Consumer medicine information

Asacol

Mesalazine

BRAND INFORMATION

Brand name

Asacol

Active ingredient

Mesalazine

Schedule

S4

 

Consumer medicine information (CMI) leaflet

Please read this leaflet carefully before you start using Asacol.

What is in this leaflet

This leaflet answers some common questions about ASACOL. It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist.

All medicines have risks and benefits. Your doctor has weighed the risks of you taking ASACOL against the benefits they expect it will have for you.

If you have any concerns about taking this medicine, ask your doctor or pharmacist.

Keep this leaflet with the medicine. You may need to read it again.

What ASACOL is used for

ASACOL contains the active ingredient mesalazine. This is an anti-inflammatory agent used to treat and prevent further episodes of ulcerative colitis.

Ulcerative colitis is a disease of the large bowel (colon) or back passage (rectum), in which the lining of the bowel becomes inflamed (red and swollen).

ASACOL acts locally at the site of inflammation (colon, rectum and terminal ileum) to reduce this inflammation.

Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed it for another reason.

ASACOL is not addictive.

It is available only with a doctor's prescription.

ASACOL is not expected to affect your ability to drive a car or operate machinery.

Before you take ASACOL

When you must not take it

Do not take ASACOL if you have an allergy to:

  • any medicine containing mesalazine
  • any of the other ingredients listed at the end of this leaflet
  • aspirin or any other salicylates.

Some of the symptoms of an allergic reaction may include:

  • shortness of breath
  • wheezing or difficulty breathing
  • swelling of the face, lips, tongue or other parts of the body
  • rash, itching or hives on the skin.

Do not take ASACOL if you have:

  • severe liver problems
  • severe kidney problems.

Do not give this medicine to children and adolescents.

The safety and effectiveness of ASACOL in this age group have not been established.

Do not take this medicine after the expiry date printed on the pack or if the packaging is torn or shows signs of tampering.

If it has expired or is damaged, return it to your pharmacist for disposal.

If you are not sure whether you should start taking this medicine, talk to your doctor.

Before you start to take it

Tell your doctor if you have allergies to any other medicines, foods, preservatives or dyes.

Tell your doctor if you have or have had any of the following medical conditions:

  • asthma or lung problems
  • liver or kidney problems
  • stomach or intestine ulcer
  • suffered a reaction after using the similar medicine sulfasalazine
  • heart problems such as inflammation of the heart muscle (myocarditis) or sac around heart (pericarditis) after using mesalazine
  • severe skin rash or skin peeling, blistering and/or mouth sores after using mesalazine.

ASACOL 400 mg and 800 mg tablets contain a small amount of lactose.

If your doctor has told you that you have intolerance to some sugars, ask your doctor before taking this medicine.

ASACOL may produce red-brown urine discoloration after contact with sodium hypochlorite bleach in the toilet water.

This is caused by a chemical reaction between the active ingredient mesalazine and bleach and is harmless.

Tell your doctor if you are pregnant or plan to become pregnant or are breastfeeding.

Your doctor can discuss with you the risks and benefits involved.

If you have not told your doctor about any of the above, tell him/her before you start taking ASACOL.

Taking other medicines

Tell your doctor or pharmacist if you are taking any other medicines, including any that you get without a prescription from your pharmacy, supermarket or health food shop.

ASACOL may interfere with the following types of medicines:

  • medicines affecting the immune system or anticancer drugs (e.g. azathioprine or 6-mercaptopurine or thioguanine)
  • medicines that prevent the formation of blood clots (anticoagulants e.g. warfarin).
  • non-steroidal anti-inflammatory drugs (e.g. medicines containing aspirin, ibuprofen or diclofenac)

How to take ASACOL

Follow all directions given to you by your doctor or pharmacist carefully. They may differ from the information contained in this leaflet.

If you do not understand the instructions on the packaging, ask your doctor or pharmacist for help.

How much to take

The usual dose to treat a current episode of ulcerative colitis is 2.4 g to 4.8 g taken once daily or in divided doses. The dosage may be adjusted by your doctor.

The usual dose to prevent an episode of ulcerative colitis is 1.6 g to 2.4 g taken once daily or in divided doses.

How to take it

Swallow the tablets whole with a full glass of water.

Do not chew, crush or break the tablets before swallowing them.

When to take it

The tablets can be taken with or without food.

How long to take it

Continue taking your medicine for as long as your doctor tells you. This medicine helps to control your condition, but does not cure it. It is important to keep taking your medicine even if you feel well.

If you forget to take it

If it is almost time for your next dose, skip the dose you missed and take the next dose as normal.

Do not take a double dose to make up for the dose that you missed.

If you are not sure what to do, ask your doctor or pharmacist.

If you take too much (overdose)

Immediately telephone your doctor or the Poisons Information Centre (telephone 13 11 26) for advice, or go to Accident and Emergency at the nearest hospital, if you think that you or anyone else may have taken too much ASACOL. Do this even if there are no signs of discomfort or poisoning. You may need urgent medical attention.

While you are taking ASACOL

Things you must do

If you are about to be started on any new medicine, remind your doctor and pharmacist that you are taking ASACOL.

Tell any other doctors, dentists, and pharmacists who treat you that you are taking this medicine.

If you are going to have surgery, tell the surgeon or anaesthetist that you are taking this medicine. It may affect other medicines used during surgery.

If you become pregnant while taking this medicine, tell your doctor immediately.

Keep all of your doctor's appointments so that your progress can be checked.

