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Olsalazine


General


Pronunciation

(ole SAL a zeen)


Brand Names: U.S.

  • Dipentum

Indications


Use: Labeled Indications

Maintenance of remission of ulcerative colitis in patients intolerant to sulfasalazine


Contraindications


Hypersensitivity to olsalazine, salicylates, or any component of the formulation


Dosing and Administration


Dosing: Adult

Ulcerative colitis: Oral: 1 g/day in 2 divided doses


Dosing: Geriatric

Refer to adult dosing.


Dosing: Renal Impairment

No dosage adjustment provided in manufacturer 's labeling. Monitor patients with impaired renal function.


Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer 's labeling. Monitor patients with impaired hepatic function.


Administration

Administer with food in evenly divided doses.


Dietary Considerations

Take with food.


Storage

Store at 20 ‚ °C to 25 ‚ °C (77 ‚ °F); excursions permitted to 15 ‚ °C to 30 ‚ °C (59 ‚ °F to 86 ‚ °F).


Dosage Forms/Strengths


Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Capsule, Oral, as sodium:

Dipentum: 250 mg


Drug Interactions

Cardiac Glycosides: 5-ASA Derivatives may decrease the serum concentration of Cardiac Glycosides. Monitor therapy

Heparin: 5-ASA Derivatives may enhance the adverse/toxic effect of Heparin. Specifically, the risk for bleeding/bruising may be increased. Monitor therapy

Heparin (Low Molecular Weight): 5-ASA Derivatives may enhance the adverse/toxic effect of Heparin (Low Molecular Weight). Specifically, the risk for bleeding/bruising may be increased. Monitor therapy

Nonsteroidal Anti-Inflammatory Agents: May enhance the nephrotoxic effect of 5-ASA Derivatives. Monitor therapy

Thiopurine Analogs: 5-ASA Derivatives may decrease the metabolism of Thiopurine Analogs. Monitor therapy

Varicella Virus-Containing Vaccines: 5-ASA Derivatives may enhance the adverse/toxic effect of Varicella Virus-Containing Vaccines. The primary concern is the potential development of Reyes Syndrome, a condition that has been associated with the use of salicylates in children with varicella infections. Consider therapy modification


Monitoring Parameters

CBC, hepatic function, renal function; stool frequency


Adverse Reactions


>10%: Gastrointestinal: Diarrhea (11% to 17%; dose related)

1% to 10%:

Central nervous system: Depression (2%), dizziness/vertigo (1%)

Dermatologic: Rash (2%), pruritus (1%)

Gastrointestinal: Abdominal pain/cramps (10%), nausea (5%), bloating (2%), stomatitis (1%), vomiting (1%)

Neuromuscular & skeletal: Arthralgia (4%)

Respiratory: Upper respiratory infection (2%)

<1% (Limited to important or life-threatening): Alkaline phosphatase increased, Alopecia, ALT increased, anemia, angioedema, aplastic anemia, AST increased, bilirubin increased, blood in stool, blurred vision, bronchospasm, cholestatic hepatitis, cholestatic jaundice, chest pain, chills, cirrhosis, dehydration, dry eyes, dyspnea, dysuria, eosinophilia, epigastric discomfort, erythema, erythema nodosum, fever, flare of symptoms, flatulence, GGT increased, heart block (second degree), hematuria, hemolytic anemia, hepatitis, hepatic failure, hepatic necrosis, hot flashes, hypertension, impotence, insomnia, interstitial nephritis, interstitial pneumonia, irritability, jaundice, Kawasaki-like syndrome, LDH increased, leukopenia, lymphopenia, menorrhagia, mood swings, muscle cramps, myalgia, myocarditis, nephrotic syndrome, neutropenia, orthostatic hypotension, palpitation, pancreatitis, pancytopenia, paresthesia, pericarditis, peripheral edema, peripheral neuropathy, photosensitivity, proteinuria, rectal bleeding, rectal discomfort, reticulocytosis, rigors, tachycardia, thrombocytopenia, tinnitus, tremor, urinary frequency, watery eyes, xerostomia


Warnings/Precautions


Concerns related to adverse effects:

- Colitis: May exacerbate symptoms of colitis.

- Diarrhea: A common adverse effect is diarrhea.

Disease-related concerns:

- Asthma: Use with caution in patients with severe allergies or asthma.

- Hepatic impairment: Use with caution in patients with hepatic impairment; monitor closely.

- Renal impairment: Use with caution in patients with renal impairment; monitor closely.

Special populations:

- Elderly: Use with caution.


Pregnancy Risk Factor

C


Pregnancy Considerations

Animal studies have demonstrated fetal developmental toxicities. There are no well-controlled studies in pregnant women. Use during pregnancy only if clearly necessary.


Actions


Pharmacology

Mesalamine (5-aminosalicylic acid) is the active component of olsalazine; the specific mechanism of action of mesalamine is unknown; however, it is thought that it modulates local chemical mediators of the inflammatory response, especially leukotrienes, and is also postulated to be a free radical scavenger or an inhibitor of tumor necrosis factor (TNF); action appears topical rather than systemic.


Absorption

<3%; very little intact olsalazine is systemically absorbed


Metabolism

Primarily via colonic bacteria to active drug, 5-aminosalicylic acid (5-ASA)


Excretion

Primarily feces; urine (<1%)


Time to Peak

~1 hour


Half-Life Elimination

54 minutes


Protein Binding

Plasma: >99%


Patient and Family Education


Patient Education

- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

- Patient may experience cramps, nausea, diarrhea, or joint pain. Have patient report immediately to prescriber signs of liver problems (dark urine, feeling tired, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or yellow skin or eyes), severe abdominal pain, bloody diarrhea, urinary retention, change in amount of urine passed, angina, tachycardia, arrhythmia, shortness of breath, bruising, or bleeding (HCAHPS).

- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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