部分中文Rowasa处方资料（仅供参考）
英文药名: Rowasa Enema(Mesalamine/5-ASA)
中文药名: 美沙拉嗪&5 -氨基水杨酸灌肠剂
药品名称
通用名称: 美沙拉嗪，5-氨基水杨酸
英文名: Mesalazine，5-Amino Salicylic Acid, Asacolitin, Claversal, Enterasin, Etiasa, Fisalamine, FIV-ASA Mesalazinum, Mesasal, Zinc 5-aminosalicylate, Pentasa-R, Rowasa, Salofalk, Saloflk
药理作用
对肠壁的炎症有显著的抑制作用；美沙拉嗪可以抑制引起炎症的前列腺素的合成和炎性介质白三烯的形成，从而对肠粘膜的炎症起显著抑制作用。对有炎症的肠壁的结缔组织效果更佳。
适应症
用于溃疡性结肠炎、溃疡性直肠炎和克隆氏病(Crohn's Disease)。
不良反应　
可能出现轻度的胃部不适。
注意事项　
①对水杨酸类药物以及本品的赋形剂过敏者忌用。
②肝肾功能不全者慎用；妊娠及哺乳期妇女慎用；两岁以下儿童不宜用。
③与氰钴胺片(VitB12片)同有，将影响氰钴胺片的吸收。
④服药时要整粒囫囵吞服，绝不可嚼碎或压碎。
Mesalamine Rectal Suspension
Dosage Form: rectal suspenson
Mesalamine Rectal Suspension USP
Rx only
Mesalamine Rectal Suspension Description
The active ingredient in Mesalamine Rectal Suspension USP, 4 g/60 mL, a disposable (60 mL) unit, is mesalamine, also known as 5-aminosalicylic acid (5-ASA). Chemically, mesalamine is 5-amino-2-hydroxybenzoic acid.
The structural formula is:
C7H7NO3 M.W. 153.14
Each rectal suspension unit contains 4 grams of mesalamine. In addition to mesalamine the preparation contains the inactive ingredients carbomer 934P, edetate disodium, potassium acetate, potassium metabisulfite, purified water and xanthan gum. Sodium benzoate is added as a preservative. The disposable unit consists of an applicator tip protected by a polyethylene cover and lubricated with USP white petrolatum. The unit has a one-way valve to prevent back flow of the dispensed product.
Mesalamine Rectal Suspension - Clinical Pharmacology
Sulfasalazine is split by bacterial action in the colon into sulfapyridine (SP) and mesalamine (5-ASA). It is thought that the mesalamine component is therapeutically active in ulcerative colitis [A.K. Azad Khan et al, Lancet 2:892-895 (1977)]. The usual oral dose of sulfasalazine for active ulcerative colitis in adults is two to four grams per day in divided doses. Four grams of sulfasalazine provide 1.6 g of free mesalamine to the colon. Each Mesalamine Rectal Suspension USP delivers up to 4 g of mesalamine to the left side of the colon.
The mechanism of action of mesalamine (and sulfasalazine) is unknown, but appears to be topical rather than systemic. Mucosal production of arachidonic acid (AA) metabolites, both through the cyclooxygenase pathways, i.e., prostanoids, and through the lipoxygenase pathways, i.e., leukotrienes (LTs) and hydroxyeicosatetraenoic acids (HETEs) is increased in patients with chronic inflammatory bowel disease, and it is possible that mesalamine diminishes inflammation by blocking cyclooxygenase and inhibiting prostaglandin (PG) production in the colon.
Preclinical Toxicology
Preclinical studies have shown the kidney to be the major target organ for mesalamine toxicity. Adverse renal function changes were observed in rats after a single 600 mg/kg oral dose, but not after a 200 mg/kg dose. Gross kidney lesions, including papillary necrosis, were observed after a single oral > 900 mg/kg dose, and after I.V. doses of > 214 mg/kg. Mice responded similarly. In a 13 week oral (gavage) dose study in rats, the high dose of 640 mg/kg/day mesalamine caused deaths, probably due to renal failure, and dose-related renal lesions (papillary necrosis and/or multifocal tubular injury) were seen in most rats given the high dose (males and females) as well as in males receiving lower doses 160 mg/kg/day. Renal lesions were not observed in the 160 mg/kg/day female rats. Minimal tubular epithelial damage was seen in the 40 mg/kg/day males and was reversible. In a six-month oral study in dogs, the no-observable dose level of mesalamine was 40 mg/kg/day and doses of 80 mg/kg/day and higher caused renal pathology similar to that described for the rat. In a combined 52 week toxicity and 127 week carcinogenicity study in rats, degeneration in kidneys was observed at doses of 100 mg/kg/day and above admixed with diet for 52 weeks, and at 127 weeks increased incidence of kidney degeneration and hyalinization of basement membranes and Bowman's capsule were seen at 100 mg/kg/day and above. In the 12 month eye toxicity study in dogs, Keratoconjunctivitis Sicca (KCS) occurred at oral doses of 40 mg/kg/day and above. The oral preclinical studies were done with a highly bioavailable suspension where absorption throughout the gastrointestinal tract occurred. The human dose of 4 grams represents approximately 80 mg/kg but when mesalamine is given rectally as a suspension, absorption is poor and limited to the distal colon (see Pharmacokinetics). Overt renal toxicity has not been observed (see ADVERSE REACTIONS and PRECAUTIONS), but the potential must be considered.