Your doctor will do tests before you start and from time to time while you are taking ASACOL to check that your liver, kidneys, blood and lungs are all right.

Drink plenty of water during treatment.

There have been a few reports of kidney stones. Drinking plenty of water may help to prevent this.

Things you must not do

Do not take ASACOL to treat any other complaints unless your doctor tells you to.

Do not give your medicine to anyone else, even if they have the same condition as you.

Do not stop taking your medicine or lower the dosage without checking with your doctor. If you stop taking it suddenly, your condition may worsen.

Side effects

Tell your doctor or pharmacist as soon as possible if you do not feel well while you are taking ASACOL.

This medicine helps most people, with ulcerative colitis, but it may have unwanted side effects in a few people. All medicines can have side effects. Sometimes they are serious, most of the time they are not. You may need medical attention if you get some of the side effects.

Do not be alarmed by the following lists of side effects. You may not experience any of them.

Ask your doctor or pharmacist to answer any questions you may have.

Tell your doctor or pharmacist if you notice any of the following and they worry you:

  • indigestion
  • mild abdominal pain
  • diarrhoea
  • flatulence
  • nausea, vomiting
  • mild rash
  • increased sensitivity of the skin to sun
  • hair loss
  • sensation of tingling, pricking and numbness
  • headache
  • dizziness
  • weight loss
  • reversible decrease in sperm count in men.

The above list includes less serious side effects of your medicine.

If you notice any of the following, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:

  • sudden signs of allergic reactions such as rash, itching or hives, shortness of breath, wheezing, coughing, or swelling of limbs, face, lips, mouth, tongue or throat which may cause difficulty swallowing or breathing
  • unexplained bruising (without injury), bleeding under your skin, purple spots or patches under your skin, anaemia (feeling tired, weak and looking pale, especially on lips, nails and inside of eyelids), fever (high temperature), sore throat or unusual bleeding (e.g. nose bleeds)
  • reddish non-elevated, target-like or circular patches on the trunk, often with central blisters, skin peeling, ulcers of mouth, throat, nose, genitals and eyes, widespread rash, fever and enlarged lymph nodes which may be accompanied by fever and flu-like symptoms
  • severe stomach or abdominal cramps or pain with nausea, vomiting, bloody diarrhoea, fever, severe headache and skin rash
  • sudden severe pain in back, side or stomach, pain or burning during urination might be symptoms of kidney stones (see also “Things you must do”)
  • liver problems with nausea, vomiting, loss of appetite, feeling generally unwell, fever, itching, yellowing of the skin and eyes, and dark coloured urine
  • muscle aches and pains, joint pain, chest pain (sometimes spreading to the neck and shoulders)
  • lung infection with fever, chills,shortness of breath, cough and phlegm.

The above list includes serious side effects. You may need urgent medical attention or hospitalisation. Serious side effects are rare.

Tell your doctor or pharmacist if you notice anything that is making you feel unwell.

Other side effects not listed above may also occur in some people. Some of these side effects (for example, changes in liver and kidney function or changes in blood testresults) can only be found when your doctor does tests from time to time to check your progress.

Tell your doctor if you often observe tablets or tablet shells in your stool while taking ASACOL 400 mg or 800 mg tablets.

There have been a few reports of intact tablets found in the stool in people taking ASACOL 400 mg and 800 mg tablets. What appear to be intact tablets may sometimes be the remains of the tablet coating.

After taking ASACOL

Storage

Keep your tablets in the packaging until it is time to take them. If you take the tablets out of the packaging, they may not keep well.

Keep your tablets in a cool dry place where the temperature stays below 25°C.

Do not store ASACOL or any other medicine in the bathroom or near a sink. Do not leave it on a window sill or in the car. Heat and dampness can damage some medicines.

Keep it where children cannot reach it. A locked cupboard at least one-and-a-half metres above the ground is a good place to store medicines.

Disposal

If your doctor tells you to stop taking this medicine or the expiry date has passed, ask your pharmacist what to do with any medicine that is left over.

Product description

What it looks like

ASACOL 400 mg, and 800 mg

ASACOL 400 mg and 800 mg tablets are coated, reddish to brownish oblong tablets with a glossy to matt finish.

The dimensions of the 400 mg tablet are: thickness 7 mm, length 15 mm and width: 6 mm.

The dimensions of the 800 mg tablet are: thickness: 8 mm, length: 17 mm and width: 8 mm.

ASACOL 400 mg and 800 mg tablets are supplied in blister packs of 30, 60, 90 or 180 tablets.

ASACOL 1600 mg

ASACOL 1600 mg tablets are coated, dark orange oblong tablets with a glossy to matte finish.

The dimensions of the 1600 mg tablet are: thickness: 9 mm, length: 23 mm and width: 11 mm.

The 1600 mg tablets are supplied in blister packs of 30, 60 or 90 tablets.

Not all pack sizes are marketed.

Ingredients

ASACOL 400 mg, 800 mg and 1600 mg tablets contain mesalazine 400 mg, 800 mg or 1600 mg as the active ingredient.

ASACOL 400 mg, and 800 mg

ASACOL 400 mg and 800 mg tablets also contain the following inactive ingredients:

  • sugars as lactose (lactose monohydrate)
  • sodium starch glycollate type A
  • magnesium stearate
  • purified talc
  • povidone
  • methacrylic acid copolymer
  • triethyl citrate
  • iron oxide yellow
  • iron oxide red
  • macrogol 6000.

