Olsalazine

INTRODUCTION

Indications

Ulcerative colitis (when patients cannot tolerate sulfasalazine).

Action

Locally acting anti-inflammatory action in the colon, where activity is probably due to inhibition of prostaglandin synthesis. Therapeutic Effects: Reduction in the symptoms of inflammatory bowel disease.

Adverse Reactions/Side Effects

CNS: ataxia, confusion, dizziness, drowsiness, headache, mental depression, psychosis, restlessness. GI: diarrhea, abdominal pain, anorexia, exacerbation of colitis, drug-induced hepatitis, nausea, vomiting. Derm: itching, rash. Hemat: blood dyscrasias.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful.

• Monitor and report signs of blood dyscrasias such as agranulocytosis (fever, sore throat, mucosal lesions, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or anemias (unusual weakness, fatigue, pallor, shortness of breath upon exertion).

• Assess dizziness, drowsiness, or ataxia that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor changes in mood and behavior, including depression, confusion, restlessness, and psychosis. Notify physician if these changes become problematic.

Patient/Client-Related Instruction

• Advise patient to guard against infection (frequent hand washing, etc.), and to avoid crowds and contact with persons with contagious diseases.

• Advise patient about the likelihood of GI reactions (nausea, vomiting, diarrhea, loss of appetite). Instruct patient to report severe or prolonged GI problems, increased symptoms of colitis, or signs of drug-induced hepatitis (yellow skin or eyes, abdominal pain, severe nausea and vomiting, fever, sore throat, malaise, weakness, facial edema).

• Instruct patient to report other untoward side effects such as severe or prolonged headache or skin reactions (rash, itching).

Pharmacokinetics

Absorption: Acts locally in colon, where 98–99% is converted to mesalamine (5-aminosalicylic acid).

Distribution: Action is primarily local and remains in the colon.

Metabolism and Excretion: 2% absorbed into systemic circulation is rapidly metabolized; mostly eliminated as mesalamine in the feces.

Half-life: 0.9 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity reactions to salicylates; Cross-sensitivity with furosemide, sulfonylurea hypoglycemic agents, or carbonic anhydrase inhibitors may exist; G6PD deficiency; Urinary tract or intestinal obstruction; Pedi: Children <2 yr (safe use not established); Porphyria.

Use Cautiously in: Severe hepatic or renal impairment; OB: Pregnancy; Geri: Geriatric patients (consider ↓ body ...