colitis (active disease and maintenance of remission)
- Crohn’s disease (mild to moderate disease)
- Proctitis and proctosigmoiditis
- Inflammatory bowel disease-associated arthritis (off-label)
3. Dosage
Adults:
- Ulcerative colitis (active disease): 2.4–4.8 g daily in divided doses.
- Ulcerative colitis (maintenance): 1.2–2.4 g daily in divided doses.
- Crohn’s disease: 2.4–4.8 g daily in divided doses.
Children (≥5 years):
- Active ulcerative colitis: 20–30 mg/kg/day in divided doses (maximum 4 g/day).
- Maintenance: 15–20 mg/kg/day in divided doses (maximum 2 g/day).
4. Administration
- Oral tablets or granules should be swallowed whole, not crushed or chewed.
- Rectal formulations (suppositories, enemas) should be used as directed, preferably at bedtime to maximise contact time with the affected area.
- Take oral forms with or after food to reduce gastrointestinal side effects.
5. Forms Available
- Oral tablets: 400 mg, 800 mg, 1.2 g
- Granules: 1 g, 2 g, 4 g
- Suppositories: 500 mg, 1 g
- Enemas: 1 g, 4 g
6. Side Effects
6.1 Common Side Effects:
- Nausea
- Diarrhoea
- Abdominal pain
- Headache
6.2 Less Common Side Effects:
- Flatulence
- Rash
- Fever
- Joint pain
6.3 Rare but Serious Side Effects:
- Pancreatitis
- Acute kidney injury (interstitial nephritis)
- Severe allergic reactions (e.g., anaphylaxis)
- Blood disorders (e.g., agranulocytosis, thrombocytopenia)
7. Warnings
- Not recommended for use in patients with a history of salicylate allergy.
- May cause kidney or liver dysfunction; regular monitoring is essential for long-term use.
- Use cautiously in patients with severe liver or kidney impairment.
8. Precautions
- Ensure adequate hydration during treatment to reduce the risk of kidney stones.
- Discontinue if acute intolerance syndrome (e.g., cramping, bloody diarrhoea) occurs.
- Monitor for worsening symptoms, especially in the early weeks of treatment.
9. Interactions
- Anticoagulants/antiplatelet drugs: Increased risk of bleeding.
- NSAIDs: Increased risk of kidney damage.
- Azathioprine or 6-mercaptopurine: Increased risk of bone marrow suppression.
10. Monitoring Parameters
- Renal function (creatinine levels, urinalysis) before and during treatment.
- Liver function tests periodically.
- Complete blood count (CBC) if there are signs of infection or bleeding.
11. Use in Children
- Safe for children over 5 years old when used for inflammatory bowel disease under medical supervision.
- Dosage should be calculated based on body weight.
12. Use in Pregnancy
- Generally considered safe during pregnancy; mesalazine is classified as Category B (no evidence of risk in human studies).
- High doses may cause neonatal renal impairment—consult a doctor for dosage adjustments.
13. Use in Elderly
- Generally well-tolerated, but elderly patients are more prone to renal and hepatic dysfunction. Monitor kidney and liver function regularly.
14. Use in Kidney Disease
- Use with caution and monitor renal function closely, as mesalazine can cause interstitial nephritis.
- Dose adjustment may be necessary in patients with mild to moderate renal impairment.
15. Use in Liver Disease
- Use cautiously in patients with mild to moderate liver impairment. Avoid use in severe hepatic dysfunction.
16. Patient Counselling Points
- Take oral formulations with food and plenty of water to minimise stomach upset.
- Do not crush or chew tablets or granules; rectal formulations must be used as prescribed.
- Report any unusual symptoms, such as severe abdominal pain, blood in the stool, or dark urine.
- Stay well hydrated during treatment to reduce the risk of kidney-related side effects.
- Continue taking the medicine even if you feel better, as it helps maintain remission.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Pentasa | Ferring | 1 g Sachet, 500 mg Tablet | $50 (30 sachets) |
Asacol | Allergan | 400 mg Tablet, 800 mg Tablet | $75 (120 tablets) |
Lialda | Shire | 1.2 g Tablet | $450 (120 tablets) |
Canasa | Aptalis Pharma | 1 g Suppository | $250 (30 units) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Mesalazine?
Mesalazine is an anti-inflammatory medication used to treat inflammatory bowel diseases like ulcerative colitis and Crohn’s disease.
2. How does Mesalazine work?
It reduces inflammation in the intestinal lining by inhibiting the production of inflammatory chemicals like prostaglandins and leukotrienes.
3. What is the recommended dosage for Mesalazine?
Dosage depends on the condition. For active ulcerative colitis, 2.4–4.8 g daily in divided doses is common for adults.
4. Can Mesalazine be taken during pregnancy?
Yes, it is generally safe during pregnancy, but high doses should be used cautiously.
5. Can I use Mesalazine while breastfeeding?
Yes, it is considered safe during breastfeeding, but monitor the baby for diarrhoea or allergic reactions.
6. What are the common side effects of Mesalazine?
Common side effects include nausea, diarrhoea, and headache.
7. Are there any serious risks with Mesalazine?
Rare risks include pancreatitis, kidney injury, and blood disorders.
8. What should I do if I miss a dose?
Take the missed dose as soon as you remember unless it is close to the next dose. Do not double the dose.
9. What happens if I overdose on Mesalazine?
Overdose may cause severe diarrhoea, vomiting, or abdominal pain. Seek medical help immediately.
10. Can Mesalazine interact with other medicines?
Yes, it interacts with anticoagulants, NSAIDs, and immunosuppressants like azathioprine.
11. Is Mesalazine safe for children?
Yes, it is safe for children aged 5 and above under medical supervision.
12. Is Mesalazine safe for elderly patients?
Yes, but kidney and liver function should be monitored closely.
13. How should Mesalazine be stored?
Store in a cool, dry place at room temperature, away from direct sunlight.
14. Do I need a prescription for Mesalazine?
Yes, Mesalazine is a prescription-only medication.
15. Can Mesalazine be taken with alcohol or specific foods?
Alcohol is not contraindicated but may worsen gastrointestinal symptoms. Consult your doctor for advice.Mesalazine is an anti-inflammatory medicine for inflammatory bowel diseases like ulcerative colitis and Crohn’s disease. Learn about its uses, dosage, side effects, and patient tips.