Indications
Mesalamine (also called mesalazine or 5-aminosalicylic acid) is used to treat mild to moderate ulcerative colitis, a long-term inflammation of the large bowel and rectum that causes bloody diarrhoea, stomach cramps and urgency. It is used both to settle flare-ups and to keep the disease in remission (calm). It is also sometimes used in Crohn’s disease affecting the colon. Suppositories and enemas are used when inflammation is in the rectum or lower colon.
How It Works
Mesalamine works directly on the lining of the bowel. It reduces the production of inflammatory substances such as prostaglandins and leukotrienes and calms the immune reaction in the bowel wall, which helps the lining heal. Tablets and capsules are specially coated to release the medicine in the lower intestine where it is needed.
Dosage and Administration
The dose depends on the product (delayed-release tablets, prolonged-release granules or capsules, suppositories or enemas) and on whether you are treating a flare or preventing one, so use it as prescribed. Swallow tablets whole; do not crush or chew them. Suppositories are usually inserted at bedtime after emptying the bowel. Drink plenty of fluids. Keep taking it even when you feel well, as stopping can lead to a relapse.
Interactions
- Azathioprine and Mercaptopurine: higher risk of low blood counts.
- Warfarin: its effect may be reduced.
- NSAIDs (such as Ibuprofen) and other medicines that can harm the kidneys: increased risk of kidney problems.
- Lactulose or other medicines that make stools more acidic: may reduce release of some delayed-release forms.
Contraindications
Do not use if you are allergic to mesalamine, salicylates (such as Aspirin) or any ingredient, or if you have severe kidney or liver disease.
Side Effects
- Headache.
- Stomach pain, nausea, wind, diarrhoea.
- Rash or itching.
- Rarely: kidney inflammation, liver problems, inflammation of the pancreas, heart muscle or lining of the heart, lung inflammation, or low blood counts.
- A reaction that looks like a worsening of colitis (cramps, bloody diarrhoea, fever) soon after starting.
Get urgent medical help for chest pain or breathlessness, severe stomach pain spreading to the back, yellow skin or eyes, unexplained bruising, bleeding, sore throat or fever, a severe skin rash with blisters or peeling, much less urine than usual, or sudden worsening of diarrhoea with fever after starting the medicine.
Pregnancy and Lactation
Mesalamine is generally considered suitable in pregnancy when needed, as keeping colitis under control is important for mother and baby; use only as advised by your doctor. Small amounts pass into breast milk; it is usually considered compatible with breastfeeding, but watch the baby for diarrhoea and tell your doctor if it occurs.
Precautions and Warnings
Your doctor will check kidney function before starting and regularly during treatment, and may check blood counts and liver tests. Tell your doctor if you have kidney or liver problems, asthma, heart problems or a history of allergy to Sulfasalazine. Kidney stones have been reported; drink enough fluids. Some products may cause orange or red urine discolouration or harmless ghost tablets in the stool.
Overdose
Overdose may cause symptoms like salicylate toxicity, such as ringing in the ears, nausea, vomiting, fast breathing and confusion. Seek medical help.
Therapeutic Class
Aminosalicylate (intestinal anti-inflammatory agent).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Suppositories: store below 25°C as directed on the pack.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.