Mesalazine
1111052
216994541
2008-06-04T03:48:40Z
SieBot
4005189
robot Adding: [[nl:Mesalazine]]
{{drugbox |
| IUPAC_name = 5-amino-2-hydroxybenzoic acid
| image = Mesalazine structure.svg
| width = 171
| CAS_number = 89-57-6
| ATC_prefix = A07
| ATC_suffix = EC02
| PubChem = 4075
| DrugBank = APRD01098
| C=7 | H=7 | N=1 | O=3
| molecular_weight = 153.135 g/mol
| smiles = Nc1ccc(O)c(c1)C(=O)O
| bioavailability = orally: 20-30% absorbed<br>rectally: 10-35%
| metabolism = Rapidly & extensively metabolised intestinal mucosal wall and the liver.
| elimination_half-life = 5 hours after initial dose.<br>At steady state 7 hours
| excretion =
| pregnancy_category =
| legal_status =
| routes_of_administration = oral [[rectal]]
}}
'''Mesalazine''' ([[International Nonproprietary Name|INN]], [[British Approved Name|BAN]]), also known as '''Mesalamine''' ([[United States Adopted Name|USAN]]) or '''5-aminosalicylic acid''' (5-ASA), is an [[anti-inflammatory]] [[medication|drug]] used to treat inflammation of the digestive tract ([[Crohn's disease]]) and mild to moderate [[ulcerative colitis]]. Mesalazine is a bowel-specific [[aminosalicylate]] drug that is metabolized in the gut and has its predominant actions there, thereby having fewer systemic side effects.
As a derivative of [[salicylic acid]], 5-ASA is also an [[antioxidant]] that traps [[free radicals]], which are potentially damaging by-products of metabolism.
5-ASA is considered the active [[Functional group|moiety]] of [[sulfasalazine]], which is metabolized to it.
==Formulations==
It is formulated for oral ingestion as tablets or granules, and for rectal administration as rectal [[suppository]], suspension or [[enema]]s. It is sold under a variety of brand names (UK: Asacol, Ipocal, Pentasa & Salofalk. US: Canasa, Rowasa, Pentasa, Asacol and Lialda). The newest of these is Lialda, approved by the FDA in January 2007 for induction of remission in ulcerative colitis. Its main benefit is that it needs to be taken only once a day, which provides convenient dosing regimen for patients.
LIALDA contains the highest mesalamine dose per tablet (1.2 g). Other currently available mesalamines require three to four times daily dosing and 6 to 16 pills a day. Whether convenience leads to improved compliance and adherence to therapy long term remains to be proven. Adherence to IBD therapy is multifactorial.
Dosing depends on the preparation used, in particular, slow-release tablets may have quite different drug delivery characteristics and are not interchangeable.
Preparations that lower stool pH (such as [[lactulose]], a laxative) will affect the binding of Mesalazine in the bowel and will therefore reduce its efficacy.
==Side effects==
Commonly:
* Diarrhea
* Nausea
* Cramping
* Flatulence <ref name="Lialda">{{cite web | title =Safety Information about Lialda | work =Lialda Side Effects | url=http://www.lialda.com/aboutLialda/sideEffect.asp | year = 2007 | month= Oct | publsiher=Shire US Inc., Wayne | accessdate=2008-01-07}}</ref>
Uncommonly:
* Headache
* Exacerbation of the colitis
* Hypersensitivity reactions (including rash, [[urticaria]], [[interstitial nephritis]] and [[lupus erythematosus]]-like syndrome)
* Hair Loss
* [[Interstitial nephritis]]
Rarely:
* Acute [[pancreatitis]],
* [[Hepatitis]]
* [[Nephrotic syndrome]]
* Blood disorders (including [[agranulocytosis]], [[aplastic anaemia]], [[leukopenia]], [[neutropenia]], [[thrombocytopenia]])
Mesalazine avoids the sulphonamide side effects of [[Sulfasalazine]] (which contains additional ([[sulfapyridine]]), but carries additional rare risks of:
* Allergic lung reactions
* Allergic [[myocarditis]]
* [[Methaemoglobinaemia]]
==Monitoring==
As a result of the small risks of kidney, liver and blood disorders, blood tests should be taken before and after starting treatment. Patients are advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment so that a [[full blood count]] can be urgently taken.
==References==
<references/>
* [[British National Formulary]] ''45'' March 2003
* {{cite book | editor= Edited by Sean C. Sweetman | title=[[Martindale: The complete drug reference]] | edition=34th edition | date=November 30, 2004 | publisher=Pharmaceutical Press | location=London | id= ISBN 0-85369-550-4}}
==External links==
* [http://healthcarebase.com/crohns-disease-5-asa-optimal-dosing.php Optimal Dosing of 5-Aminosalicylic Acid: 5 Decades of Choosing Between Politicians]
* [http://www.ccfa.org/reuters/mesalamine "Novel formulation increases efficacy of mesalamine for treating ulcerative colitis"] Reuters article on Lialda/Mezavant trial success.
* [http://www.asacol.com Asacol Official Site]
{{Antidiarrheals, intestinal anti-inflammatory/anti-infective agents}}
[[Category:Anti-inflammatory agents|*]]
[[Category:Gastroenterology]]
[[Category:Phenols]]
[[Category:Benzoic acids]]
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