Balsalazide sodium

How it works

It is a prodrug that is cleaved by colonic bacteria to release the active moiety mesalazine (5-aminosalicylic acid) directly in the colon, where it exerts a topical anti-inflammatory effect on the bowel mucosa.

Prescribing in practice

• Aminosalicylates can cause blood dyscrasias, and patients should be advised to report unexplained bleeding, bruising, sore throat, fever or malaise that may indicate a blood disorder requiring a full blood count.
• Renal function should be assessed before and during treatment because mesalazine-related nephrotoxicity, including interstitial nephritis, can occur.
• Use with caution in patients with salicylate hypersensitivity, and be aware that mesalazine-induced cardiac hypersensitivity and acute intolerance reactions can occur.

Monitoring

Monitor renal function before starting and periodically during treatment, and check a full blood count if a blood dyscrasia is suspected.

Counselling the patient

• Keep taking it as prescribed, including for maintenance, even when you feel well.
• Report unexplained bruising, bleeding, sore throat or fever straight away.
• Tell your prescriber if you have a history of aspirin or salicylate allergy.

Evidence & guidelines

Oral aminosalicylates are recommended first-line in NICE guidance for inducing and maintaining remission in mild to moderate ulcerative colitis.