ASACOL 1600 mg

ASACOL 1600 mg tablets also contain the following inactive ingredients:

  • microcrystalline cellulose
  • sodium starch glycollate type A
  • hypromellose
  • colloidal anhydrous silica
  • magnesium stearate
  • methacrylic acid copolymer
  • triethyl citrate
  • glycerol monostearate
  • maize starch
  • polysorbate 80
  • macrogol 6000
  • iron oxide yellow
  • iron oxide red
  • monobasic potassium phosphate
  • sodium hydroxide.

Supplier

ASACOL is supplied in Australia by:

Chiesi Australia Pty Ltd
Suite 3, 22 Gillman Street
Hawthorn East, VIC 3123
Email: [email protected]
Website: www.chiesi.com.au

Australian registration numbers:

ASACOL 400 mg: AUST R 261419

ASACOL 800 mg: AUST R 261420

ASACOL 1600 mg: AUST R 322671

This leaflet was prepared in June 2023.

ASACOL® is a registered trademark of Tillotts Pharma AG, Switzerland.

Published by MIMS September 2023

BRAND INFORMATION

Brand name

Asacol

Active ingredient

Mesalazine

Schedule

S4

 

1 Name of Medicine

Mesalazine.

2 Qualitative and Quantitative Composition

Asacol enteric coated tablets contain 400 mg, 800 mg or 1600 mg mesalazine as the active ingredient.

Excipient with known effect.

Sugars as lactose (400 mg and 800 mg tablets).
For the full list of excipients, see Section 6.1 List of Excipients.

3 Pharmaceutical Form

Asacol 400 mg and 800 mg.

Asacol enteric coated tablets are reddish to brownish oblong tablets with a glossy to matte finish (Asacol 400 mg dimensions: 15 x 6 x 7 mm; Asacol 800 mg dimensions: 17 x 8 x 8 mm).

Asacol 1600 mg.

Asacol enteric coated tablets are film coated dark orange oblong tablets with a glossy to matte finish (Asacol 1600 mg dimensions: 23 x 11 x 9 mm).

4 Clinical Particulars

4.1 Therapeutic Indications

Asacol is indicated for the treatment of mild to moderate ulcerative colitis and maintenance of remission in adults.

4.2 Dose and Method of Administration

Dosage.

Adults.

Acute disease.

2.4 g to 4.8 g per day taken once daily or in divided doses. The dosage can be adjusted in accordance with the response to treatment.

Maintenance therapy.

1.6 g to 2.4 g per day taken once daily or in divided doses.

Elderly population.

The normal adult dose can be taken unless liver or renal function is severely impaired, see Section 4.3 Contraindications; Section 4.4 Special Warnings and Precautions for Use. No studies have been carried out in the elderly population.

Method of administration.

The tablets must be swallowed whole preferably with some liquid.
The tablets must not be chewed, crushed or broken before swallowing. The tablets can be taken with or without food. If one or more doses have been missed, the next dose should be taken as usual.

4.3 Contraindications

Hypersensitivity to the active substance or to any of the excipients listed in Section 6.1 List of Excipients.
Known hypersensitivity to salicylates.
Severe liver impairment.
Severe renal impairment (GFR < 30 mL/min/1.73 m2).

4.4 Special Warnings and Precautions for Use

Identified precautions.

Blood tests (differential blood count; liver function parameters such as ALT or AST; serum creatinine) and urinary status (dip-sticks) should be determined prior to and during treatment, at the discretion of the treating physician. As a guideline, follow-up tests are recommended 14 days after commencement of treatment, then a further two to three tests at intervals of 4 weeks.
If the findings are normal, follow-up tests should be carried out every 3 months. If additional symptoms occur, these tests should be performed immediately.

Blood dyscrasia.

Serious blood dyscrasias have been very rarely reported. Asacol therapy should be stopped immediately if there is a suspicion or evidence of blood dyscrasia (signs of unexplained bleeding, bruising, purpura, anaemia, persistent fever or sore throat), and the patient should be advised to seek immediate medical advice.

Cardiac hypersensitivity reactions.

Mesalazine-induced cardiac hypersensitivity reactions (myocarditis and pericarditis) have rarely been reported with Asacol. In case of a suspected mesalazine-induced cardiac hypersensitivity, Asacol must not be reintroduced. Caution should be taken in patients with previous myocarditis or pericarditis of allergic background regardless of its origin.

Pulmonary disease.

Patients with pulmonary disease, in particular asthma, should be carefully monitored during treatment with Asacol.

Adverse drug reactions to sulfasalazine.

Patients with a history of adverse drug reactions to sulfasalazine therapy should be kept under close medical supervision. Treatment must be stopped immediately if acute symptoms of intolerance occur such as abdominal cramps, acute abdominal pain, fever, severe headache and rash.

Gastric and duodenal ulcers.

Caution is recommended when treating patients with existing gastric or duodenal ulcer.

Nephrolithiasis.

Cases of nephrolithiasis have been reported with the use of mesalazine, including stones with mesalazine content. Ensure adequate fluid intake during treatment.

Discolouration of urine after contact with sodium hypochlorite.

Mesalazine may produce red-brown urine discoloration after contact with sodium hypochlorite bleach (e.g. in toilets cleaned with sodium hypochlorite contained in certain bleaches).

Severe cutaneous adverse reactions.

Severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported in association with mesalazine treatment.
Mesalazine should be discontinued, at the first appearance of signs and symptoms of severe skin reactions, such as skin rash, mucosal lesions, or any other sign of hypersensitivity.

