Pharm

Sulfa-free 5-Aminosalacylic acid

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Sulfa-free 5-Aminosalacylic acid, Sulfa-free 5-ASA, Mesalamine, Asacol, Pentasa, Rowasa, Lialda, Delzicol

  • 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. Lialda 1200 mg, 2-4 tabs PO once daily
    4. Apriso 1.5 grams orally every morning
  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. Kornbluth (2010) Am J Gastroenterol 105(3): 501-23 [PubMed]