Mesalazina Eg (Mesalazine)

Mesalazine is used in the management of inflammatory bowel disease, targeting colonic inflammation.

• Ulcerative colitis: Reduces mucosal inflammation and helps achieve clinical remission.
• Crohn's disease (colonic involvement): Decreases intestinal inflammation and supports maintenance of remission.
• Maintenance therapy: Sustains remission in patients with previously controlled IBD.

• Mesalazine exerts its anti‑inflammatory effect by inhibiting cyclooxygenase and lipoxygenase enzymes in the colonic mucosa, which lowers the synthesis of prostaglandins and leukotrienes. This reduction in eicosanoid production diminishes neutrophil activation and cytokine release, thereby decreasing mucosal inflammation and promoting healing of the intestinal lining. Additionally, mesalazine scavenges free radicals and modulates NF‑κB signaling, further contributing to its anti‑inflammatory profile.

Mesalazine may be associated with a range of adverse reactions, varying from mild to severe.

Common Side Effects

• Nausea: mild stomach upset, often transient.
• Headache: transient cranial discomfort, usually low intensity.
• Abdominal pain: cramping or discomfort in the abdomen, may improve with food.
• Diarrhea: loose stools, occasionally accompanied by urgency.
• Flatulence: increased intestinal gas leading to bloating.

Serious or Rare Side Effects

• Severe allergic reaction: rash, itching, swelling, or difficulty breathing indicating possible anaphylaxis.
• Hepatotoxicity: elevated liver enzymes or jaundice, requiring laboratory monitoring.
• Nephrotoxicity: impaired kidney function or blood in urine, may necessitate renal assessment.
• Blood dyscrasias: anemia, leukopenia, or thrombocytopenia, observed in blood counts.
• Myocarditis: inflammation of heart muscle, extremely rare but serious.

When prescribing mesalazine, several precautionary measures should be observed to ensure patient safety.

• Renal function: monitor serum creatinine and eGFR regularly.
• Hepatic function: assess liver enzymes before initiation and periodically.
• Blood counts: perform complete blood count to detect hematologic abnormalities.
• Pregnancy: use only if potential benefit justifies potential risk, as safety data are limited.
• Concomitant NSAIDs: avoid or use with caution due to increased nephrotoxicity risk.
• Store at ambient temperature: keep below 25 °C, in original packaging, protected from moisture and light.

Mesalazine can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Azathioprine or 6‑mercaptopurine: increased risk of bone marrow suppression.
• Anticoagulants (warfarin): enhanced anticoagulant effect, may raise INR.

Moderate Interactions (Monitor Closely)

• NSAIDs: additive nephrotoxic potential, monitor renal function.
• Oral corticosteroids: may increase risk of infection, observe clinical status.
• Digoxin: possible increase in serum levels, check concentrations.
• Oral contraceptives: may reduce efficacy, advise alternative contraception.