Asacol 400 mg and 800 mg.

Tablets in stool.

A limited number of reports of intact 400 mg and 800 mg tablets in the stool have been received. What appear to be intact tablets may in some cases represent largely empty shells of the coated tablets. If intact tablets are observed in the stool repeatedly, the patient should consult his/her physician.

Tablets contain lactose.

Patients with rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption should not take Asacol 400 mg and 800 mg.

Use in hepatic impairment.

There have been reports of increased liver enzyme levels in patients taking preparations containing mesalazine. Caution is recommended if Asacol is administered to patients with liver impairment.

Use in renal impairment.

It is recommended that the renal function is monitored prior to and repeatedly whilst on mesalazine therapy. Caution should be exercised when initiating treatment in patients with raised serum creatinine or proteinuria.
Mesalazine-induced renal toxicity should be suspected if the renal function deteriorates during treatment and the treatment should be stopped immediately.
Short monitoring intervals for monitoring of renal function early after the start of Asacol therapy will discover rare acute renal reactions. In the absence of an acute renal reaction, monitoring intervals can be extended to every 3 months and then annually after 5 years.

Use in the elderly.

Mesalazine should be administered with caution in the elderly.
Asacol should only be used in elderly patients with normal or non-severe hepatic and renal impairment (see Section 4.4 Special Warnings and Precautions for Use, Use in hepatic impairment, Use in renal impairment).

Paediatric use.

Asacol 400 mg and 800 mg.

As there is only limited documentation for an effect in children (age 6-18 years), administration in this age group is not recommended.

Asacol 1600 mg.

The safety and efficacy of Asacol in children and adolescents aged younger than 18 years of age has not been established.

Effects on laboratory tests.

Several reports of possible interference with measurements, by liquid chromatography, of urinary normetanephrine causing false-positive test result have been observed in patients exposed to sulfasalazine or its metabolite, mesalazine.

4.5 Interactions with Other Medicines and Other Forms of Interactions

No interaction studies have been performed.
There is weak evidence that mesalazine might decrease the anticoagulant effect of warfarin.
Caution is recommended for the concomitant use of mesalazine with known nephrotoxic agents, including non-steroidal anti-inflammatory drugs (NSAIDs) and azathioprine as these may increase the risk of renal adverse reactions.
A possible increase in the myelosuppressive effects of azathioprine, 6-mercaptopurine or thioguanine in patients who are concomitantly treated with any of these preparations, should be taken into account. Life-threatening infection can occur. Patients should be closely observed for signs of infection and myelosuppression. Haematological parameters, especially the leucocyte, thrombocyte and lymphocyte cell counts should be monitored regularly (weekly), especially at initiation of such combination therapy (see Section 4.4 Special Warnings and Precautions for Use). If white blood cells are stable after 1 month, testing every 4 weeks for the following 12 weeks followed by 3 monthly monitoring intervals appears to be justified.

4.6 Fertility, Pregnancy and Lactation

Effects on fertility.

No effects on fertility or reproductive performance were observed in male or female rats at oral doses of mesalazine of up to 480 mg/kg/day (similar to the maximal recommended human dose of Asacol on a body surface area basis).
(Category C)
Mesalazine is known to cross the placental barrier, but available data are insufficient to assess the risk of adverse effects on either pregnancy or the health of the foetus/neonate. Nonsteroidal anti-inflammatory drugs inhibit prostaglandin synthesis and, when given during the latter part of pregnancy, may cause closure of the foetal ductus arteriosus, foetal renal impairment, inhibition of platelet aggregation, and delay labour and birth. Continuous treatment with nonsteroidal anti-inflammatory drugs during the last trimester of pregnancy should only be given on sound indications. During the last few days before expected birth, agents with an inhibitory effect on prostaglandin synthesis should be avoided.
There are no adequate data on the use of Asacol in pregnant women. However, data on a limited number (n = 627) of exposed pregnancies indicate no adverse effect of mesalazine on pregnancy or on the health of the foetus/newborn child. To date no other relevant epidemiological data are available.
In one single case after long-term use of a high dose of mesalazine (2-4 g, orally) during pregnancy, renal failure in a neonate was reported.
Oral administration of mesalazine to rats and rabbits during the period of organogenesis at doses up to 480 mg/kg/day (about one to two times the maximum recommended clinical dose of Asacol on a body surface area basis) did not cause embryofetal toxicity or teratogenicity in the presence of maternotoxicity.
Asacol should only be used during pregnancy if the potential benefit outweighs the possible risk.
 N-acetyl-5-aminosalicylic acid and to a lesser degree mesalazine are excreted in breast milk. The clinical significance of this has not been determined. Only limited experience during lactation in women is available to date. Hypersensitivity reactions such as diarrhoea in the infant cannot be excluded. Therefore, Asacol should only be used during breast-feeding, if the potential benefit outweighs the possible risk. If the infant develops diarrhoea, breast-feeding should be discontinued.
In rats, oral administration of mesalazine from late gestation to weaning at doses of 480 mg/kg/day (similar to the maximal recommended clinical dose of Asacol on a body surface area basis) was associated with toxicity to dams and offspring. A dose of 120 mg/kg/day was devoid of toxicity in either generation.

4.7 Effects on Ability to Drive and Use Machines

Asacol has no or negligible influence on the ability to drive and use machines.

4.8 Adverse Effects (Undesirable Effects)

Summary of the safety profile.