Pharmacokinetics
Mesalamine administered rectally is poorly absorbed from the colon and is excreted principally in the feces during subsequent bowel movements. The extent of absorption is dependent upon the retention time of the drug product, and there is considerable individual variation. At steady state, approximately 10 to 30% of the daily 4 gram dose can be recovered in cumulative 24 hour urine collections. Other than the kidney, the organ distribution and other bioavailability characteristics of absorbed mesalamine in man are not known. It is known that the compound undergoes acetylation but whether this process takes place at colonic or systemic sites has not been elucidated.

Whatever the metabolic site, most of the absorbed mesalamine is excreted in the urine as the N-acetyl-5-ASA metabolite. The poor colonic absorption of rectally administered mesalamine is substantiated by the low serum concentration of 5-ASA and N-acetyl-5-ASA seen in ulcerative colitis patients after dosage with mesalamine. Under clinical conditions patients demonstrated plasma levels 10 to 12 hours post mesalamine administration of 2 mcg/mL, about two-thirds of which was the N-acetyl metabolite. While the elimination half-life of mesalamine is short (0.5 to 1.5 h), the acetylated metabolite exhibits a half-life of 5 to 10 hours [U. Klotz, Clin. Pharmacokin. 10:285-302 (1985)]. In addition, steady state plasma levels demonstrated a lack of accumulation of either free or metabolized drug during repeated daily administrations.

Efficacy
In a placebo-controlled, international, multicenter trial of 153 patients with active distal ulcerative colitis, proctosigmoiditis or proctitis, Mesalamine Rectal Suspension reduced the overall disease activity index (DAI) and individual components as follows:

EFFECT OF TREATMENT ON SEVERITY OF DISEASE DATA FROM U.S.-CANADA TRIAL COMBINED RESULTS OF EIGHT CENTERS Activity Indices, 

	N	Baseline	Day 22	End Point	Change Baseline to End point*
Overall DAI	Mesalamine	76	7.42	4.05†	3.37‡	-55.07%‡
	Placebo	77	7.40	6.03	5.83	-21.58%
Stool Frequency	Mesalamine		1.58	1.11§	1.01†	-0.57*
	Placebo		1.92	1.47	1.50	-0.41
Rectal Bleeding	Mesalamine		1.82	0.59‡	0.51‡	-1.30‡
	Placebo		1.73	1.21	1.11	-0.61
Mucosal Inflammation	Mesalamine		2.17	1.22†	0.96‡	-1.21†
	Placebo		2.18	1.74	1.61	-0.56
Physician's Assessment of Disease Severity	Mesalamine		1.86	1.13‡	0.88‡	-0.97‡
	Placebo		1.87	1.62	1.55	-0.30

