mercaptopurine and balsalazide

5-Aminosalicylic acid (5-ASA)-containing drugs are the mainstay of therapy in inflammatory bowel disease, but adverse reactions to these medications are relatively common. Because there may be a lack of cross-reactivity among the various 5-ASA formulations, treatment with alternative preparations is sometimes possible even after an apparent allergic reaction to a 5-ASA product.. To describe a patient with a possible allergy to 2 different 5-ASA drugs who tolerated a third.. A 27-year-old man with Crohn disease developed a rash while taking mesalamine (Pentasa and Asacol). Treatment with 5-ASA products was discontinued, and 6-mercaptopurine and prednisone were prescribed. He then experienced multiorgan failure secondary to herpes simplex infection, which required discontinuation of the immunosuppressive therapy. After recovery from the acute infection, he underwent successful graded challenge with balsalazide.. The patient continued treatment with balsalazide for 9 months, with good control of his inflammatory bowel disease and no adverse effects.. Adverse reactions to 1 or more 5-ASA medications do not necessarily preclude the use of others in the same class. A treatment algorithm for patients with adverse reactions to 5-ASA is outlined based on the case report and review of the literature.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Crohn Disease; Cross Reactions; Drug Hypersensitivity; Exanthema; Herpes Simplex; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Mesalamine; Phenylhydrazines; Prednisone

We evaluated the effect of coadministration of sulphasalazine, mesalamine, and balsalazide on the pharmacokinetics and pharmacodynamics of azathioprine and 6-mercaptopurine.. Thirty four patients with Crohn's disease receiving azathioprine or 6-mercaptopurine were enrolled in an eight week non-randomised parallel group drug interaction study and treated with mesalamine 4 g/day, sulphasalazine 4 g/day, or balsalazide 6.75 g/day. The primary outcome measure was the occurrence of clinically important leucopenia during the study, defined separately as total leucocyte counts < 3.0 x 10(9)/l and < or = 3.5 x 10(9)/l. Whole blood 6-thioguanine nucleotide concentrations were determined.. Three patients could not be evaluated for the primary outcome measure. In the remaining 31 patients, the frequency of total leucocyte counts < 3.0 and < or = 3.5 were: 1/10 and 5/10 in the mesalamine group; 1/11 and 6/11 in the sulphasalazine group; and 0/10 and 2/10 in the balsalazide group. There were significant increases in mean whole blood 6-thioguanine nucleotide concentrations from baseline at most time points in the mesalamine and sulphasalazine groups but not in the balsalazide group.. In patients with Crohn's disease receiving azathioprine or 6-mercaptopurine, coadministration of mesalamine, sulphasalazine, and possibly balsalazide results in an increase in whole blood 6-thioguanine nucleotide concentrations and a high frequency of leucopenia.

Topics: Adult; Aminosalicylic Acids; Analysis of Variance; Anti-Inflammatory Agents, Non-Steroidal; Azathioprine; Binomial Distribution; Chromatography, High Pressure Liquid; Confidence Intervals; Drug Interactions; Female; Humans; Immunosuppressive Agents; Leukopenia; Male; Mercaptopurine; Mesalamine; Methyltransferases; Phenylhydrazines; Sulfasalazine; Thioguanine

Topics: Aminosalicylic Acids; Anti-Ulcer Agents; Antirheumatic Agents; Azathioprine; Drug Interactions; Drug Therapy, Combination; Humans; Inflammatory Bowel Diseases; Mercaptopurine; Mesalamine; Phenylhydrazines

Topics: Administration, Oral; Aminosalicylic Acids; Antimetabolites; Azathioprine; Drug Interactions; Humans; Inhibitory Concentration 50; Mercaptopurine; Mesalamine; Methyltransferases; Phenylhydrazines; Prodrugs