Organ specific adverse drug reactions affecting the heart, lungs, liver, kidneys, pancreas, skin and subcutaneous tissue have been reported.
Treatment must be stopped immediately if acute symptoms of intolerance occur such as abdominal cramps, acute abdominal pain, fever, severe headache and rash.
Severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), have been reported in association with mesalazine treatment (see Section 4.4 Special Warnings and Precautions for Use).

Tabulated summary of adverse reactions.

Undesirable effects reported from clinical studies and other sources are listed in Table 1.
The following definitions apply to the incidence of undesirable effects: common (≥ 1/100 to < 1/10), uncommon (≥ 1/1,000 to < 1/100), rare (≥ 1/10,000 to < 1/1,000), very rare (< 1/10,000), not known (cannot be estimated from the available data).

Description of selected adverse reactions.

An unknown number of the above-mentioned adverse effects are probably associated to the underlying inflammatory bowel disease rather than Asacol/mesalazine medication. This holds true especially for gastrointestinal adverse effects, arthralgia and alopecia.
To avoid blood dyscrasia resulting from developing bone marrow depression patients should be monitored with care (see Section 4.4 Special Warnings and Precautions for Use).
Under co-administration of mesalazine with immunosuppressive drugs such as azathioprine or 6-mercaptopurine or thioguanine, life-threatening infection can occur (see Section 4.5 Interactions with Other Medicines and Other Forms of Interactions).

Photosensitivity.

More severe reactions are reported in patients with pre-existing skin conditions such as atopic dermatitis and atopic eczema.

Paediatric population.

There is no safety experience with the use of Asacol tablets in the paediatric population. It is expected that the target organs of possible adverse reactions in the paediatric population are the same as for adults (heart, lungs, liver, kidneys, pancreas, skin and subcutaneous tissue).

Reporting suspected adverse effects.

Reporting suspected adverse reactions after registration of the medicinal product is important. It allows continued monitoring of the benefit-risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions at www.tga.gov.au/reporting-problems.

4.9 Overdose

There is little data on overdose (e.g. intended suicide with high oral doses of mesalazine), which do not indicate renal or hepatic toxicity. There is no specific antidote and treatment is symptomatic and supportive.
For information on the management of overdose, contact the Poisons Information Centre on 13 11 26 (Australia).

5 Pharmacological Properties

5.1 Pharmacodynamic Properties

Pharmacotherapeutic group: Intestinal anti-inflammatory agents, ATC code: A07EC02.

Mechanism of action.

Asacol contains mesalazine, also known as 5-aminosalicylic acid, which has a topical anti-inflammatory effect on the colonic mucosal cells through a mechanism that has not yet been fully clarified.
Mesalazine has been shown to inhibit LTB4-stimulated migration of intestinal macrophages by restricting migration of macrophages to inflamed areas. The production of pro-inflammatory leukotrienes (LTB4 and 5-HETE) in macrophages of the intestinal wall is thereby inhibited. Mesalazine has been shown to activate PPAR-γ receptors which counteract nuclear activation of intestinal inflammatory responses.
Under trial conditions mesalazine inhibited the cyclooxygenase and thus, the release of thromboxane B2 and prostaglandin E2, but the clinical meaning of this effect is still unclear. Mesalazine inhibits the formation of platelet activating factor (PAF). Mesalazine is also an antioxidant; it has been shown to decrease formation of reactive oxygen products and to capture free radicals.

Clinical trials.

Induction of remission in mild-moderate ulcerative colitis.

Asacol 400 mg.

A phase 3, multicentre, randomised, double-blind, double-dummy, placebo controlled study conducted in 53 centres across Japan between 2005 and 2007, compared the efficacy and safety of two doses of Asacol 400 mg tablets (2.4 g/day and 3.6 g/day, given in 3 equally divided doses) versus Pentasa 250 mg tablets (2.25 g/day, given in 3 equally divided doses) and placebo, for the induction of remission in patients with mild to moderate active UC. Two hundred and twenty nine (229) patients aged 16 to 64 years were enrolled with initial UC Disease Activity Index (UC-DAI) of 3 to 8.
The primary efficacy endpoint was the reduction of the UC-DAI score from baseline to week 8 or at discontinuation. Secondary endpoints of remission rate and efficacy rates were assessed. See Table 2.
Reductions in UC-DAI score verified the superiority of the 3.6 g/day Asacol group to the Pentasa group, and non-inferiority of the 2.4 g/day Asacol group compared to the Pentasa group. The three active groups were also compared to placebo, but only the 3.6 g/day Asacol group demonstrated a statistically significant difference; group difference 2.7 (95% CI: 1.4, 3.9).
The remission rates were 30.3% in the 2.4 g/day Asacol group, 45.3% in the 3.6 g/day Asacol group, 28.6% in the 2.25 g/day Pentasa group, and 9.4% in the placebo group. The efficacy rates were 45.5% in the 2.4 g/day Asacol group, 64.1% in the 3.6 g/day Asacol group, 49.2% in the 2.25 g/day Pentasa group, and 28.1% in the placebo group.

Asacol 800 mg.

