Mesalamine

Sulfasalazine hypersensitivity, renal insufficiency, coagulation abnormalities, pyloric stenosis

Use caution in active PUD, severe renal failure

Do not use with lactulose or drugs that lower intestinal pH

Although pericarditis rarely occurs, investigate any chest pain or dyspnea

Oligospermia has been reported in males

Hepatic failure may occur, particularly with preexisting liver impairment

May lead to falsely elevated test results when measuring urinary normetanephrine by liquid chromatography with electrochemical detection, because of the similarity in the chromatograms of normetanephrine and mesalamine’s main metabolite, N-acetyl aminosalicylic acid; an alternative, selective assay for normetanephrine should be considered

Worsening of colitis/IBD may occur following initiation of therapy

Renal impairment, including minimal change nephropathy, acute and chronic interstitial nephritis, and renal failure, reported; cases of nephrolithiasis reported; mesalamine-containing stones are radiotransparent and undetectable by standard radiography or computed tomography (CT); ensure adequate fluid intake during treatment; evaluate renal function prior to initiation of therapy and periodically while on therapy

Evaluate renal function in all patients prior to initiation and periodically while on therapy; the risk of adverse reactions to this drug may be greater in patients with impaired renal function; mesalamine is known to be substantially excreted by the kidney; evaluate the risks and benefits in patients with known renal impairment or taking nephrotoxic drugs; monitor renal function

Acute intolerance syndrome may occur; symptoms include cramping, abdominal pain, bloody diarrhea, and sometimes fever, headache, malaise, pruritis, rash, conjunctivitis, and may be difficult to distinguish from an ulcerative colitis exacerbation; monitor for worsening symptoms; discontinue if acute intolerance syndrome suspected

Hypersensitivity reactions, including myocarditis and pericarditis reported; evaluate patients immediately and discontinue if hypersensitivity reaction suspected