Anti-inflammatory medication
Not to be confused with
Aspirin , also known as acetylsalicylic acid (ASA).
Mesalazine
Trade names Asacol, Lialda, Pentasa, Delzicol, others
[1] Other names mesalamine, 5-aminosalicylic acid, 5-ASA, Mesalamine (
USAN
US )
AHFS /
Drugs.com
Monograph
MedlinePlus
a688021
License data
Pregnancy category
Routes of administration
By mouth ,
rectal
ATC code
Legal status
Bioavailability orally: 20–30% absorbed rectally: 10–35%
Metabolism Rapidly & extensively metabolized intestinal mucosal wall and the liver
Elimination half-life 5 hours after initial dose. At steady state 7 hours
5-Amino-2-hydroxybenzoic acid
CAS Number
PubChem
CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (
EPA )
ECHA InfoCard
100.001.745
Formula C 7 H 7 N O 3
Molar mass 153.137 g·mol−1 3D model (
JSmol )
Melting point 283 °C (541 °F)
InChI=1S/C7H7NO3/c8-4-1-2-6(9)5(3-4)7(10)11/h1-3,9H,8H2,(H,10,11)
Y Key:KBOPZPXVLCULAV-UHFFFAOYSA-N
Y
(verify)
Mesalazine , also known as mesalamine or 5-aminosalicylic acid (5-ASA ), is a medication used to treat
inflammatory bowel disease , including
ulcerative colitis and
Crohn's disease .
[1] It is generally used for mildly to moderately severe disease.
[1] It is taken by mouth or
rectally .
[1] The formulations which are taken by mouth appear to be similarly-effective.
[12]
Common side-effects include headache, nausea, abdominal pain, and fever.
[1] Serious side-effects may include
pericarditis ,
liver problems , and
kidney problems .
[1]
[12] Use in
pregnancy and
breastfeeding appears safe.
[12] In people with a
sulfa allergy certain formulations may result in problems.
[1] Mesalazine is an
aminosalicylate and
anti-inflammatory .
[1]
[12] It works by direct contact with the
intestines .
[1]
Mesalazine was approved for medical use in the United States in 1987.
[1]
[8] It is on the
World Health Organization's List of Essential Medicines .
[13] It is available as a
generic medication .
[1]
[14]
[15]
[16] In 2021, it was the 239th most commonly prescribed medication in the United States, with more than 1 million prescriptions.
[17]
[18]
Medical uses
It is used to treat
inflammatory bowel disease , including
ulcerative colitis and
Crohn's disease (effective only in colonic diseases).
[1]
In 2022 Germany introduced guidance to use mesalamine to treat acute uncomplicated
diverticulitis .
[19]
Side-effects
Most often reported side-effects are gastrointestinal (GI) (but may also include headache), including: nausea, diarrhea, and abdominal pain.
[7]
Very rarely, use of mesalazine has been associated with an exacerbation of the symptoms of
colitis ,
Stevens Johnson syndrome , and
erythema multiforme .
[7]
Pregnancy
There is no data on use in pregnant women, but the drug does cross the placenta and is excreted in
breast milk . The drug should not be used in children under two years of age,
[7] people with
kidney disease ,
[7] or people who are allergic to
aspirin .
[7]
Chemistry
Mesalazine is the active
moiety of
sulfasalazine , which is metabolized to
sulfapyridine and mesalazine.
[20] It is also the active component of the prodrug
balsalazide along with the inert carrier molecule 4-aminobenzoyl-beta-alanine.
[21] It is in the category of
disease-modifying antirheumatic drugs (DMARDs) family of medications.
[22] It is unclear exactly how it works.
[22] Mesalazine is claimed to be a
PPAR-γ agonist .
[23]
Mechanism of action
Exact mechanism of mesalazine is unknown, but is speculated that mesalazine decreases synthesis of
prostaglandin and
leukotriene , modulating the inflammatory response derived from the
cyclooxygenase and
lipooxygenase pathways.
[24] It appears to act locally on colonic mucosa.
[25]
Society and culture
Brand names
Mesalazine is sold under various names including Apriso, Asacol, Asacol HD, Canasa, Delzicol, Fivasa, Lialda, Salofalk, Pentasa, Rowasa, Octasa, and Sfrowasa. In Europe, it is sold under the name Salofalk (rectal suppository).
[26]
[27]
References
^
a
b
c
d
e
f
g
h
i
j
k
l
"Mesalamine Monograph for Professionals" . Drugs.com . American Society of Health-System Pharmacists.
^
"Mesalamine Use During Pregnancy" . Drugs.com . 18 September 2018. Retrieved 30 December 2019 .
^
"Mesalazine Sun/ Mesalz (Sun Pharma ANZ Pty Ltd)" . Therapeutic Goods Administration (TGA) . 13 January 2023. Retrieved 9 April 2023 .
^
"Product monograph brand safety updates" . Health Canada . February 2024. Retrieved 24 March 2024 .
^
"Regulatory Decision Summary for Mezera" . Drug and Health Products Portal . 5 February 2024. Retrieved 2 April 2024 .
^
"Drug and medical device highlights 2018: Helping you maintain and improve your health" .
Health Canada . 14 October 2020. Retrieved 17 April 2024 .
