Aminosalicylates [5-ASA] in Inflammatory Bowel Diseases

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1 TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Aminosalicylates in Inflammatory Bowel Diseases An information guide

2 Aminosalicylates [5-ASA] in Inflammatory Bowel Diseases Your doctor has started you on an aminosalicylate. This information guide is designed to answer some questions that you may have. Why has my Consultant started me on aminosalicylates? Aminosalicylates [5-ASA's] are a group of drugs used to treat inflammatory bowel disease (IBD). They are used to induce remission (control symptoms) and in the long-term to keep symptoms away and prevent flare-ups. During flare-ups, your doctor may choose to increase the dose of aminosalicylates and/or consider adding in other medications in tablet, suppository or enema form. What are aminosalicylates? All aminosalicylates contain the active ingredient called 5- aminosalicylic acid (5-ASA) and which have an anti-inflammatory effect on the cells of the gut. Aminosalicylates are prescription-only and are usually prescribed by a specialist. They include mesalazine, balsalazide, olsalazine and sulfasalazine and these are available in various different brand names. The type of aminosalicylate that you are prescribed may depend upon where the inflammation is and/or the extent of disease in your gut. 2

3 What do I need to tell the doctor before I start taking aminosalicylates? If you are allergic to aspirin you must tell your doctor or IBD specialist nurse before taking aminosalicylates. Some aminosalicylates may also not be suitable for people with certain liver and kidney problems. How and when do I take aminosalicylates? Aminosalicylates may be taken as a tablet or as a suppository or enema inserted into the back passage. Tablets or capsules should be swallowed whole with a glass of water and not chewed. If you have forgotten to take a dose, take it as soon as you remember. If it is almost time for your next dose, than do not take the dose that you missed. Tablets may be dissolved in a small amount of water which releases granules that can be swallowed, they are not to be chewed. Suppository and enema treatments may be recommended when inflammation is at the lower end of your gut so that it can be applied directly to the affected area. They should be inserted after you have opened your bowels, and the longer you can keep the medication in the gut the better: to give it time to work effectively. It may give you the feeling that you need to open your bowels again but this should pass. Will I need to have any blood tests? You will need to have a blood test before starting aminosalicylates, at 3 months of treatment, and then less frequently for the remainder of your treatment, e.g. every 6 or 12 months. This may be more frequent if you have kidney disease. 3

4 What are the side effects? The most common side effects when people take aminosalicylates are not serious and include headache and malaise (a vague feeling of illness), cramps and gas, which may occur in just over 10% of people taking this medication. Nausea, skin rash and hair loss has been noted in 1-10% of patients. Mild watery diarrhoea can occur in up to 8 percent of patients on oral 5-ASA preparations. Sulfasalazine may change the colour of your tears and urine to orange. It may even stain contact lenses in some people and as such it is recommended that if this is the case, that glasses should be worn instead. A rare but serious side effect is a condition called blood dyscrasia, where the bone marrow does not produce enough blood cells to fight off infection or stop bleeding. Therefore if you develop any unexplained bleeding or bruising, sore throat, fever or malaise then you must stop the medication and report this to your GP/the IBD specialist immediately. Very rare side effects affect less than 1 percent of people, but are potentially serious. They include inflammation of the lung (pneumonitis), inflammation of the tissue surrounding the heart (pericarditis), and inflammation of the pancreas (pancreatitis). Inflammation of the kidney (interstitial nephritis) can also occur, although this can usually be detected with routine blood tests performed at 3 months of treatment and then 6-12 monthly during treatment. 4

5 Do aminosalicylates affect pregnancy or fertility? Women who are pregnant or planning pregnancy should discuss their treatment with their doctor or IBD specialist nurse. It is recommended that conception should be planned during a remission period and that aminosalicylates should be continued throughout pregnancy as a flare-up is more harmful to the baby than medication. Balsalazide is not recommended in pregnancy and this should be changed to an alternative. Sulfasalazine can cause a reduced sperm count in some men. This effect is reversible and counts return to normal within 2-3 months of stopping treatment. Can I drink alcohol whilst taking aminosalicylates? Yes, alcohol consumption in moderation as per the national guidelines is safe whilst taking aminosalicylates. How long will I need to take this medication? If well tolerated, aminosalicylates are usually prescribed long-term as maintenance treatment and increased to treat flare-ups. You may therefore need to take them for many years, even when you are well and symptom-free because not taking them regularly will increase the risk of a flare-up. Also, they appear to have a role in protection against bowel cancer in individuals with a long history of IBD. You should not stop taking aminosalicylates without consulting your doctor. 5

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8 If English is not your frst language and you need help, please contact the Ethnic Health Team on Jeżeli angielski nie jest twoim pierwszym językiem i potrzebujesz pomocy proszę skontaktować się z załogą Ethnic Health pod numerem telefonu For general enquiries please contact the Patient Advice and Liaison Service (PALS) on For enquiries regarding clinic appointments, clinical care and treatment please contact and the Switchboard Operator will put you through to the correct department / service Date of publication: November 2014 Date of review: November 2017 Ref: PI (DS) 895 The Pennine Acute Hospitals NHS Trust Wood pulp sourced from sustainable forests