Professional view

mesalazine: prescribing and clinical use

Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.

mesalazine: clinical details

Prescribing considerations

Confirm disease location and choose a formulation designed to release mesalazine at that site.
Prescribe and document the intended brand or formulation; assess symptom control and tolerability if switching.
Assess renal and hepatic function and previous reactions to mesalazine, salicylates or sulphasalazine.
Maintain adequate hydration, particularly where kidney stones or crystalluria are a concern.
The selected enema contains metabisulphite, which can rarely cause severe hypersensitivity or bronchospasm.

Contraindications and cautions

Hypersensitivity to mesalazine, salicylates or relevant formulation excipients.
Severe renal or hepatic impairment, according to the product-specific SmPC.

Monitoring

Obtain baseline renal function and urea and electrolytes; consider full blood count and liver-function tests.
Repeat renal monitoring after initiation and periodically thereafter, using relevant product information, local arrangements and individual risk factors.
Monitor more frequently with renal impairment or interacting nephrotoxic or myelosuppressive treatment.
Investigate promptly if renal function declines or symptoms suggest blood dyscrasia, hepatic injury, pancreatitis, cardiac hypersensitivity or severe skin reaction.

Clinical pharmacology

Mesalazine is 5-aminosalicylic acid and works predominantly through local exposure of inflamed intestinal mucosa. It is acetylated in the bowel wall and liver to largely inactive N-acetyl-mesalazine; systemic exposure and renal elimination remain relevant to safety.

Formulation and product differences

Tillotts modified-release tablets use a pH-responsive coating designed to release in the terminal ileum and colon.
Salofalk gastro-resistant tablets have pH-dependent release.
Pentasa tablets and granules contain ethylcellulose-coated microgranules that release mesalazine continuously through the gastrointestinal tract across enteral pH conditions.
Suppositories primarily treat the rectum; enemas spread further through the distal colon.
Oral preparations are not automatically interchangeable because release site, administration and licensed indications differ.