5-Aminosalicylates

Question 1

What is an example of 5-ASA

Answer 1

Sulfasalizine, mesalizine

Question 2

What are the indications for 5-ASA use

Answer 2

• UC (mild-mod)
• Crohn’s
• Rheumatoid Arthritis (sulfasalizine)

Question 3

What is the mechanisms of action

Answer 3

• Pro-drugs reduced by bowel flora
• 5-aminosalicylate is an anti-inflammatory
• Works in large intestine

Mechanism still unclear

Question 4

What are the side effects

Answer 4

• GI upset (D, V, N, abdo pain, dyspepsia)
• Headache

Rarely
- blood dyscrasias (leucopenia, thrombocytopenia), low sperm count, hypersensitivity (inc fever, rash + liver abnormalities), renal impairment

Question 5

What are the contraindications

Answer 5

• Salicylate/ aspirin hypersensitivity
• Renal impairment
• severe liver disease

Question 6

What are the interactions

Answer 6

• Some have pH-sensitive coating –> interact with PPIs (^ acid so premature break down) + lactulose (lowers pH + may prevent release)

Question 7

Important notes

Answer 7

Mesalazine has fewer side effects

Sulfasalazine contains a sulphonamide

Allergy to this very common

Also causes many of 5-ASA side effects

Monitor U&E 3 months prior to starting and
annually during treatment.

Granules, tablets or suppository