Mesalazine is the most commonly prescribed medication for mild to moderate ulcerative colitis.
It is generally well tolerated with some reported side effects.
Dr Narula and colleagues from Canada summarized adverse drug events to mesalazine, and recommended techniques for management.
The team also determined if there is a dose‐dependent relationship between high vs low dosing and occurrence of adverse drug events.
The researchers performed a literature search for relevant studies from inception to 2017 of the MEDLINE database.
There were 2 reviewers that screened and assessed all titles identified.
Data obtained from randomised controlled trials was used to estimate incidence rates of each adverse event.
The researchers initially considered 3581 articles.
Of these, 3573 were screened, 622 reviewed and 91 included. Adverse events attributed to mesalazine included inflammatory reactions, pancreatitis, cardiotoxicity, hepatotoxicity, musculoskeletal complaints, respiratory symptoms, nephropathies and sexual dysfunction.
There does not appear to be a dose‐dependent relationship of mesalazine and occurrence of adverse events.
Dr Narula's team concludes, "Patients on mesalazine should be monitored for worsening of ulcerative colitis and development of new onset organ dysfunction."
"High‐dose mesalazine appears to have similar safety profile as low dose, and is not associated with greater risk of adverse events."
"Prior to placing a patient on mesalazine, baseline liver and renal function should be evaluated."
"Renal function should be periodically assessed, whereas other testing should be performed depending on development of symptoms."