Percent change for overall DAI only (calculated by taking the average of the change for each individual patient).
Significant mesalamine/placebo difference. p < 0.01
Each parameter has a 4 point scale with a numerical rating: 0 = normal, 1 = mild, 2 = moderate, 3 = severe. The four parameters are added together to produce a maximum overall DAI of 12.
Significant mesalamine/placebo difference. p < 0.05
N  Baseline  Day 22 End Point Change Baseline to End point*
Overall DAI  Mesalamine 76 7.42 4.05† 3.37‡ -55.07%‡
Placebo 77 7.40 6.03 5.83 -21.58%  
Stool Frequency Mesalamine  1.58 1.11 1.01 -0.57*
Placebo  1.92 1.47 1.50 -0.41  
Rectal Bleeding Mesalamine  1.82 0.59 0.51 -1.30‡
Placebo  1.73 1.21 1.11 -0.61  
Mucosal Inflammation Mesalamine  2.17 1.22 0.96‡ -1.21
Placebo  2.18 1.74 1.61 -0.56  
Physician's Assessment of Disease Severity Mesalamine  1.86 1.13‡ 0.88‡ -0.97‡
Placebo  1.87 1.62 1.55 -0.30  
Differences between mesalamine and placebo were also statistically different in subgroups of patients on concurrent sulfasalazine and in those having an upper disease boundary between 5 and 20 or 20 and 40 cm. Significant differences between mesalamine and placebo were not achieved in those subgroups of patients on concurrent prednisone or with an upper disease boundary between 40 and 50 cm.

Indications and Usage for Mesalamine Rectal Suspension
Mesalamine Rectal Suspension is indicated for the treatment of active mild to moderate distal ulcerative colitis, proctosigmoiditis or proctitis.
Contraindications
Mesalamine Rectal Suspension is contraindicated for patients known to have hypersensitivity to the drug or any component of this medication.
Warnings
Mesalamine Rectal Suspension contains potassium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. The overall prevalence of sulfite sensitivity in the general population is unknown but probably low. Sulfite sensitivity is seen more frequently in asthmatic or in atopic nonasthmatic persons.
Epinephrine is the preferred treatment for serious allergic or emergency situations even though epinephrine injection contains sodium or potassium metabisulfite with the above-mentioned potential liabilities. The alternatives to using epinephrine in a life-threatening situation may not be satisfactory. The presence of a sulfite(s) in epinephrine injection should not deter the administration of the drug for treatment of serious allergic or other emergency situations.
Precautions
Mesalamine has been implicated in the production of an acute intolerance syndrome characterized by cramping, acute abdominal pain and bloody diarrhea, sometimes fever, headache and a rash; in such cases prompt withdrawal is required. The patient's history of sulfasalazine intolerance, if any, should be re-evaluated. If a rechallenge is performed later in order to validate the hypersensitivity it should be carried out under close supervision and only if clearly needed, giving consideration to reduced dosage. In the literature one patient previously sensitive to sulfasalazine was rechallenged with 400 mg oral mesalamine; within eight hours she experienced headache, fever, intensive abdominal colic, profuse diarrhea and was readmitted as an emergency. She responded poorly to steroid therapy and two weeks later a pancolectomy was required.
Although renal abnormalities were not noted in the clinical trials with Mesalamine Rectal Suspension, the possibility of increased absorption of mesalamine and concomitant renal tubular damage as noted in the preclinical studies must be kept in mind. Patients on Mesalamine Rectal Suspension, especially those on concurrent oral products which liberate mesalamine and those with preexisting renal disease, should be carefully monitored with urinalysis, BUN (blood urea nitrogen), and creatinine studies.
In a clinical trial most patients who were hypersensitive to sulfasalazine were able to take mesalamine enemas without evidence of any allergic reaction. Nevertheless, caution should be exercised when mesalamine is initially used in patients known to be allergic to sulfasalazine. These patients should be instructed to discontinue therapy if signs of rash or fever become apparent.
While using Mesalamine Rectal Suspension, some patients have developed pancolitis. However, extension of upper disease boundary and/or flare-ups occurred less often in the Mesalamine Rectal Suspension treated group than in the placebo-treated group.
Worsening of colitis or symptoms of inflammatory bowel disease, including melena and hematochezia, may occur after commencing mesalamine.
Rare instances of pericarditis have been reported with mesalamine containing products including sulfasalazine. Cases of pericarditis have also been reported as manifestations of inflammatory bowel disease. In the cases reported with Mesalamine Rectal Suspension, there have been positive rechallenges with mesalamine or mesalamine containing products. In one of these cases, however, a second rechallenge with sulfasalazine was negative throughout a 2 month follow-up. Chest pain or dyspnea in patients treated with Mesalamine Rectal Suspension should be investigated with this information in mind. Discontinuation of Mesalamine Rectal Suspension may be warranted in some cases, but rechallenge with mesalamine can be performed under careful clinical observation should the continued therapeutic need for mesalamine be present.
Carcinogenesis, Mutagenesis, Impairment of Fertility
Mesalamine caused no increase in the incidence of neoplastic lesions over controls in a 2 year study of Wistar rats fed up to 320 mg/kg/day of mesalamine admixed with diet. Mesalamine is not mutagenic to Salmonella typhimurium tester strains TA98, TA100, TA1535, TA1537, TA1538. There were no reverse mutations in an assay using E. coli strain WP2UVRA. There were no effects in an in vivo mouse micronucleus assay at 600 mg/kg and in an in vivo sister chromatid exchange at doses up to 610 mg/kg. No effects on fertility were observed in rats receiving up to 320 mg/kg/day. The oligospermia and infertility in men associated with sulfasalazine has very rarely been reported among patients treated with mesalamine.
Pregnancy
Teratogenic Effects
Pregnancy (category B)
Teratologic studies have been performed in rats and rabbits at oral doses up to five and eight times respectively, the maximum recommended human dose, and have revealed no evidence of harm to the embryo or the fetus. There are, however, no adequate and well controlled studies in pregnant women for either sulfasalazine or 5-ASA. Because animal reproduction studies are not always predictive of human response, 5-ASA should be used during pregnancy only if clearly needed.
Nursing Mothers
It is not known whether mesalamine or its metabolite(s) are excreted in human milk. As a general rule, nursing should not be undertaken while a patient is on a drug since many drugs are excreted in human milk.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established.
Adverse Reactions
Clinical Adverse Experience
Mesalamine Rectal Suspension is usually well tolerated. Most adverse effects have been mild and transient.

