Dose Of Mesalazine Research Articles

Mesalazine dose and rectal tissue concentrations: 'complex' relationship

Mesalazine dose and rectal tissue concentrations: 'complex' relationship

Foetal outcome in women with inflammatory bowel disease treated during pregnancy with oral mesalazine microgranules.

Little information is available about the safety of high doses of mesalazine during pregnancy. To study the fate of pregnancy and foetal outcome in women taking 1-4 g/day of mesalazine microgranules for inflammatory bowel disease. Case reports were collected from the Pharmacovigilance Department of Ferring SA, France, from a survey conducted in three gastroenterology units, and from a teratology information service. The evolution of pregnancy and foetal outcome were assessed by questionnaire. The study covered a total of 123 pregnancies (126 foetuses). Ninety-six women took mesalazine during the first trimester, 85 during the second and 83 during the third. The mean daily dose was 2.1+/-0.8 g; 86 women received <3 g/day (low-dose group), 37 women received > or =3 g/day (high-dose group). The following abnormalities were observed in the low-dose and high-dose groups, respectively: ectopic pregnancy (1/0), spontaneous abortions (1/1), foetal death (0/1), premature deliveries (3/5, P < 0.05), congenital malformations (3/1) and one case of lethal oxalosis. Abnormalities were not considered to be related to mesalazine. The use of oral mesalazine microgranules during pregnancy is safe at doses < or =2 g/day, and probably also at a dose of 3 g/day.

A comparison of two different doses of balsalazide and one dose of mesalazine in chronic treatment of ulcerative colitis

A comparison of two different doses of balsalazide and one dose of mesalazine in chronic treatment of ulcerative colitis

Drug therapy: dose-response relationship of oral mesalazine in inflammatory bowel disease.

Mesalazine is widely used in the treatment of inflammatory bowel disease. Little is known about the dose-response relationship and about possible dose related side effects. In ulcerative colitis higher dosages of mesalazine (3 g) are more effective in maintaining a remission than lower dosages (1.5 g). In mild to moderately active ulcerative colitis, studies also indicate that higher dosages might be more effective in inducing remission. Dose-comparing studies in Crohn's disease are even more sparse, but the available results indicate higher efficacy at higher dose levels. None of the known side effects of mesalazine are clearly dose-related. A pH-dependent release system, however, can cause a sudden release of high doses of mesalazine. Consequent peak levels in serum have been implicated in mesalazine induced nephrotoxicity. In conclusion, despite the current practice of using increasing dosages of mesalazine in inflammatory bowel disease, both efficacy and safety have been established tentatively.

Distribution and anti-inflammatory effect of mesalazine on carrageenan-induced colitis in the rabbit.

1. A controlled-release preparation of mesalazine microgranules (PentasaR; Ferring AS, Vanlose, Denmark) releases the active ingredient over a wide area from the small intestine to the rectum and is consequently expected to bring about therapeutic benefits to patients with ulcerative colitis and Crohn's disease. 2. Mesalazine microgranules (50 or 150 mg/kg per day) were administered orally to each rabbit with carrageenan-induced colitis for six weeks. Its inhibitory effect on colonic mucosal damage was assessed in terms of the microscopic damage scores, leukotriene B4 concentrations and concentrations of mesalazine derivatives. 3. At the end of the experiment, the mesalazine 150 mg group had gained a significantly greater bodyweight than the control group. Microscopic damage was significantly lower in the 150 mg group than in the untreated control group. Tissue concentrations of 5-aminosalicylic acid and acetyl-5-amino-salicylic acid in the small and large intestine were higher in the 150 mg group than in the 50 mg group. Mucosal leukotriene B4 levels tended to be lower in rabbits receiving the larger dose of mesalazine. 4. The present study indicates that slow release 5-amino-salicylic acid at the larger dose reaches the large bowel in sufficiently high concentrations following oral administration and significantly reduces carrageenan-induced colitis in the rabbit.

