mesalamine, Pentasa, Rowasa, Asacol, Lialda, Canasa
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: mesalamine (5-aminosalicylic acid)
BRAND NAMES: Pentasa, Rowasa, Asacol, Lialda, Canasa
DRUG CLASS AND MECHANISM: Mesalamine is a drug used for treating ulcerative colitis. The exact mechanism of mesalamine is not known but is believed to be by reducing inflammation in the colon. Ulcerative colitis and other inflammatory diseases cause excessive production of chemicals, for example, prostaglandins, that produce inflammation in the colon. Prostaglandins are produced by the enzymes, cyclooxygenase and lipoxygenase. These enzymes are over-active in individuals with ulcerative colitis. Mesalamine may work by blocking the activity of cyclooxygenase and lipoxygenase, thereby, reducing the production of prostaglandins. Reduced production of prostaglandins decreases inflammation in the colon and the symptoms associated with ulcerative colitis. Available forms of mesalamine differ in their route of administration and how often they are administered. Mesalamine was approved by the FDA in December 1987.
GENERIC AVAILABLE: Yes (rectal enema)
STORAGE: The tablets, capsules, and enemas should be stored at room temperature, 15-30 C (59-86 F). The suppositories should be stored below 25 C (77 F) without freezing.
PRESCRIBED FOR: Mesalamine is used for the treatment of mild to moderately severe ulcerative colitis. The suppositories are limited to use in ulcerative colitis involving only the rectum (proctitis) and the enemas to colitis involving only the part of the colon close to the rectum (distal colitis) or proctitis. While the benefits of mesalamine can be seen within 3 to 21 days of starting therapy, it may take up to three to six weeks for the enemas and suppositories, six weeks for the tablets, and eight weeks for the capsules to have maximum effect.
DRUG INTERACTIONS: Oral mesalamine formulations are associated with several drug interactions. Combining mesalamine with drugs that affect kidney function, for example, nonsteroidal antiinflammatory drugs (NSAIDs) or ibuprofen may increase the likelihood of reduced function of the kidneys. Concurrent use of mesalamine and 6-mercaptopurine or azathioprine (Imuran) may increase the likelihood of disorders of the blood cells, particularly reduced numbers of cells. Mesalamine may increase the blood thinning effect of warfarin (Coumadin).
PREGNANCY: There are no adequate human studies of mesalamine during pregnancy. Mesalamine is known to cross the placenta into the fetus, but animal studies revealed no evidence of harm to the fetus. Mesalamine should only be used during pregnancy if it is felt that the benefit of its use justifies the unknown risks.
NURSING MOTHERS: Mesalamine is excreted in breast milk. Mesalamine should only be used by nursing mothers if it is felt that the benefit of its use justifies the potential but unknown risk to the infant.
SIDE EFFECTS: The most common side effects of mesalamine are headache and flatulence. Hair loss and itching also may occur. Infrequent side effects include increased heart rate, acne, pancreatitis, back pain, fatigue, tremor, ear pain, and blood disorders.
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