ADVERSE REACTIONS OCCURRING IN MORE THAN 0.1% OF Mesalamine Rectal Suspension TREATED PATIENTS (COMPARISON TO PLACEBO)

SYMPTOM	MESALAMINE N = 815 N	%	PLACEBON = 128 N	%
Abdominal Pain/Cramps/Discomfort	66	8.10	10	7.81
Headache	53	6.50	16	12.50
Gas/Flatulence	50	6.13	5	3.91
Nausea	47	5.77	12	9.38
Flu	43	5.28	1	0.78
Tired/Weak/Malaise/Fatigue	28	3.44	8	6.25
Fever	26	3.19	0	0.00
Rash/Spots	23	2.82	4	3.12
Cold/Sore Throat	19	2.33	9	7.03
Diarrhea	17	2.09	5	3.91
Leg/Joint Pain	17	2.09	1	0.78
Dizziness	15	1.84	3	2.34
Bloating	12	1.47	2	1.56
Back Pain	11	1.35	1	0.78
Pain on Insertion of Enema Tip	11	1.35	1	0.78
Hemorrhoids	11	1.35	0	0.00
Itching	10	1.23	1	0.78
Rectal Pain	10	1.23	0	0.00
Constipation	8	0.98	4	3.12
Hair Loss	7	0.86	0	0.00
Peripheral Edema	5	0.61	11	8.59
UTI/Urinary Burning	5	0.61	4	3.12
Rectal Pain/Soreness/Burning	5	0.61	3	2.34
Asthenia	1	0.12	4	3.12
Insomnia	1	0.12	3	2.34