Availability of Mesalazine (5-Aminosalicylic Acid) from Enemas and Suppositories during Steady-State Conditions

The local and systemic bioavailability of a mesalazine enema (Pentasa, Ferring A/S, Denmark) and a mesalazine suppository (Pentasa, Ferring) was assessed during steady-state conditions. Eleven healthy subjects took 1 g of the enema or the suppository twice daily for 1 week, with a drug-free period of at least 1 week in between. At the end of each treatment period the urine and faeces were collected for 48 h, and the concentrations of mesalazine and the metabolite acetyl-mesalazine were measured. Plasma concentrations of drug and metabolite were measured hourly during a 12-h dose interval. The faecal water concentration of mesalazine was significantly higher after suppository treatment (55.7 mmol/l) compared with enema treatment (31.7 mmol/l) (p less than 0.01). The systemic absorption was low; 15% of daily mesalazine dose was recovered in urine after enema treatment and 10% after suppositores (p less than 0.01). Plasma concentrations were low, and no accumulation of either mesalazine or acetyl-mesalazine occurred. In conclusion, the enema and the suppository can be continuously administered as 1 g of mesalazine twice daily, respectively, giving high faecal water concentrations of mesalazine and a low systemic absorption.

Mesalazine: A Global Safety Evaluation

The potential benefit of sulphasalazine in inflammatory bowel disease is limited by the wide variety of side effects that occur in about one-third of treated patients. Most of the side effects of sulphasalazine are due to the sulphapyridine moiety. Claversal has the advantage of delivering the active ingredient of sulphasalazine--mesalazine--without the undesirable effects of sulphapyridine. Four international multicentre trials involving 932 patients with ulcerative colitis or Crohn's disease compared 0.75 g/day or 1.5 g/day mesalazine, 1.5 g/day or 3.0 g/day sulphasalazine, or placebo. Forty-seven (14%) of 331 patients receiving mesalazine reported adverse events, whereas 33 (23%) of 144 patients receiving sulphasalazine and 23 (19%) of 123 patients receiving placebo reported adverse effects. When lower doses of both mesalazine (0.75 g/day) and sulphasalazine (1.5 to 2.0 g/day) were evaluated in a maintenance trial, the percentage of adverse events was similar for both drugs--14% and 12%, respectively. In these trials the incidence of adverse effects was similar with both doses of mesalazine; however, doubling the sulphasalazine dose resulted in a twofold increase in adverse effects. In contrast, mesalazine appeared not to induce dose-related effects, suggesting that patients may be able to tolerate even higher mesalazine doses than those studied. The withdrawal rate owing to adverse events in all four controlled trials was similar for patients treated with mesalazine (6%) and sulphasalazine (8%). Results of an open postmarketing sampling trial of just over 1700 patients in Germany showed a low overall incidence of adverse effects (3%) with mesalazine and none of the rare, more serious effects, such as hepatoxicity, agranulocytosis, or pulmonary complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Mesalazine: An Overview of Key Preclinical Studies

Studies were undertaken to evaluate the clinical relevance of toxicologic assessments of mesalazine and to establish mesalazine pharamcokinetics. In the toxicology studies groups of rats and dogs received various doses of mesalazine, ranging from 40 to 320 mg/kg of body weight, for 6 or 12 months. Evidence of renal papillary necrosis was found at 60 or 100 mg/kg in dogs and 320 mg/kg in rats. Data are presented to show that drug absorption after the clinical doses of mesalazine given to human patients is much lower than after the potentially nephrotoxic doses given to experimental animals. In the pharmacokinetic studies plasma from rats and dogs given various doses of mesalazine was analysed for mesalazine and its major metabolites. The results demonstrated that mesalazine in pharmaceutic preparations is not likely to present a nephrotoxic risk to patients, given the low systemic exposure achieved. After 12 months of mesalazine administration to dogs, many showed an ocular condition diagnosed as keratoconjunctivitis sicca. Experimental and epidemiologic evidence demonstrates that this condition is peculiar to dogs, and there are no reports of untoward ocular effects in patients receiving long-term therapy with mesalazine.