Inflammatory bowel disease, or IBD, is the term used for conditions in which a patient's immune system incorrectly attacks the patient's intestines. IBDs include ulcerative colitis and Crohn's disease, both of which are treated with anti-inflammatory medications to reduce symptoms such as diarrhea, blood in the stool and abdominal pain. One such medication is Asacol, which is a brand name for the generic drug mesalamine. It is released within the intestine and is only minimally absorbed by the rest of the body; this may reduce unwanted side effects. However, patients with IBD have several alternatives that are similar to Asacol.
Sulfasalazine
Like mesalamine, sulfasalazine, brand name Azulfidine, is considered a 5-ASA derivative. When taken by mouth, sulfasalazine is broken down into active components called metabolites. It is officially approved by the U.S. Food and Drug Administration to treat ulcerative colitis, but is also used to treat Crohn's disease. However, according to UpToDate contributors Dr. Richard Farrell and Dr. Mark Peppercorn, experts in inflammatory bowel disease, sulfasalazine should only be used in treating active Crohn's disease, not maintaining remission of Crohn's. In contrast, for patients with ulcerative colitis, sulfasalazine may be used both to treat active symptoms and prevent recurrence of symptoms. According to the medical reference UpToDate, side effects include upset stomach at the onset of treatment, headaches, rashes and a reversible decrease in sperm count in men. Less frequent side effects, occurring in less than 10 percent of patients include dizziness, hives, and abnormal liver function test results.
Olsalazine
Olsalazine, brand name Dipentum, is another medication that is closely related to Asacol. Like Asacol, olsalazine is a 5-ASA medication that may be used to treat inflammatory bowel disease. The IBD experts writing in UpToDate, Drs. Farrell and Peppercorn, do not recommend using olsalazine to treat Crohn's disease that affects the lower part of small intestine, called the ileum; however, they do advocate its use in treating ulcerative colitis, as well as Crohn's disease that affects the colon, or large intestine. An advantage of olsalazine is that it does not contain the sulfa component of sulfasalazine. This means that patients with IBD who are allergic to sulfa may still benefit from the anti-inflammatory properties of a 5-ASA drug without worrying about having an allergic reaction. MedlinePlus lists several possible side effects of olsalazine including joint pain, dizziness, blurry vision, lack of appetite, diarrhea and upset stomach. More serious and rare side effects include bleeding disorders and liver damage.
Balsalazide
Balsalazide, brand name Colazol, is another anti-inflammatory, 5-ASA derivative used in the treatment of mild to moderate ulcerative colitis; however, it is not recommended for treating Crohn's disease. A study published in the April 2009 edition of the "Digestive Diseases and Sciences" journal compared the effectiveness of balsalazide and mesalamine and found that balsalazide was actually better at inducing remission of ulcerative colitis and as effective as mesalamine in maintaining remission. Medline Plus provides a long list of possible side effects of this medication including joint pain, upset stomach, diarrhea; insomnia, and headache. Rarely, liver damage, jaundice, and liver failure may occur, but according to UpToDate, this occurs in less than one percent of cases.
References
- Prescribing Information: Asacol
- "UpToDate;" Medical management of Crohn's disease in adults; R. Farrell and M. Peppercorn; March 2010
- MedlinePlus: Olsalazine
- MedlinePlus: Balsalazide
- "Digestive Diseases and Sciences;" Comparison of Mesalazine and Balsalazide in Induction and Maintenance of Remission in Patients with Ulcerative Colitis: a Meta-analysis; R. Rahimi et. al.; April 2009