In addition, the following adverse events have been identified during post-approval use of products which contain (or are metabolized to) mesalamine in clinical practice: nephrotoxicity, pancreatitis, fibrosing alveolitis and elevated liver enzymes. Cases of pancreatitis and fibrosing alveolitis have been reported as manifestations of inflammatory bowel disease as well. Published case reports and/or spontaneous postmarketing surveillance have described rare instances of aplastic anemia, agranulocytosis, thrombocytopenia, eosinophilia, pancytopenia, neutropenia, oligospermia, and infertility in men. Anemia, leukocytosis, and thrombocytosis can be part of the clinical presentation of inflammatory bowel disease.
Hair Loss
Mild hair loss characterized by "more hair in the comb" but no withdrawal from clinical trials has been observed in 7 of 815 mesalamine patients but none of the placebo-treated patients. In the literature there are at least six additional patients with mild hair loss who received either mesalamine or sulfasalazine. Retreatment is not always associated with repeated hair loss.

Overdosage
There have been no documented reports of serious toxicity in man resulting from massive overdosing with mesalamine. Under ordinary circumstances, mesalamine absorption from the colon is limited.
Mesalamine Rectal Suspension Dosage and Administration
The usual dosage of Mesalamine Rectal Suspension USP in 60 mL units is one rectal instillation (4 grams) once a day, preferably at bedtime, and retained for approximately eight hours. While the effect of Mesalamine Rectal Suspension USP may be seen within 3 to 21 days, the usual course of therapy would be from 3 to 6 weeks depending on symptoms and sigmoidoscopic findings. Studies available to date have not assessed if Mesalamine Rectal Suspension will modify relapse rates after the 6 week short-term treatment. Mesalamine Rectal Suspension USP is for rectal use only.
Patients should be instructed to shake the bottle well to make sure the suspension is homogeneous. The patient should remove the protective sheath from the applicator tip. Holding the bottle at the neck will not cause any of the medication to be discharged. The position most often used is obtained by lying on the left side (to facilitate migration into the sigmoid colon); with the lower leg extended and the upper right leg flexed forward for balance. An alternative is the knee-chest position. The applicator tip should be gently inserted in the rectum pointing toward the umbilicus. A steady squeezing of the bottle will discharge most of the preparation. The preparation should be taken at bedtime with the objective of retaining it all night. Patient instructions are included with every seven units.
How is Mesalamine Rectal Suspension Supplied
Mesalamine Rectal Suspension USP, 4 g/60 mL for rectal administration is a off-white to tan colored suspension. Each disposable enema bottle contains 4 grams of mesalamine in 60 mL aqueous suspension. Enema bottles are supplied in boxed, foil-wrapped trays of seven. Mesalamine Rectal Suspension USP, 4 g/60 mL is for rectal use only.
Patient instructions are included.
Store at 20º to 25ºC (68º to 77ºF) [See USP Controlled Room Temperature]. Once the foil-wrapped unit of seven bottles is opened, any bottles remaining after 14 days should be discarded. Contents of enemas removed from the foil pouch may darken with time. Slight darkening will not affect potency, however, product with dark brown contents should be discarded.
NOTE: Mesalamine Rectal Suspension USP, 4 g/60 mL will cause staining of direct contact surfaces, including but not limited to fabrics, flooring, painted surfaces, marble, granite, vinyl, and enamel. Take care in choosing a suitable location for administration of this product.

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产地国家: 美国
原产地英文药品名:
MESALAMINE
原产地英文化合物名称:
5-Amino Salicylic Acid
中文参考商品译名:
美沙拉嗪灌肠混悬剂(ROWASA灌肠剂仿制药) 4克/60毫升/瓶 7瓶/盒
中文参考药品译名:
美沙拉嗪
中文参考化合物名称:
5-氨基水杨酸
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产地国家: 美国
原产地英文药品名:
MESALAMINE
原产地英文化合物名称:
5-Amino Salicylic Acid
中文参考商品译名:
美沙拉嗪灌肠混悬剂(ROWASA灌肠剂仿制药) 4克/60毫升/瓶 28瓶/盒
中文参考药品译名:
美沙拉嗪
中文参考化合物名称:
5-氨基水杨酸