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MESALAZINE
Indications
treatment of mild to moderate ulcerative
colitis and maintenance of remission;
see also under
preparations
Cautions
see notes above; elderly;
interactions:
Appendix 1 (aminosalicylates)
Blood disorders
See recommendation above
Contra-indications
see notes above
Hepatic impairment
avoid in severe impairment
Renal impairment
use with caution;
avoid if eGFR
less than 20 mL/minute/1.73 m
2
Pregnancy
negligible quantities cross placenta
Breast-feeding
diarrhoea reported but negligible
amounts detected in breast milk;
monitor infant for
diarrhoea
Side-effects
see notes above
Dose
. See under preparations,
below
Note
The delivery characteristics of
oral
mesalazine pre-
parations may vary;
these preparations should not be con-
sidered interchangeable
Asacol
c
(Warner Chilcott) A
Foam enema
,
mesalazine 1 g/metered application,
net price 14-application canister with disposable
applicators and plastic bags = £26.72.
Counselling,
blood disorder symptoms (see recommendation
above)
Excipients
include disodium edetate, hydroxybenzoates (parabens),
polysorbate 20,
sodium metabisulphite
Dose
acute attack affecting the rectosigmoid region,
1 metered
application (mesalazine 1 g) into the rectum daily for 4–6 weeks;
acute attack affecting the descending colon,
2 metered applica-
tions (mesalazine 2 g) once daily for 4–6 weeks;
CHILD 12–18
years,
see
BNF for Children
Suppositories
,
mesalazine 250 mg,
net price 20-sup-
pos pack = £4.82;
500 mg,
10-suppos pack = £4.82.
Counselling,
blood disorder symptoms (see recom-
mendation above)
Dose
acute attack or maintenance, by rectum 0.75–1.5 g daily in
divided doses, with last dose at bedtime;
CHILD 12–18 years,
see
BNF for Children
Asacol
c
MR
(Warner Chilcott) A
Tablets
, red, e/c, mesalazine 400 mg, net price 90-tab
pack = £29.41,
120-tab pack = £39.21.
Label:
5,
25,
counselling,
blood disorder symptoms (see recom-
mendation above)
Dose
ulcerative colitis, acute attack, 2.4 g daily in divided doses;
maintenance of remission of ulcerative colitis and Crohn’s ileo-
colitis,
1.2–2.4 g daily in divided doses;
CHILD 12–18 years, see
BNF for Children
Tablets
, red-brown, e/c, mesalazine 800 mg, net price
180-tab pack = £117.62.
Label:
5,
25,
counselling,
blood disorder symptoms (see recommendation
above)
Dose
ADULT over 18 years, ulcerative colitis, acute attack,
2.4–
4.8 g daily in divided doses;
maintenance of remission of ulcer-
ative colitis and Crohn’s ileo-colitis, up to 2.4 g daily in divided
doses
Note
Preparations that
lower
stool
pH (e.g.
lactulose)
may
prevent release of mesalazine
Ipocol
c
(Sandoz) A
Tablets
,
e/c,
mesalazine 400 mg,
net price 120-tab
pack = £41.62.
Label:
5,
25, counselling,
blood dis-
order symptoms (see recommendation above)
Dose
acute attack,
2.4 g daily in divided doses;
maintenance,
1.2–2.4 g daily in divided doses;
CHILD 12–18 years,
see
BNF for
Children
Note
Preparations that lower stool pH (e.g. lactulose) may prevent
release of mesalazine
Mesren
c
MR
(IVAX) A
Tablets
, red-brown, e/c, mesalazine 400 mg, net price
90-tab pack = £19.50, 120-tab pack = £26.00. Label: 5,
25,
counselling,
blood disorder symptoms (see
recommendation above)
Dose
ADULT and CHILD over 12 years, ulcerative colitis,
acute
attack,
2.4 g daily in divided doses;
maintenance of remission of
ulcerative colitis and Crohn’s ileo-colitis, 1.2–2.4 g daily in divided
doses
Mezavant
c
XL
(Shire) A
Tablets
,
m/r,
red-brown,
e/c,
mesalazine 1.2 g,
net
price 60-tab pack = £62.44. Label: 21, 25, counselling,
blood disorder symptoms (see recommendations
above)
Dose
ADULT over 18 years, acute attack, 2.4 g once daily, increase
if necessary to 4.8 g once daily (review treatment at 8 weeks);
maintenance, 2.4 g once daily
Pentasa
c
(Ferring) A
Tablets
,
m/r,
scored,
mesalazine 500 mg (grey),
net
price 100-tab pack = £24.21.
Counselling,
adminis-
tration,
see dose,
blood disorder symptoms (see
recommendation above)
Dose
ADULT and CHILD over 15 years, acute attack, up to 4 g daily
in 2–3 divided doses; maintenance, 2 g once daily; tablets may be
dispersed in water,
but should not be chewed;
CHILD 5–15 years
see
BNF for Children
Granules
,
m/r,
pale grey-brown, mesalazine 1 g/
sachet, net price 50-sachet pack = £28.82; 2 g/sachet,
60-sachet pack = £72.05. Counselling, administration,
see dose,
blood disorder symptoms (see recommen-
dation above)
Dose
acute attack,
up to 4 g daily in 2–4 divided doses;
main-
tenance, 2 g once daily; granules should be placed on tongue and
washed down with water or orange juice without chewing;
CHILD
5–18 years see
BNF for Children
Retention enema
,
mesalazine 1 g in 100-mL pack.
Net price 7 enemas = £17.73.
Counselling,
blood
disorder symptoms (see recommendation above)
Dose
by rectum ADULT and CHILD over 12 years, 1 enema at
bedtime
Suppositories
,
mesalazine 1 g.
Net price 28-suppos
pack = £40.01. Counselling, blood disorder symptoms
(see recommendation above)
Dose
by rectum ulcerative proctitis, ADULT and CHILD over 15
years, acute attack, 1 g daily for 2–4 weeks; maintenance, 1 g daily;
CHILD 12–15 years see
BNF for Children
Salofalk
c
(Dr Falk) A
Tablets
,
e/c,
yellow,
mesalazine 250 mg.
Net price
100-tab pack = £16.19. Label: 5, 25, counselling, blood
disorder symptoms (see recommendation above)
Dose
acute attack,
0.5–1 g 3 times daily;
maintenance,
500 mg
three times daily;
CHILD 12–18 years see
BNF for Children
Granules
,
m/r,
grey,
e/c,
vanilla-flavoured, mesal-
azine 500 mg/sachet,
net price 100-sachet pack =
£28.74;
1 g/sachet,
50-sachet pack = £28.74;
1.5 g/
sachet,
60-sachet pack = £48.85.
Label:
25,
counsel-
ling,
administration,
see dose,
blood disorder symp-
toms (see recommendation above)
Excipients
include aspartame (section 9.4.1)
Dose
acute attack, 1.5–3 g once daily (preferably in the morning)
or
0.5–1 g 3 times daily; maintenance, 500 mg 3 times daily; CHILD
6–18 years see
BNF for Children
Counselling
granules should be placed on tongue and washed
down with water without chewing
Note
Preparations that lower stool pH (e.g. lactulose) may prevent
release of mesalazine
62
1.5.1 Aminosalicylates
BNF 61
1
Gastro-intestinal system