Mode of action
Exact mechanism unknown but exert local anti-inflammatory action in the bowel wall.
Indications
Inflammatory large bowel disease, acute and maintenance; Ulcerative colitis, rectal Ulcerative colitis, rectal
(suppository) and rectosigmoidal (enema) disease.
Contraindications
Allergy to salicylates.
Specific considerations
Renal impairment: use with caution; monitor regularly, especially in severe impairment; possible risk of worsening
renal impairment.
Hepatic impairment: use with caution in severe impairment as hepatically cleared.
Children: not marketed for use in children <12 years but dose below has been used
Surgery: continue treatment throughout perioperative period.
Pregnancy: safe to use; ADEC category C.
Breastfeeding: safe to use.
Adverse effects
More common with higher doses
Common: nausea, rash, headache, diarrhea.
Infrequent: interstitial nephritis.
Rare: neuropathy,. blood dyscrasias, pancreatitis (reversible), hepatitis.
Dosage
Ulcerative colitis
enema, rectal foam, 2–4 g once daily, enema, suppository, 1 g once daily.
Acute: tablet, 500 mg 3 times daily, tablet, granule, 500 mg – 1 g 3 times daily.
Maintenance: tablet, 250 mg 3 times daily, tablet, granule, 500 mg 3 times daily.
Crohn’s disease
Acute: tablet, 500 mg 3 times daily, tablet, 1–1.5 g 3 times daily.
Maintenance: tablet, 250 mg 3 times daily, tablet, 500 mg – 1 g 3 times daily.
Child: tablet, initially, 15–20 mg/kg 3 times daily; maintenance, 10 mg/kg 2–3 times daily.
Counselling
Swallow tablets or granules whole without chewing or crushing them.
Take tablets at least half an hour before food.
Practice points
the value of mesalazine in small bowel Crohn’s disease is controversial
Products
MESALAZINE ENEMA 1 GM (PENTASA®)
MESALAZINE POWDER 1 GM SACHET (PENTASA®)
MESALAZINE SUPP. 1 GM (PENTASA®)
MESALAZINE TABS 400 MG (ASACOL®, MEZACOL®)
MESALAZINE TABS 500 MG (PENTASA®)
