Aminosalicylates for Inflammatory Bowel Disease

Uses

Side Effects

Handling

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Uses

What is Aminosalicylates for Inflammatory Bowel Disease for?

Aminosalicylates or 5-ASAs are used for inducing and maintaining remission in Crohn’s Disease and Ulcerative Colitis. They reduce inflammation in the damaged lining of the intestine. Each brand works differently, releasing active drug in different part of the intestine. (Sulfasalazine may also be used in other condition like Rheumatoid Arthritis).

Your doctor will start you on the one that will give you the most benefit. It is important that you stick to the same medication unless your doctor tells you otherwise.

How should I take or use Aminosalicylates for Inflammatory Bowel Disease?

Oral 5-ASAs are usually taken twice or three times daily. Your doctor may start with a lower dose to minimize the side effects and increase the dose slowly over time.

Rectal 5-ASAs are usually given once at night, up to two times a day for severe condition.

Higher doses are usually given for acute attacks and lower doses are used to maintain remission.

Improvement in symptoms occur gradually, takes about 6-12 weeks to see effect.

How should it be taken?

Drugs	Route	Administration	Timing with regard to food
Salofalk ® (Mesalazine) Rectal Foam	Rectal	Refer to Mesalazine Rectal Foam PIL
Pentasa ® (Mesalazine PR) tablet	Oral	Swallow whole; if unable to swallow, tablets can be dissolved in about 50mL of water. Do not crush/chew the small granules	Take with or without food
Salofalk ® (Mesalazine EC) tablet	Oral	Cannot be crush/ chew/ cut. Swallow whole. (Due to pH-dependent release nature of drug). Take with plenty of fluid.	Take 30-60 min before food.
Sulfasalazine EC tablet	Oral	Recommended to swallow whole to prevent gastric side effects. If unable to swallow, tablet can be crushed/cut. Take with plenty of fluid.	Take with or after food to minimize side effects

What should I do if I forget to take or use Aminosalicylates for Inflammatory Bowel Disease?

If you forget a dose, take it as soon as you remember. If it is nearer to the time of your next dose, skip the missed dose. Do not take two doses at the same.

Side Effects

What are some common side effects of Aminosalicylates for Inflammatory Bowel Disease?

You may experience the following side effects while on Aminosalicylates. Tell your doctor if you encounter any of them so that adjustments to your therapy may be made to reduce the occurrence of these side effects where possible. These include:

	Sulfasalazine	Mesalazine (Oral)
Common	Nausea and vomiting Headache and dizziness Abdominal pain and indigestion Diarrhea Orange/ yellow discoloration of urine or perspiration from skin. Extended wear soft contact lens may be permanently stained yellow Metallic taste in mouth Mild rash and itchiness Drug fever- due to sulfa component	Nausea and vomiting Headache and dizziness Abdominal pain and indigestion Diarrhea Mild rash and itchiness
Less common/ rare	Decrease in sperm production (reversible once stopped) Yellowing of skin, eye Pins and needles in hands and feet Bone marrow suppression - manifested as sore throat, mouth ulcers, unexplained bruising/bleeding, unusual tiredness, prolonged infection or fever Ringing in ears Increased sensitivity to sun - apply sunscreen Reversible lung inflammation manifested as breathlessness Depression Kidney pain/ inflammation Pancreatitis manifested as severe abdominal pain	Yellowing of skin, eye Bone marrow suppression - manifested as sore throat, mouth ulcers, unexplained bruising/bleeding, unusual tiredness, prolonged infection or fever Kidney pain/ inflammation Pancreatitis manifested as severe abdominal pain

If you experience any severe signs of illness, or side effects such as unexplained bruising, bleeding (nosebleeds), sore throat, fever or malaise, severe abdominal pain, or a blistering skin rash contact your doctor immediately.

Handling

How should I store Aminosalicylates for Inflammatory Bowel Disease?

Keep away from children
Keep in a cool, dry place, away from direct sunlight
Store at room temperature
Store in cool, dry place away from direct heat and light. Do not refrigerate.

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What else should I know about Aminosalicylates for Inflammatory Bowel Disease?

Aminosalicylates

If you are allergic to salicylic acid/ salicylates such as aspirin, please inform your doctor before taking this medication.

Sulfasalazine

If you are allergic to sulfa drugs (e.g. co-trimoxazole), or if you have ever developed any rash, hives, swelling or shortness of breath after taking a sulfa drug, please inform your doctor before taking this medication.
Please inform your doctor/pharmacist if you have G6PD deficiency or if you are pregnant/breastfeeding.
May reduce body’s ability to absorb folate, hence, your doctor may prescribe folic acid supplement together when needed.

As aminosalicylates may interact with some medications, please consult your pharmacist or doctor if you are taking or before taking any other medications. E.g. antacids, warfarin, digoxin.

Disclaimers

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System, and SingHealth), community pharmacies (Guardian, Unity, and Watsons), and the Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.