Tablets, m/r tablets, sachets.

• There is no evidence to show that any one oral preparation of mesalazine is more effective than another; however, the delivery characteristics of oral mesalazine preparations may vary. It is recommended that mesalazine is prescribed by brand name (Asacol^®, Asacol^® MR, Ipocol^®, Mezavant^® XL, Octasa^®, Pentasa^®, or Salofalk^®).
• If it is necessary to switch a patient to a different brand of mesalazine, the patient should be advised to report any changes in symptoms.
• Initiate all non-oral mesalazine products in secondary care.
• Give Octasa^® for all newly initiated patients. Patients on Asacol^® can safely be switched to Octasa^®. Routine switching of brands is not expected.
• Patients prescribed mesalazine require 6 monthly or annual blood tests for renal function when treatment is stable.

Crohns patients prescribed mesalazine should undergo a specialist review given the updated guidance from the Gastroenterology working group: "There is almost no convincing evidence of any therapeutic benefit for the use of any form of mesalazine in Crohns. All patients with Crohns currently receiving mesalazine should be reviewed with consideration of the aim of stopping this treatment." 

Retention enema, foam enema, suppositories.

• To be initiated in secondary care.
• Only Asacol^® foam enemas are licensed for 2g doses to treat disease in the descending colon.

Crohns patients prescribed mesalazine should undergo a specialist review given the updated guidance from the Gastroenterology working group: "There is almost no convincing evidence of any therapeutic benefit for the use of any form of mesalazine in Crohns. All patients with Crohns currently receiving mesalazine should be reviewed with consideration of the aim of stopping this treatment.

Tablets, soluble tablets (expensive), retention enema, foam enema (expensive), suppositories.

• Rectal formulations are active in different areas of the GI tract so may not be interchangeable - see BNF for details.

• MR Capsules - once daily administration.
• Prescribe by brand name.
  
  For patients with active Crohn's disease who are at high risk of corticosteroid side effects with, or intolerant of conventional steroids (e.g. prednisolone).

Jan 18 (reviewed Sept 19): There is a shortage of this product due to a change of manufacturer and there is currently no date for when this is expected to be available again. Budesonide foam enema can be used as an alternative for adults in the interim at a dose of 1 application daily ( Note this product is not licensed in under 18s). 

For eosinophilic esophagitis (EoE) in adults.

Unlicensed
RBCH: Consultant Gastroenterologist for Crohn’s disease where patients are unable to swallow capsules

All products should be prescribed by brand. Biosimilars should be used where possible.

RBCH: Preferred brand is Flixabi