page83
Suppositories
,
mesalazine 500 mg.
Net price 30-
suppos pack = £14.81.
Counselling,
blood disorder
symptoms (see recommendation above)
Dose
ADULT and CHILD over 15 years, acute attack,
by rectum,
0.5–1 g 2–3 times daily adjusted according to response;
CHILD 12–
15 years see
BNF for Children
Enema
,
mesalazine 2 g in 59-mL pack.
Net price 7
enemas = £29.92.
Counselling,
blood disorder symp-
toms (see recommendation above)
Dose
acute attack
or
maintenance,
by rectum,
2 g daily at bed-
time;
CHILD 12–18 years see
BNF for Children
Rectal foam
, mesalazine 1 g/metered application, net
price 14-application canister with disposable appli-
cators and plastic bags = £30.17.
Counselling,
blood
disorder symptoms (see recommendation above)
Excipients
include cetostearyl alcohol,
disodium edetate, polysorbate
60,
propylene glycol,
sodium metabisulphite
Dose
mild ulcerative colitis affecting sigmoid colon and rectum,
ADULT and CHILD over 12 years,
2 metered applications (mesal-
azine 2 g) into the rectum at bedtime or in 2 divided doses
OLSALAZINE SODIUM
Indications
treatment of mild ulcerative colitis and
maintenance of remission
Cautions
see notes above; interactions: Appendix 1
(aminosalicylates)
Blood disorders
See recommendation above
Contra-indications
see notes above
Renal impairment
use with caution;
manufacturer
advises avoid in significant impairment
Pregnancy
manufacturer advises avoid unless poten-
tial benefit outweighs risk
Breast-feeding
monitor infant for diarrhoea
Side-effects
see notes above;
watery diarrhoea com-
mon;
also reported,
tachycardia, palpitation,
pyrexia,
blurred vision,
and photosensitivity
Dose
.
ADULT
and
CHILD
over 12 years,
acute attack,
1 g daily
in divided doses after meals increased if necessary
over 1 week to max. 3 g daily (max.
single dose 1 g);
maintenance,
500 mg twice daily after meals
.
CHILD
under 12 years see
BNF for Children
Dipentum
c
(UCB Pharma) A
Capsules
,
brown,
olsalazine sodium 250 mg.
Net
price 112-cap pack = £19.77.
Label:
21,
counselling,
blood disorder symptoms (see recommendation
above)
Tablets
,
yellow,
scored,
olsalazine sodium 500 mg.
Net price 60-tab pack = £21.18. Label: 21, counselling,
blood disorder symptoms (see recommendation
above)
SULFASALAZINE
(Sulphasalazine)
Indications
treatment of mild to moderate and severe
ulcerative colitis and maintenance of remission; active
Crohn’s disease; rheumatoid arthritis (section 10.1.3)
Cautions
see notes above; also history of allergy or
asthma;
G6PD deficiency (section 9.1.5);
slow acety-
lator status;
risk of haematological and hepatic toxi-
city (differential white cell,
red cell,
and platelet
counts initially and at monthly intervals for first 3
months;
liver function tests at monthly intervals for
first 3 months); maintain adequate fluid intake; upper
gastro-intestinal side-effects common over 4 g daily;
acute porphyria (section 9.8.2);
interactions: Appen-
dix 1 (aminosalicylates)
Blood disorders
See recommendation above
Contra-indications
see notes above;
also sulphona-
mide hypersensitivity; child under 2 years of age
Hepatic impairment
use with caution
Renal impairment
risk of toxicity,
including crystal-
luria,
in moderate impairment—ensure high fluid
intake; avoid in severe impairment
Pregnancy
theoretical risk of neonatal haemolysis in
third trimester;
adequate folate supplements should
be given to mother
Breast-feeding
small amounts in milk (1 report of
bloody diarrhoea);
theoretical risk of neonatal hae-
molysis especially in G6PD-deficient infants
Side-effects
see notes above;
also cough,
insomnia,
dizziness,
fever,
blood disorders (including Heinz
body anaemia, megaloblastic anaemia), proteinuria,
tinnitus,
stomatitis,
taste disturbances,
and pruritus;
less commonly
dyspnoea,
depression,
convulsions,
vasculitis, and alopecia; also reported loss of appetite,
hypersensitivity reactions (including exfoliative
dermatitis,
epidermal necrolysis,
photosensitivity,
anaphylaxis,
serum sickness),
ataxia,
hallucinations,
aseptic meningitis,
oligospermia, crystalluria,
distur-
bances of smell, and parotitis;
yellow-orange disco-
loration of skin, urine, and other body fluids; some soft
contact lenses may be stained
Dose
. By mouth,
acute attack 1–2 g 4 times daily (but see
cautions) until remission occurs (if necessary corti-
costeroids may also be given), reducing to a main-
tenance dose of 500 mg 4 times daily;
CHILD
2–12
years see
BNF for Children
. By rectum,
in suppositories,
alone or in conjunction
with oral treatment 0.5–1 g morning and night after a
bowel movement;
CHILD
5–12 years see
BNF for
Children
Sulfasalazine
(Non-proprietary) A
Tablets
,
sulfasalazine 500 mg,
net price 112 = £6.74.
Label: 14, counselling, blood disorder symptoms (see
recommendation above), contact lenses may be
stained
Tablets
,
e/c,
sulfasalazine 500 mg.
Net price 112-tab
pack = £14.46.
Label:
5,
14, 25,
counselling,
blood
disorder symptoms (see recommendation above),
contact lenses may be stained
Brands include
Sulazine EC
c
Suspension
,
sulfasalazine 250 mg/5 mL,
net price
500 mL = £29.50.
Label:
14,
counselling,
blood dis-
order symptoms (see recommendation above),
con-
tact lenses may be stained
Excipients
may include alcohol
Salazopyrin
c
(Pharmacia) A
Tablets
,
yellow,
scored,
sulfasalazine 500 mg,
net
price 112-tab pack = £6.97.
Label:
14,
counselling,
blood disorder symptoms (see recommendation
above), contact lenses may be stained
EN-Tabs
c
(= tablets e/c), yellow,
f/c,
sulfasalazine
500 mg,
net price 112-tab pack = £8.43.
Label:
5,
14,
25,
counselling,
blood disorder symptoms (see
recommendation above), contact lenses may be
stained
Suppositories
, yellow, sulfasalazine 500 mg, net price
10 = £3.30.
Label:
14,
counselling,
blood disorder
symptoms (see recommendation above), contact
lenses may be stained
BNF 61
1.5.1 Aminosalicylates
63
1
Gastro-intestinal system