A multi-national, multicentre, randomised, placebo-controlled, double-blind phase 3 study was conducted by Tillotts Pharma in 26 study centres in the Ukraine, Belarus, India, and Turkey to determine the efficacy of Asacol 4.8 g/day (3 x 800 mg tablets, given twice a day) to induce remission after 6 weeks of treatment compared to placebo in patients with mild to moderate UC.
The initial primary efficacy endpoint (as per FDA Guidelines) of the proportion of patients achieving clinical and endoscopic remission at week 6 was modified prior to the unblinding of treatment allocation in order to be consistent with the European Guideline which defined clinical remission (UC-DAI; score of 0 for stool frequency and rectal bleeding and absence of urgency) at week 6 as the only primary efficacy endpoint for the analysis. Endoscopic remission (sigmoidoscopic score of ≤ 1 at week 6) was added as a new secondary endpoint.
For the ITT population clinical remission (primary endpoint) at week 6 was achieved in 42 (30.0%) of the subjects who received Asacol 800 mg tablets and 29 (20.68%) of the subjects who received placebo (p = 0.069; 95% CI of the between group difference = [-0.7%, 19.43%]). The difference between Asacol 800 mg and placebo did not meet the pre-set significance level of p < 0.05 for clinical remission, however, all pre-specified secondary endpoints were met.
For the ITT population week 6 endoscopic remission was achieved in 64 (45.7%) of the subjects who received Asacol 800 mg tablets and 35 (24.8%) of the subjects who received placebo (p < 0.001; 95% CI: 9.7%, 31.3%). Endoscopic remission at week 10 was achieved in 73 (52.1%) of the subjects who received Asacol 800 mg tablets and 52 (36.9%) of placebo-treated subjects (p = 0.010; CI: 3.6%, 26.3%). Clinical remission at week 10 was achieved in 57 (40.7%) of the subjects who received Asacol 800 mg and 30 (21.3%) of placebo-treated subjects (p < 0.001; 95% CI: 8.6%, 29.6%).
A secondary post-hoc analysis was also conducted, in which data form India (identified as the outlier country) were excluded. This reanalysis showed a statistically significant result (p = 0.02) for the primary endpoint; clinical remission at week 6. All secondary endpoints apart from the modified UC-DAI score at week 6 were statistically significant. The results of the secondary endpoints were similar to what was observed with the ITT population, where all secondary endpoints were statistically significant.

Asacol 1600 mg.

This indication was investigated in a randomised, active-controlled, double-blind, multi-centre, non-inferiority induction trial study with 817 patients receiving 3.2 g mesalazine daily for 8 weeks.
At week 8, 22.4% of the Per-Protocol patients treated with Asacol 1600 mg tablets and 24.6% of those treated with Asacol 400 mg tablets achieved clinical and endoscopic remission. The unadjusted between group difference was 2.2% (95% confidence interval: -8.1% up to 3.8%). Once daily Asacol 1600 mg were considered to be non-inferior to twice daily Asacol 400 mg in inducing clinical and endoscopic remission.
A total of 10.3% of patients treated with Asacol 1600 mg and 9.8% of patients receiving Asacol 400 mg reported treatment related adverse events. The incidence of subjects with serious adverse events (SAEs) in both treatment groups was 2.0% versus 1.7%.
Maintenance of remission in mild-moderate ulcerative colitis.

Asacol 400 mg tablets.

A multi-centre, randomised, double-blind study was conducted to verify the non-inferiority of Asacol 400 mg (2.4 g/day, given in 3 equally divided doses) to Pentasa 250 mg tablets (2.25 g/day, given in 3 equally divided doses) for the maintenance of remission in patients with mild to moderate UC. The primary endpoint was the proportion of patients without bloody stools.
One hundred and thirty one (131) outpatients aged 16 to 64 years with quiescent UC (UC-DAI ≤ 2) 2 and a bloody stool score of 0 were included. Over a period of 48 weeks, the two groups were administered either Asacol 2.4 g/day (n = 65) or Pentasa 2.25 g/day (n = 66). A total of 34 patients withdrew from the study. The most frequent reason for withdrawal was relapse of UC based on the discontinuation criteria of a bloody stool score of 1 or more and UC-DAI of 3 or more (Asacol, 10; Pentasa, 13), and the second most common reason was the occurrence of AEs (Asacol, 1; Pentasa, 3).
The proportion of patients without bloody stools after the 48 week treatment period was 76.9% in the Asacol group and 69.2% in the Pentasa group. The difference between the two groups was 7.7% (95% CI: -7.4, 22.8), and the lower limit of CI was more than "-10.0%", the critical value for demonstration of predetermined non-inferiority. The hazard ratio for time to bloody stools was 0.690 (95% CI: 0.353, 1.350). There was no significant difference in the results of the log-rank test between the two groups (p = 0.27), but the time to bloody stools (secondary endpoint) tended to be longer in the Asacol group in comparison with the Pentasa group.
The proportion of patients without relapse was 80.0% in the Asacol group and 79.7% in the Pentasa group. The time to relapse was prolonged in the Asacol group compared to the Pentasa group, but the difference was not statistically significant (p = 0.79). The decrease in UC-DAI at the final assessment was -0.8 in the Asacol group and -0.9 in the Pentasa group, respectively, and the difference between the two groups was not significant.

Asacol 1600 mg.

