Ken P. K. Wan
Drugs in this class are used for: |
| Ulcerative colitis |
Drugs in this class include balsalazide, mesalazine, olsalazine and sulfasalazine. They are available as tablets, enemas or suppositories.
Topical therapy is preferably used for distal disease. Foam preparations and suppositories are useful where patients have difficulty retaining liquid enemas.
Different formulations of aminosalicylates are not interchangeable as they are designed to release the active drug at different sites in the colon. They should therefore be prescribed by brand name.
Dosage regimen
* Balsalazide: Adults only, three 750mg capsules three times daily with food until remission or for up to 12 weeks. Maintenance two 750mg capsules twice daily. Maximum eight daily.
* Mesalazine tablets 400mg: Adults only, up to six daily in divided doses for acute attack; maintenance of remission three to six daily in divided doses. For sustained release and other presentations see SPCs.
* Olsalazine: Adults only, initially 1g daily in divided doses after food, increasing if necessary to a maximum 3g daily over one week. Maintenance 500mg twice daily after food.
* Sulfasalazine: Adults 1-2g four times daily until remission occurs. Maintenance500mg four times daily. See SPC for children’s doses and other presentations.
Patient knowledge
* Does the patient know the aim of the treatment? This is to control the symptoms and prevent relapse. It is important that patients can identify the symptoms during a flare-up, which may include watery and bloody diarrhoea, abdominal pain, pain when passing stools, fever, malaise, nausea, weight loss and anaemia.
Is the medicine working?
* Aminosalicylates often work well for mild or moderate flare-ups. They need to be taken every day for a few weeks until symptoms clear.
* If the flare-up is severe or the medicine is not working, patients are advised to increase the dose or switch to a short course of steroids.
* Other medicines such as azathioprine or 6-mercaptopurine are sometimes used if aminosalicylates are not working. In more severe cases, surgery may be considered.
Side effects
* Aminosalicylates often cause nausea, vomiting, diarrhoea, abdominal pain, headache and rash. Serious reactions are rare, but can include Stevens-Johnson syndrome, acute pancreatitis, blood disorders and renal dysfunction. Aminosalicylates should not be taken by patients who are allergic to aspirin.
Monitoring
* Aminosalicylates warrant regular blood counts, because of the risk of blood dyscrasias. Patients should be advised to seek immediate medical attention if they experience any of the following: unexplained bleeding, bruising, sore throat, fever or malaise. Patients with renal impairment should have regular renal function monitoring.
Lifestyle
* Ensure patients are taking their medication every day to prevent relapse of symptoms.
* Advise patients to seek medical advice if flare-up occurs.
* A balanced diet is advisable. Foods containing soluble fibre such as peeled vegetables, oat bran and white rice are generally beneficial to patients with ulcerative colitis. Foods containing high amounts of insoluble fibre such as cabbage, mushroom, wheat bran and broccoli should be avoided during flare-ups. Foods containing high amounts of dairy fats such as milk and cheese should also be avoided.
* Fish oils, especially from oily fish such as sardines, have been shown to improve symptoms.
Ken P. K. Wan is a community pharmacist in Clacton-on-Sea, Essex
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