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Related to Dipentum: Azulfidine, Colazal
Pharmacologic class: Salicylate
Therapeutic class: Anti-inflammatory
Pregnancy risk category C
Unknown. Converts to active form, mesalamine, which blocks cyclooxygenase and inhibits prostaglandin production in colon.
Capsules: 250 mg
⊘Indications and dosages
➣ Ulcerative colitis in patients who can't tolerate sulfasalazine
Adults: 500 mg P.O. b.i.d.
• Hypersensitivity to drug or other salicylates
Use cautiously in:
• hepatic or renal impairment, severe allergy, bronchial asthma
• pregnant or breastfeeding patients
• children younger than age 14.
• Give with meals to reduce GI irritation.
CNS: headache, fatigue, depression, vertigo
GI: nausea, vomiting, diarrhea, abdominal pain, cramps, dyspepsia, bloating, stomatitis
Musculoskeletal: joint pain
Respiratory: upper respiratory infection
Skin: rash, itching
Drug-drug.Anticoagulants, coumarin derivatives: prolonged prothrombin time, increased International Normalized Ratio
Drug-food.Any food: decreased GI irritation
• Monitor neurologic status. Stay alert for depression.
• Assess GI symptoms. Encourage adequate fluid intake to avoid dehydration.
• Monitor urinalysis, blood urea nitrogen, and creatinine in patients with renal impairment.
• Instruct patient to take with food and to continue taking drug even after symptoms improve.
• Tell patient to eat appropriate foods in small, frequent servings to minimize GI upset.
• Advise patient to contact prescriber if symptoms worsen or don't improve after 1 to 2 months of therapy.
• Tell patient he may require periodic proctoscopy and sigmoidoscopy to determine response to drug.
• Caution patient to avoid driving and other hazardous activities until he knows how drug affects mood and wakefulness.
• As appropriate, review all significant adverse reactions and interactions, especially those related to the drugs and foods mentioned above.
ClassificationTherapeutic: gastroinestinal anti inflammatories
Time/action profile (levels)
|PO||unknown||1 hr; 4–8 hr||12 hr|
Adverse Reactions/Side Effects
Central nervous system
- mental depression
- diarrhea (most frequent)
- abdominal pain
- exacerbation of colitis
- drug-induced hepatitis
- blood dyscrasias
Drug-Drug interaction↑ risk of bleeding after neuraxial anesthesia with low molecular weight heparins and heparinoids ; discontinue olsalazine before initiation of therapy or monitor closely if discontinuation not possible.May ↓ metabolism, and ↑ effects/toxicity of mercaptopurine or thioguanine with and ↑ risk of myelosuppression (use lowest possible dose and monitor closely).↑ risk of developing Reye's syndrome; avoid olsalazine during 6 wk after varicella vaccine.
- Assess patient for allergy to sulfonamides and salicylates. Patients allergic to sulfasalazine may take mesalamine or olsalazine without difficulty, but therapy should be discontinued if rash or fever occur.
- Monitor intake and output ratios. Fluid intake should be sufficient to maintain a urine output of at least 1200–1500 mL daily to prevent crystalluria and stone formation.
- Inflammatory Bowel Disease: Assess abdominal pain and frequency, quantity, and consistency of stools at the beginning of and throughout therapy.
- Lab Test Considerations: Monitor urinalysis, BUN, and serum creatinine prior to and periodically during therapy.
- Olsalazine may cause ↑ AST and ALT levels.
- Lab Test Considerations: Monitor CBC prior to and every 3–6 mo during prolonged therapy. Discontinue olsalazine if blood dyscrasias occur.
Potential Nursing DiagnosesAcute pain (Indications)
- Oral: Administer with food in evenly divided doses every 12 hr.
- Instruct patient to take medication as directed, even if feeling better. Take missed doses as soon as remembered unless almost time for next dose.
- May cause dizziness. Caution patient to avoid driving or other activities that require alertness until response to medication is known.
- Advise patient to notify health care professional if skin rash, sore throat, fever, mouth sores, unusual bleeding or bruising, wheezing, fever, or hives occurs.
- Instruct patient to notify health care professional if symptoms do not improve after 1–2 mo of therapy.
- Instruct patient to notify health care professional if symptoms worsen or do not improve. If symptoms of acute intolerance (cramping, acute abdominal pain, bloody diarrhea, fever, headache, rash) occur, discontinue therapy and notify health care professional immediately.
- Inform patient that proctoscopy and sigmoidoscopy may be required periodically during treatment to determine response.
- Decrease in diarrhea and abdominal pain.
- Return to normal bowel pattern in patients with inflammatory bowel disease. Effects may be seen within 3–21 days. The usual course of therapy is 3–6 wk.
- Maintenance of remission in patients with inflammatory bowel disease.
- Decrease in pain and inflammation, and increase in mobility in patients with rheumatoid arthritis.