727 patients participated in an open label extension (OLE) of the induction study.
The daily dose of Asacol in the maintenance phase was allocated depending on the 8 or 12-week induction results.
Patients in clinical remission (202) at week 12 on either formulation had a dose reduction to 1.6 g/day with 70.3% (142/202) maintaining remission to week 38.
Patients with a clinical response (274) at week 12 on either formulation continued to receive 3.2 g/day and a further 33.9% (93/274) of them went into remission.
Initial non-responders on either formulation (243) at week 8 who responded after a further 8 weeks on 4.8 g/day plus another 8 non responders at week 12 on 3.2 g/day (total 199), remained on 4.8 g/day for another 22 weeks in the study. Of those up dosed to 4.8 g/day 26.8% (61/228) achieved a later clinical remission.
The incidence of treatment related adverse events was 13.9% (28/202), 8.8% (24/274) and 10.7% (26/243) of patients in the 1.6, 3.2 and 4.8 g/day dose groups, respectively.
The incidence of SAEs in the OLE was low and independent of daily dose, with 5.0% (10/202), 4.4% (12/274) and 1.6% (4/243) of patients in the 1.6, 3.2 and 4.8 g/day dose groups affected.

5.2 Pharmacokinetic Properties

Absorption.

Asacol 400 mg and 800 mg tablets consists of a tablet core which is coated with a copolymer providing the tablet a pH-dependent disintegration behaviour. Therefore Asacol tablets resist the acidic environment of the stomach and small intestine, whereas disintegration and drug release occurs from pH 7 onwards to ensure start of drug delivery at the target site (i.e. from the terminal ileum onwards). Asacol 1600 mg tablets contain a core of mesalazine covered by a multi-layer coating system. This system consists of a layer of methacrylic acid copolymer combined with starch particles on top of a middle alkaline buffer layer (which accelerates drug release). The coating is designed to delay release of mesalazine until intestinal fluids reach a pH of 7. The starch can be digested by colonic bacteria which also provides a second trigger for release of mesalazine from the coated tablet.
Systemic bioavailability/plasma concentrations of mesalazine are of no relevance for therapeutic efficacy, but rather a criterion for safety.

Asacol 400 mg.

After administration of a single dose of 2.4 g mesalazine (6 x Asacol 400 mg tablets) to healthy volunteers under fasting conditions, quantifiable amounts (> 2.00 nanogram/mL) of mesalazine were observed in plasma after 4.5 h (median Tlag). The geometric mean Cmax value of mesalazine was 722.11 nanogram/mL with a median Tmax of about 9.5 h, whereas that of N-acetyl mesalazine was 1437.90 nanogram/mL with a median Tmax of 12.0 h.
The same study showed that when administered with concomitant food intake, quantifiable amounts of mesalazine were observed after 9.0 h (median tlag). The geometric mean Cmax value of mesalazine was 1725.93 nanogram/mL with a median Tmax of about 22.0 h, whereas that of N-acetyl mesalazine was 2235.32 nanogram/mL with a median Tmax of 24.0 h.
Based on the recovery of unchanged mesalazine and the main metabolite N-acetyl mesalazine in collected urine after oral administration under fed conditions approximately 30% of the dose (about 90% as metabolite) was excreted renally within 60 h.
Mesalazine Cmax values increased 2.39-fold under fed conditions, and the extent of exposure (AUC0-tlast) increased 1.57-fold. Under the same conditions, N-acetyl mesalazine Cmax-values increased 1.55-fold, whereas the extent of exposure only increased by about 1.1-fold.

Asacol 800 mg.

After administration of a single dose of 2.4 g mesalazine (3 x Asacol 800 mg tablets) to healthy volunteers under fasting conditions, quantifiable amounts (> 2.00 nanogram/mL) of mesalazine were observed in plasma after 4.5 h (median Tlag). The geometric mean Cmax value of mesalazine was 387.86 nanogram/mL with a median Tmax of 14.0 h, whereas that of N-acetyl mesalazine was 971.09 nanogram/mL with an identical median Tmax (i.e. 14.0 h).
The same study showed that when administered with concomitant food intake, quantifiable amounts of mesalazine were observed after 14.5 h (median tlag). The geometric mean Cmax-value of mesalazine was 653.56 nanogram/mL with a median tmax of about 30.0 h, whereas that of N-acetyl mesalazine was 1245.46 nanogram/mL with a median tmax of 30.0 h.
Based on the recovery of unchanged mesalazine and the main metabolite N-acetyl mesalazine in collected urine after oral administration under fed conditions, approximately 23% of the dose (more than 95% as metabolite) was excreted renally within 60 h.
Mesalazine Cmax-values increased 1.69-fold, and the extent of exposure (AUC0-tlast) increased 1.23-fold. Under the same conditions, N-acetyl mesalazine Cmax-values increased 1.28-fold, whereas the extent of exposure remained practically unchanged.

Asacol 1600 mg.

A single dose of a Asacol 1600 mg in healthy volunteers in the fasted state resulted in a 1.5-fold increase of mesalazine Cmax and a 1.4-fold increase of AUC compared to fed state.

Distribution.

About 43% mesalazine and about 78% N-acetyl mesalazine are bound to plasma proteins.

Asacol 400 mg.

Approximately 75% of the administered dose remains in the gut lumen and the mucosal tissue. The mean apparent volume of distribution per kg of body weight (Vdw) was 59.07 L/kg (geometric mean: 48.86 L/kg) after a single dose of 2.40 g of mesalazine (6 x Asacol 400 mg tablets) in healthy volunteers under fasting conditions. Based upon the absorption of 24.8% of the administered dose, this parameter is equal to 14.65 L/kg (geometric mean: 12.12 L/kg).

Asacol 800 mg.

