1. Gastro-intestinal system (drugs 2)

Question 1

Mesalazine - MOA

Answer 1

Mesalazine (also known as 5-aminosalicylic acid) has an anti-inflammatory effect through a mechanism that has not been fully clarified.
May restrict migration of macrophages to inflamed areas.

Question 2

Mesalazine - screening points (7)

Answer 2

1. UC + Crohn’s
2. CIs: severe liver impairment, severe renal impairment (<30), blood clotting disease, if severe salicylate hypersensitivity (cross-sensitivity)
3. Warfarin (may decrease anticoagulant effect). Also azathioprine, 6-MCP or thioguanine may increase myelosuppressive effects.
4. Patients need to remain well hydrated. Stop immediately if evidence of renal impairment. Avoid if eGFR<20. Manufacturer advises caution in mild to moderate hepatic impairment.
5. Negligible quantities cross placenta, monitor breast fed infant for diarrhoea, Not licensed for pts <5 y.
6. Monitor renal function before starting an oral aminosalicylate, at 3 months and then annually during treatment
7. No evidence to show that any one preparation of oral mesalazine (available as oral/ suppository/ enema) is more effective than another, however, the delivery characteristics of preparations may vary. If necessary to switch to a different brand, advise patients to report any changes in symptoms.

Question 3

Mesalazine - counselling points

Answer 3

1. Advise to report any unexplained bleeding, brusining purpura, sore throat, fever or malaise that occurs during treatment. If necessary to change to a different brand, advise patient to report any changes in symptoms.
2. For M/R tabs other than pentasa: take with or just after food/ a meal. Swallow whole. For G/R tablets other than Octasa: do not take indigestion remidies 2 hours before or after taking this medicine. Swallow whole. For M/R granules: swallow whole.
3. Eat and drink normally when taking. Make sure to drink adequate fluids, especially if unwell. To avoid problems with kidney.