Home Drug Guide Mesalamine

Drug Guide

Generic Name

Mesalamine

Brand Names Rowasa, Sfrowasa, Asacol, Pentasa, Canasa, Asacol Hd, Lialda, Apriso, Delzicol

Classification

Therapeutic: Aminosalicylate anti-inflammatory

Pharmacological: Drug that reduces inflammation by inhibiting prostaglandin and leukotriene synthesis

FDA Approved Indications

Ulcerative colitis
Crohn's disease (certain formulations)

Mechanism of Action

Mesalamine exerts its anti-inflammatory effects locally in the gastrointestinal tract by inhibiting cyclooxygenase (COX) and lipoxygenase pathways, thus reducing the production of inflammatory prostaglandins and leukotrienes.

Dosage and Administration

Adult: Varies based on formulation; typically, 800 mg to 4,000 mg daily divided into doses, taken orally or rectally as prescribed.

Pediatric: Use with caution; dosing depends on age and weight, consult specific formulation guidelines.

Geriatric: Adjust dosing based on renal and hepatic function; monitor for adverse effects.

Renal Impairment: Altered dosing; close monitoring recommended.

Hepatic Impairment: Adjustments may not be necessary, but caution advised.

Pharmacokinetics

Absorption: Limited absorption from the gastrointestinal tract, especially with rectal forms.

Distribution: Primarily local, minimal systemic distribution.

Metabolism: Partially metabolized in the intestinal wall.

Excretion: Excreted primarily in feces; minimal renal excretion.

Half Life: Approximately 7 hours, varies based on formulation.

Contraindications

Hypersensitivity to mesalamine or salicylates.
History of hypersensitivity reactions to 5-aminosalicylic acid products.

Precautions

Monitor renal function; use cautiously in renal impairment.
Use with caution in hepatic impairment.
Patients with infections or known TB should be monitored carefully.

Adverse Reactions - Common

Headache (Common)
Nausea (Common)
Abdominal pain (Common)
Flatulence (Common)

Adverse Reactions - Serious

Pancreatitis (Uncommon)
Rectal bleeding (with rectal formulations) (Uncommon)
Hypersensitivity reactions, including rash and fever (Uncommon)
Acute intolerance syndrome (fever, eosinophilia, malaise) (Rare)

Drug-Drug Interactions

Azathioprine or 6-mercaptopurine (may increase risk of pancreatitis)
Other NSAIDs

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor renal function, complete blood count, and liver function tests periodically.

Diagnoses:

Risk for renal impairment
Impaired comfort related to gastrointestinal discomfort

Implementation: Administer as prescribed; educate patient on correct administration, especially for rectal formulations.

Evaluation: Assess symptom improvement and monitor for adverse effects.

Patient/Family Teaching

Take medication as directed.
Report any signs of allergic reactions, sore throat, unusual bleeding, or symptoms of pancreatitis.
Maintain hydration and follow dietary guidance.
Be aware of possible gastrointestinal side effects.

Special Considerations

Black Box Warnings:

Potential for increased risk of cardiovascular, renal, and gastrointestinal adverse effects with high-dose or long-term use.
Rare reports of cardiac hypersensitivity reactions.

Genetic Factors: N/A

Lab Test Interference: May cause elevated serum amylase or lipase during pancreatitis.

Overdose Management

Signs/Symptoms: Nausea, vomiting, abdominal pain, bleeding, tinnitus (rare).

Treatment: Supportive care; activated charcoal if ingestion was recent; hemodialysis in severe cases.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C); protect from moisture.

Stability: Stable under recommended storage conditions.