1.5.1 Aminosalicylates

Aminosalicylates may cause blood dyscrasias and patients should be told to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise.

All aminosalicylates are classified as 'Specialist' drugs to reflect the need for specialist input but continuation supplies may be prescribed in primary care.

Mesalazine

Octasa®

  • Tablets modified-release 400mg, 800mg (£18.20 = 1.2g daily)

Asacol® MR

  • Tablets modified-release 400mg, 800mg (£27.45 = 1.2g daily)
  • Foam enema 1g (£26.72 = 14 applications)

Mezavant® XL

  • Tablets 1.2g (£40.09 = 2.4g daily)

Pentasa®

  • Tablets modified-release 500mg, 1g (£34.43 = 2g daily)
  • Retention enema 1g/100ml (£17.73 = 7 enemas)
  • Suppositories 1g (£40.01 = 1g daily)

Salofalk®

  • Enema 2g in 59ml (£29.92 = 7 enemas)
  • Suppositories 500mg, 1g (£14.81, £29.62 = 30)
  • Prolonged release granules 500mg, 1g, 1.5g, 3g (£24.14 = 500mg 3 times daily)

Indications

  • Treatment of mild to moderate ulcerative colitis and maintenance of remission

Dose

  • Asacol® foam enema: acute attack affecting the rectosigmoid region, 1g daily for 4–6 weeks; acute attack affecting the descending colon, 2g once daily for 4–6 weeks
  • Pentasa® retention enema: 1 enema at bedtime
  • Salofalk® enema: 2g daily at bedtime
  • Pentasa® suppositories: acute attack, 1g daily for 2–4 weeks; maintenance, 1g daily
  • Salofalk® suppositories: acute attack, 0.5–1g 2–3 times daily adjusted according to response
  • Salofalk® prolonged release granules: acute attack, 1.5–3g once daily (preferably in the morning) or 0.5–1g 3 times daily; maintenance, 500mg 3 times daily
  • Octasa®/ Asacol® MR tablets: ulcerative colitis, acute attack, 2.4–4.8g daily in divided doses; maintenance of remission of ulcerative colitis and Crohn's ileo-colitis, up to 2.4g daily in divided doses
  • Mezavant® XL tablets: acute attack, 2.4g once daily, increase if necessary to 4.8g once daily (review treatment at 8 weeks); maintenance, 2.4g once daily
  • Pentasa® tablets: acute attack, up to 4g daily in 2–3 divided doses; maintenance, 2g once daily

Notes

  1. Mesalazine suppositories are preferable to steroid enemas in maintenance therapy
Sulfasalazine
  • Tablets 500mg (£6.86 = 500mg four times a day)
  • Tablets EC 500mg (£11.08 = 500mg four times a day)
  • Suspension 250mg/5ml (£97.26 = 500mg four times a day)

Indications

  • Treatment of mild to moderate and severe ulcerative colitis and maintenance of remission
  • Active Crohn's disease
  • Rheumatoid arthritis

Dose

  • Acute attack 1–2g 4 times daily until remission occurs, reducing to a maintenance dose of 500mg 4 times daily

Notes

  1. For Western locality please refer to Shared Care Information
  2. For South Devon and Torbay CCG please refer to Shared Care Information
  3. Sulfasalazine is rarely used for new patients although many patients are established on it and experience no side effects. It is useful for patients with concomitant rheumatoid disease
Acetarsol
  • Suppositories 20mg (unlicensed)

 

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