Pharm

Sulfa-free 5-Aminosalacylic acid

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Sulfa-free 5-Aminosalacylic acid, Sulfa-free 5-ASA, Mesalamine, Asacol, Pentasa, Rowasa, Mesalamine MMX, Lialda, Delzicol, Balsalazide Disodium, Giazo, Colazal

  • Mechanism
  1. 5-Aminosalicylic Acid Derivative
  • Indications
  1. Inflammatory Bowel Disease
    1. Ulcerative Colitis
    2. Crohns Disease
  • General
  1. Rectal forms are preferred for Proctitis
  2. Use oral and rectal forms combined for better results where pancolitis is present
  1. Oral
    1. Active disease: 2.4 to 4.8 grams/day divided 3 times daily
    2. Maintenance: 1.2 to 2.4 grams/day divided 3 times daily
  2. Suppository
    1. Active disease: 1000 mg once daily
    2. Maintenance: 500 mg once to twice daily
  3. Enema
    1. Active disease: 1 to 4 grams daily
    2. Maintenance: 2-4 grams daily to every third day
  1. Oral
    1. Asacol 800 mg orally three times daily
    2. Pentasa 1000 mg orally four times daily
    3. Mesalamine MMX (e.g. Lialda) 1200 mg orally twice daily (up to 2-4 tabs orally once daily or in divided dosing)
    4. Apriso 1.5 grams orally every morning
    5. Balsalazide Disodium (Giazo, Colazal) 750 mg orally three times daily
  2. Rectal (Provides high distal colon concentrations)
    1. Rowasa 500 mg suppository per Rectum twice daily
    2. Rowasa 4g in 60 ml Enema at bedtime
    3. Canasa 1000 mg rectal suppository at bedtime
  • Adverse Effects
  1. Interstitial Nephritis
  2. Suppositories and enemas may cause rectal irritation
  • References
  1. Adams (2013) Am Fam Physician 87(10): 699-705 [PubMed]
  2. Adams (2022) Am Fam Physician 105(4): 406-11 [PubMed]
  3. Kornbluth (2010) Am J Gastroenterol 105(3): 501-23 [PubMed]