1. Overview

• Generic name: Mesalazine
• Brand names: Apriso, Asacol, Canasa, Lialda, Pentasa, Rowasa
• Drug class: Anti-inflammatory

Mesalazine (also known as mesalamine) is a salicylic acid derivative. It has anti-inflammatory effect and sometimes it is used with other medications (e.g. corticosteroid).

Mesalazine (Lialda) is a prescription medication that is used in the treatment of ulcerative colitis and Crohn’s disease. It is available as tablets, granules, suppositories and enema.

2. Uses

Mesalazine (mesalamine) is an anti-inflammatory agent that reduces inflammation in colon. It acts by inhibiting the production of prostaglandin in the colon.

Oral mesalazine: is usually used in the treatment and maintenance of remission of mild to moderate active ulcerative colitis.

Rectal mesalazine: is used to treat active distal ulcerative colitis, proctosigmoiditis or proctitis.

3. Dosage forms & strengths

Mesalazine (Lialda) is available as:

Rectal dosage forms

Oral dosage forms

1. Rectal Suspension: 4 g/60 mL
2. Suppository: 1000mg
3. Controlled-Release Capsules: 250 mg, 500 mg
4. Extended-Release Capsules: 375 mg
5. Delayed-Release Capsules: 400 mg
6. Delayed-Release Tablets: 400mg, 800 mg, 1.2 g

4. How and when to use mesalazine?

Mesalazine suppository, suspension and oral forms should be stored at room temperature and protected from light. If the disease affects lower colon and the rectum, using mesalazine suppositories and enemas will be useful.

Tablets should be taken as whole (not chewed) three times daily, while suppositories should be used once daily at bedtime.

Delayed-release or controlled-release forms should not be crushed.

If you forget a dose, take the missed dose as soon as you remember, however, if you are supposed to take your next dose within 2 hours, take one dose now and skip the next dose. Do not stop taking mesalazine without consulting your doctor.

5. Special precautions

Before using this drug, consult your doctor if:

• You have blood clotting abnormalities.
• You have long-term liver diseases.
• You are allergic to mesalazine, sulfites or any salicylates.
• You are taking other drugs.
• You have renal impairment.

Pregnancy and breastfeeding:

Small amounts of mesalazine cross the placenta and pass into breast milk. However, it should be used with caution in pregnant and breast-feeding patients. It is best to discuss the matter with your doctor.

It is not recommended for use in infants and children under 15 years.

6. Who cannot take mesalazine?

Mesalazine is not suitable for certain individuals who:

• Have diseases such as pericarditis, myocarditis
• Are hypersensitive to mesalazine
• Have active peptic ulcer

In elderly dose reduction may be necessary, especially in those with kidney impairment.

7. Mesalazine side effects

The most common side effects of the drug are on the gastrointestinal tract. Common side effects of mesalazine include:

• Diarrhea
• Dizziness
• Nausea
• Vomiting
• Abdominal pain
• Fatigue

On rare occasions, you might have:

• Hair loss
• Decreased appetite
• Flatulence
• worsening of colitis
• Back or joint pain
• Anal irritation

Mesalazine side effects in detail.

8. Interactions

Mesalazine can interact with several drugs and other substances resulting in undesired effects. Interaction can affect activity of the drug or increase severity of side effects.

1. Lactulose: lactulose reduce the release of mesalazine at its site of action.
2. Warfarin: Effect of warfarin is reduced by Mesalazine.
3. Azathioprine and Mercaptopurine: these drugs can increase the risk of blood problems if used with Mesalazine.

Formulation related interactions

These interactions are specific to a brand of mesalazine named Apriso, drugs that interact with Apriso include:

1. Antacids: these drugs may decrease the therapeutic effect of Mesalazine.
2. H2-Antagonists: May decrease the effect of Mesalazine.
3. Proton Pump Inhibitors (e.g. omeprazole, lansoprazol): Can reduce the therapeutic effect of Mesalazine.