Approximately 77% of the administered dose remains in the gut lumen and the mucosal tissue. The mean apparent volume of distribution per kg of body weight (Vdw) was 147.73 L/kg (geometric mean: 76.06 L/kg) after a single dose of 2.40 g of mesalazine (3 x Asacol 800 mg tablets) in healthy volunteers under fasting conditions. Based upon the absorption of 23.2% of the administered dose, this parameter is equal to 34.27 L/kg (geometric mean: 17.65 L/kg).

Asacol 1600 mg.

The mean apparent volume of distribution (Vdw) was 25 L/kg.

Metabolism.

Mesalazine is metabolised both by the intestinal mucosa and the liver to the inactive metabolite N-acetyl mesalazine. At least 90% of the drug recovered in the urine after oral administration is found as the main metabolite N-acetyl-mesalazine.

Excretion.

Asacol 400 mg.

The elimination of mesalazine is essentially urinary and faecal in the form of mesalazine and its N-acetyl metabolite. The geometric mean of total apparent clearance of mesalazine after administration of 2.40 g of mesalazine (6 x Asacol 400 mg tablets) in healthy volunteers under fasting conditions was about 135 L/h (geometric mean, CV% = 61.43%, inter-subject). The median elimination half-life was 20 h ranging from 5 to 77 h.
About 25% of the total dose administered was recovered in the urine within 60 h after fasted administration mainly as N-acetyl mesalazine and as the parent compound (about 1%).

Asacol 800 mg.

The elimination of mesalazine is essentially urinary and faecal in the form of mesalazine and its N-acetyl metabolite. The geometric mean of total apparent clearance of mesalazine after administration of 2.40 g of mesalazine (3 x Asacol 800 mg tablets) in healthy volunteers under fasting conditions was about 318 L/h (geometric mean, CV% = 137.67%, inter-subject). The median elimination half-life was 17 h ranging from 10 to 50 h.
About 23% of the total dose administered was recovered in the urine within 60 h after fasted administration mainly as N-acetyl mesalazine and as the parent compound (about 1%).

Asacol 1600 mg.

The elimination of mesalazine is essentially urinary and faecal in the form of mesalazine and its N-acetyl metabolite. The median elimination half-life of mesalazine was 10 h range 4 to 23 h.

Linearity/non-linearity.

In a cross-over design with 3 test periods and 3 ascending oral doses of Asacol 400 mg tablets administered 6 hourly over 4 consecutive doses (total daily dose of mesalazine: 3200, 4800, 6400 mg) it was shown that the absorption and elimination kinetics for mesalazine are dose independent for the 3 doses evaluated. For each dose, about ¾ of the dose was available for the therapeutic activity for the colon. Only about ¼ of each dose was absorbed and excreted in the urine, primarily as the metabolite. Based on urine drug excretion, plasma drug Cmax and the combined plasma AUC values, there was a linear dose response for the 3 Asacol tablet doses. The clinical performance of Asacol 400 mg tablets should be similar for the range of doses evaluated in this study.

5.3 Preclinical Safety Data

Genotoxicity.

No evidence of genotoxicity was observed with mesalazine in assays for bacterial gene mutation in vitro, mammalian cell sister chromatid exchange, chromosomal aberrations in Chinese hamster ovary cells in vitro, or chromosomal damage in vivo.

Carcinogenicity.

There was no evidence of carcinogenicity in rats or mice treated with mesalazine in the diet for two years at respective doses up to 480 and 2000 mg/kg/day. In rats, estimated respective exposures (plasma AUC) of mesalazine and its metabolite N-acetyl-5-aminosalicyclic acid were about 4- and 2.5-fold the corresponding clinical exposures at the maximum recommended dose of Asacol. In mice, the highest dose tested was about twice the maximum recommended human dose on a body surface area basis.

6 Pharmaceutical Particulars

6.1 List of Excipients

Asacol 400 mg and 800 mg.

The 400 mg and 800 mg tablet core contains: lactose monohydrate, sodium starch glycollate type A, magnesium stearate, purified talc and povidone. The film-coating contains: methacrylic acid copolymer, triethyl citrate, iron oxide yellow, iron oxide red and macrogol 6000.

Asacol 1600 mg.

The 1600 mg tablet core contains: microcrystalline cellulose, sodium starch glycollate type A, hypromellose, colloidal anhydrous silica and magnesium stearate. The film-coating contains: methacrylic acid copolymer, triethyl citrate, glycerol monostearate, maize starch, polysorbate 80, macrogol 6000, iron oxide yellow, iron oxide red, monobasic potassium phosphate and sodium hydroxide.

6.2 Incompatibilities

Incompatibilities were either not assessed or not identified as part of the registration of this medicine.

6.3 Shelf Life

In Australia, information on the shelf life can be found on the public summary of the Australian Register of Therapeutic Goods (ARTG). The expiry date can be found on the packaging.

6.4 Special Precautions for Storage

Store below 25°C.

6.5 Nature and Contents of Container

Asacol 400 mg and 800 mg.

PVC/aluminium blister strips packed in cartons containing either 30, 60, 90 or 180 tablets.

Asacol 1600 mg.

PVC/aluminium blister strips packed in cartons containing either 30, 60 or 90 tablets. Not all pack sizes may be marketed.

6.6 Special Precautions for Disposal

In Australia, any unused medicine or waste material should be disposed of in accordance with local requirements.

6.7 Physicochemical Properties

Chemical structure.


Formula: C7H7NO3.
Molecular weight: 153.1.

CAS number.

89-57-6.

7 Medicine Schedule (Poisons Standard)

Prescription only medicine (Schedule 4).

Summary Table of Changes