Dosing & Uses
Dosage Forms & Strengths
capsule
- 750mg (Colazal)
tablet (dsc)
- 1.1g (Giazo)
Ulcerative Colitis
Colazal: 3 capsules (2.25 g total) PO TID (total dose 6.75 g/day x 8-12 weeks
Giazo (males): 3 tablets (3.3 g total) PO BID (total dose 6.6 g/day) x 8 weeks
Dosing Considerations
Giazo: Locally acting aminosalicylate indicated for the treatment of mildly to moderately active ulcerative colitis in male patients 18 years of age and older; effectiveness in female patients was not demonstrated in clinical trials
Colazal: Safety and effectiveness beyond 12 weeks in adults not established
Dosage Forms & Strengths
capsule
- 750mg (Colazal)
Ulcerative Colitis
Giazo: Safety and efficacy not established in children <18 years
5-17 years (Colazal)
- <5 years: Safety and efficacy not established
- May initiate at either 6.75 g/day or 2.25 g/day
- 3 capsules (2.25 g total) PO TID (total dose 6.75 g/day) x8 weeks, OR
- 1 capsule (750 mg) PO TID (total dose 2.25 g/day) for up to 8 weeks
Dosing Considerations
Colazal: Safety and effectiveness beyond 8 weeks in pediatric patients 5 years to 17 years of age not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (3)
- baricitinib
balsalazide will increase the level or effect of baricitinib by decreasing elimination. Avoid or Use Alternate Drug. Coadministration of baricitinib with strong organic anion transporter 3 (OAT3) inhibitors is not recommended.
- measles, mumps, rubella and varicella vaccine, live
balsalazide, measles, mumps, rubella and varicella vaccine, live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.
- varicella virus vaccine live
balsalazide, varicella virus vaccine live. Mechanism: unspecified interaction mechanism. Avoid or Use Alternate Drug. Risk of Reye's Syndrome with combination; avoid salicylate use for 6 wks after vaccination.
Monitor Closely (18)
- acetazolamide
acetazolamide, balsalazide. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
acetazolamide, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Use Caution/Monitor. Salicylate levels increased at moderate doses; risk of CNS toxicity. Salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid). - azithromycin
azithromycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- brinzolamide
brinzolamide, balsalazide. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- clarithromycin
clarithromycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- erythromycin base
erythromycin base will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- griseofulvin
griseofulvin decreases levels of balsalazide by unknown mechanism. Use Caution/Monitor.
- methazolamide
methazolamide, balsalazide. Either increases levels of the other by Other (see comment). Use Caution/Monitor. Comment: Carbonic anhydrase inhibitors (CAIs) and salicylates inhibit each other's renal tubular secretion, resulting in increased plasma levels. CAIs also shift salicylates from plasma to the CNS, leading to potential neurotoxicity.
- mycophenolate
balsalazide will increase the level or effect of mycophenolate by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
- pivmecillinam
pivmecillinam, balsalazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- probenecid
balsalazide will increase the level or effect of probenecid by acidic (anionic) drug competition for renal tubular clearance. Use Caution/Monitor.
balsalazide decreases effects of probenecid by unknown mechanism. Use Caution/Monitor. - roxithromycin
roxithromycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.
- temocillin
temocillin, balsalazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- ticarcillin
ticarcillin, balsalazide. Either increases levels of the other by decreasing renal clearance. Use Caution/Monitor.
- voclosporin
voclosporin, balsalazide. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.
- warfarin
balsalazide increases effects of warfarin by anticoagulation. Use Caution/Monitor.
Minor (125)
- aceclofenac
aceclofenac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acemetacin
acemetacin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- acyclovir
balsalazide will increase the level or effect of acyclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aluminum hydroxide
aluminum hydroxide, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- amikacin
amikacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- aminohippurate sodium
balsalazide will increase the level or effect of aminohippurate sodium by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ascorbic acid
balsalazide decreases levels of ascorbic acid by increasing renal clearance. Minor/Significance Unknown.
- aspirin
aspirin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin rectal
aspirin rectal will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aspirin/citric acid/sodium bicarbonate
aspirin/citric acid/sodium bicarbonate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- aztreonam
aztreonam will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- bendroflumethiazide
bendroflumethiazide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- budesonide
budesonide decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- bumetanide
balsalazide, bumetanide. Other (see comment). Minor/Significance Unknown. Comment: Salicylates are less likely than other NSAIDs to interact w/bumetanide.
- calcium carbonate
calcium carbonate, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- cefadroxil
cefadroxil will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
cefadroxil will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. - cefamandole
cefamandole will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
cefamandole will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. - cefpirome
cefpirome will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
cefpirome will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. - celecoxib
celecoxib will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- cephalexin
cephalexin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
cephalexin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown. - chlorhexidine oral
chlorhexidine oral will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- chlorothiazide
chlorothiazide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- chlorpropamide
balsalazide will increase the level or effect of chlorpropamide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
balsalazide increases effects of chlorpropamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate. - chlorthalidone
chlorthalidone will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- choline magnesium trisalicylate
choline magnesium trisalicylate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ciprofloxacin
ciprofloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- clindamycin
clindamycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- cortisone
cortisone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- cyanocobalamin
balsalazide decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- cyclopenthiazide
cyclopenthiazide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- dapsone
dapsone will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- deflazacort
deflazacort decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- demeclocycline
demeclocycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- dexamethasone
dexamethasone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- diclofenac
diclofenac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- diflunisal
diflunisal will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- doxycycline
doxycycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ertapenem
ertapenem will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ethanol
ethanol increases toxicity of balsalazide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.
