5-Aminosalicylic acid in patients with an ileo-rectal anastomosis. A comparison of the fate of sulfasalazine and Pentasa.
The pharmacokinetics of 5-aminosalicylic acid (5-ASA) from sulphasalazine (SASP) and the slow-release 5-ASA preparation Pentasa was investigated in a cross-over study in 9 otherwise healthy patients with an ileo-rectal anastomosis. The 24-hour recoveries of the drugs were 90.5% and 84.7%, respectively. The median release of 5-ASA from SASP was 50% and from Pentasa 75%. Equal amounts of 5-ASA (18.0% vs 17.9%) were found in the faeces, and a significantly larger amount (4.4% vs 28.9%) of the metabolite N-acetyl-5-aminosalicylic acid (ac-5-ASA) was found in faeces following Pentasa. A larger amount of 5-ASA was absorbed and subsequently excreted in the urine, mainly as the metabolite (2.5% vs 20.5%) from Pentasa. This confirms previous results in ileostomized patients treated with Pentasa. The present findings also demonstrate that bacterial azo-reduction of SASP in patients with ileorectal anastomosis may be an adequate way to deliver 5-ASA in this type of patient. Both treatments may be used in these patients during a flare up of ulcerative colitis, but randomized studies are needed.
D000636:Aminosalicylic Acids / Q000008:administration & dosage / Q000097:blood / Q000378:metabolism*; D003082:Colectomy; D003692:Delayed-Action Preparations; D005243:Feces / Q000032:analysis; D006801:Humans; D007082:Ileum / Q000601:surgery*; D019804:Mesalamine; D012007:Rectum / Q000601:surgery*; D012460:Sulfasalazine / Q000378:metabolism*
D000636:Aminosalicylic Acids; D003692:Delayed-Action Preparations; D012460:Sulfasalazine; D019804:Mesalamine; C028836:N-acetyl-5-aminosalicylic acid