Mesalamine

INTRODUCTION

Indications

Inflammatory bowel diseases, including Ulcerative colitis, Proctitis, Proctosigmoiditis.

Action

Locally acting anti-inflammatory action in the colon, where activity is probably due to inhibition of prostaglandin synthesis. Therapeutic Effects: Reduction in the symptoms of inflammatory bowel disease.

Adverse Reactions/Side Effects

CNS: headache, dizziness, malaise, weakness. EENT: pharyngitis, rhinitis. CV: pericarditis. GI: diarrhea, eructation (PO), flatulence, nausea, vomiting. GU: interstitial nephritis, pancreatitis, renal failure. Derm: hair loss, rash. Local: anal irritation (enema, suppository). MS: back pain. Misc: ANAPHYLAXIS, acute intolerance syndrome, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Be alert for signs of pericarditis, including sharp chest pain, shortness of breath when reclining, dry cough, abdominal or leg edema, low-grade fever, weakness, fatigue, and malaise. Report these signs to the physician.

• Monitor signs of kidney inflammation and kidney failure, including decreased urine output, increased blood pressure, muscle cramps/twitching, edema/weight gain from fluid retention, yellowish brown skin, and confusion that progresses to seizures and coma. Report these signs to the physician immediately.

• Monitor improvements in GI symptoms (decreased abdominal pain, cramps, diarrhea, and so forth) to help document whether drug therapy is successful.

• Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and foods that may cause an increase in GI irritation.

• Advise patient about the likelihood of GI problems such as nausea, diarrhea, vomiting, belching, flatulence, and anal irritation. Instruct patient to report severe or prolonged GI reactions, or signs of pancreatitis such as upper abdominal pain (especially after eating), indigestion, weight loss, and oily stools.

• Instruct patient to report other bothersome side effects such as severe or prolonged headache, fever, nasal/pharyngeal irritation, or skin problems (rash, hair loss).

Pharmacokinetics

Absorption: 28% absorbed following oral administration; 10–30% absorbed from the colon, depending on retention time, following rectal administration.

Distribution: Unknown.

Metabolism and Excretion: Some metabolism occurs, site unknown; mostly eliminated unchanged in the feces.

Half-life: 12 hr PO (range 2–15 hr); 0.5–1.5 hr rectal.