^
a
b
c
d
e
f
"Asacol 400mg MR Tablets - Summary of Product Characteristics (SmPC)" . (emc) . 14 April 2016. Retrieved 30 December 2019 .
^
a
b
"Asacol HD- mesalamine tablet, delayed release" . DailyMed . 15 April 2018. Retrieved 30 December 2019 .
^
"Pentasa- mesalamine capsule" . DailyMed . 8 November 2021. Retrieved 17 May 2022 .
^
"Lialda- mesalamine tablet, delayed release" . DailyMed . 8 November 2021. Retrieved 17 May 2022 .
^ Human Medicines Evaluation Division (15 October 2020).
"Active substance: mesalazine" (PDF) . List of nationally authorised medicinal products . European Medicines Agency.
^
a
b
c
d British national formulary: BNF 76 (76 ed.). Pharmaceutical Press. 2018. pp. 39–41.
ISBN
9780857113382 .
^
World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021) . Geneva: World Health Organization.
hdl :
10665/345533 . WHO/MHP/HPS/EML/2021.02.
^
"ANDA Approval Reports - 2017 First Generic Drug Approvals" .
Food and Drug Administration (FDA) . 3 November 2018. Retrieved 8 April 2019 .
^
"2022 First Generic Drug Approvals" . U.S.
Food and Drug Administration (FDA) . 3 March 2023.
Archived from the original on 30 June 2023. Retrieved 30 June 2023 .
^
"Competitive Generic Therapy Approvals" . U.S.
Food and Drug Administration (FDA) . 29 June 2023.
Archived from the original on 29 June 2023. Retrieved 29 June 2023 .
^
"The Top 300 of 2021" . ClinCalc .
Archived from the original on 15 January 2024. Retrieved 14 January 2024 .
^
"Mesalamine - Drug Usage Statistics" . ClinCalc . Retrieved 14 January 2024 .
^ Peery AF (12 November 2022).
"New German guidelines for the management of diverticulitis" . United European Gastroenterology Journal . 10 (9): 913–914.
doi :
10.1002/ueg2.12331 .
PMC
9731652 .
PMID
36302089 .
^ Finkel R, Clark MA, Cubeddu LX (2009). Lippincott's Illustrated Reviews: Pharmacology (Fourth ed.). Lippincott Williams & Wilkins.
ISBN
978-0-7817-7155-9 .
^ "Balsalazide: increasing the choice for patients with ulcerative colitis". Drugs & Therapy Perspectives . 19 (1–4): 1–4. 2003.
doi :
10.2165/00042310-200319100-00001 .
S2CID
195230977 .
^
a
b
"Sulfasalazine" . The American Society of Health-System Pharmacists.
Archived from the original on 21 December 2016. Retrieved 8 December 2016 .
^ Cevallos SA, Lee JY, Velazquez EM, Foegeding NJ, Shelton CD, Tiffany CR, et al. (January 2021). Ehrt S (ed.).
"5-Aminosalicylic Acid Ameliorates Colitis and Checks Dysbiotic Escherichia coli Expansion by Activating PPAR-γ Signaling in the Intestinal Epithelium" . mBio . 12 (1): e03227–20.
doi :
10.1128/mBio.03227-20 .
PMC
7845635 .
PMID
33468700 .
^ Nakashima J, Preuss CV (2022).
"Mesalamine (USAN)" . StatPearls . Treasure Island (FL): StatPearls Publishing.
PMID
31869178 . Retrieved 1 September 2022 .
^ Iacucci M, de Silva S, Ghosh S (February 2010).
"Mesalazine in inflammatory bowel disease: a trendy topic once again?" . Canadian Journal of Gastroenterology . 24 (2): 127–133.
doi :
10.1155/2010/586092 .
PMC
2852235 .
PMID
20151072 .
^
"Substance Name: Mesalamine [USAN:USP]" . ChemIDplus . Retrieved 2 October 2020 .
^
"Mesalamine Uses, Side Effects & Warnings" . Drugs.com . 30 August 2019. Retrieved 2 October 2020 .
Rehydration Intestinal anti-infectives Intestinal
adsorbents
Antipropulsives (
opioids ) Intestinal anti-inflammatory agents Antidiarrheal micro-organisms Other antidiarrheals
Receptor (
ligands )
DP (D2 ) Tooltip Prostaglandin D2 receptor
DP1 Tooltip Prostaglandin D2 receptor 1
DP2 Tooltip Prostaglandin D2 receptor 2
EP (E2 ) Tooltip Prostaglandin E2 receptor
EP1 Tooltip Prostaglandin EP1 receptor
EP2 Tooltip Prostaglandin EP2 receptor
EP3 Tooltip Prostaglandin EP3 receptor
EP4 Tooltip Prostaglandin EP4 receptor Unsorted
FP (F2α ) Tooltip Prostaglandin F receptor
IP (I2 ) Tooltip Prostacyclin receptor
TP (TXA2 ) Tooltip Thromboxane receptor Unsorted
Enzyme (
inhibitors )
COX (
PTGS )
PGD2 S Tooltip Prostaglandin D synthase
PGES Tooltip Prostaglandin E synthase
PGFS Tooltip Prostaglandin F synthase
PGI2 S Tooltip Prostacyclin synthase
TXAS Tooltip Thromboxane A synthase
Others