- etodolac
etodolac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- fenoprofen
fenoprofen will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- fleroxacin
fleroxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- flurbiprofen
flurbiprofen will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- folic acid
balsalazide decreases levels of folic acid by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- fosfomycin
fosfomycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ganciclovir
balsalazide will increase the level or effect of ganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- gemifloxacin
gemifloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- gentamicin
gentamicin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- glimepiride
balsalazide increases effects of glimepiride by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- glipizide
balsalazide increases effects of glipizide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- glyburide
balsalazide increases effects of glyburide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- hydrochlorothiazide
hydrochlorothiazide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- ibuprofen
ibuprofen will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ibuprofen IV
ibuprofen IV will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- indapamide
indapamide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- indomethacin
indomethacin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- insulin aspart
balsalazide increases effects of insulin aspart by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin detemir
balsalazide increases effects of insulin detemir by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin glargine
balsalazide increases effects of insulin glargine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin glulisine
balsalazide increases effects of insulin glulisine by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin lispro
balsalazide increases effects of insulin lispro by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin NPH
balsalazide increases effects of insulin NPH by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- insulin regular human
balsalazide increases effects of insulin regular human by pharmacodynamic synergism. Minor/Significance Unknown. Large dose of salicylate.
- ketoprofen
ketoprofen will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac
ketorolac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- ketorolac intranasal
ketorolac intranasal will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- L-methylfolate
balsalazide decreases levels of L-methylfolate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- levofloxacin
levofloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- linezolid
linezolid will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- lornoxicam
lornoxicam will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meclofenamate
meclofenamate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- mefenamic acid
mefenamic acid will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meloxicam
meloxicam will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- meropenem
meropenem will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- meropenem/vaborbactam
meropenem/vaborbactam will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- mesalamine
balsalazide will increase the level or effect of mesalamine by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methyclothiazide
methyclothiazide will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- metolazone
metolazone will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- metronidazole
metronidazole will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- minocycline
minocycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- moxifloxacin
moxifloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- nabumetone
nabumetone will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- naproxen
naproxen will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- neomycin PO
neomycin PO will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- nitrofurantoin
nitrofurantoin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ofloxacin
ofloxacin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- oxaprozin
oxaprozin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- oxytetracycline
oxytetracycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- parecoxib
parecoxib will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- paromomycin
paromomycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- piroxicam
piroxicam will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- pivmecillinam
pivmecillinam will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- prednisolone
prednisolone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- prednisone
prednisone decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- quinupristin/dalfopristin
quinupristin/dalfopristin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- rose hips
rose hips will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
balsalazide decreases levels of rose hips by increasing renal clearance. Minor/Significance Unknown.
rose hips increases levels of balsalazide by decreasing renal clearance. Minor/Significance Unknown. - salicylates (non-asa)
salicylates (non-asa) will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- salsalate
salsalate will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sodium bicarbonate
sodium bicarbonate, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- sodium citrate/citric acid
sodium citrate/citric acid, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).
- streptomycin
streptomycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- sulfadiazine
sulfadiazine will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
balsalazide increases levels of sulfadiazine by unspecified interaction mechanism. Minor/Significance Unknown. - sulfamethoxazole
sulfamethoxazole will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
balsalazide increases levels of sulfamethoxazole by unspecified interaction mechanism. Minor/Significance Unknown. - sulfasalazine
sulfasalazine will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- sulfisoxazole
sulfisoxazole will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
balsalazide increases levels of sulfisoxazole by unspecified interaction mechanism. Minor/Significance Unknown. - sulindac
sulindac will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- teicoplanin
teicoplanin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- temocillin
temocillin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tetracycline
tetracycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- ticarcillin
ticarcillin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tigecycline
tigecycline will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tobramycin
tobramycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- tolazamide
balsalazide increases effects of tolazamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- tolbutamide
balsalazide increases effects of tolbutamide by plasma protein binding competition. Minor/Significance Unknown. Large dose of salicylate.
- tolfenamic acid
tolfenamic acid will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- tolmetin
tolmetin will increase the level or effect of balsalazide by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases levels of balsalazide by increasing renal clearance. Minor/Significance Unknown.
- trimethoprim
trimethoprim will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- valganciclovir
balsalazide will increase the level or effect of valganciclovir by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
- vancomycin
vancomycin will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Minor/Significance Unknown.
- verapamil
verapamil increases effects of balsalazide by unknown mechanism. Minor/Significance Unknown. Enhanced antiplatelet activity.
- willow bark
balsalazide will increase the level or effect of willow bark by acidic (anionic) drug competition for renal tubular clearance. Minor/Significance Unknown.
willow bark increases effects of balsalazide by pharmacodynamic synergism. Minor/Significance Unknown. Willow bark contains salicylic acid, which may have additive effects/toxicity with salicylate drugs.
Adverse Effects
>10%
Headache (15% peds)
Abdominal pain (13% peds )
Vomiting (10% peds)
1-10% (Adults)
Headache (8%)
Abdominal pain (6%)
Nausea (5%)
Diarrhea (5%)
Respiratory infection (4%)
Arthralgia (4%)
Vomiting (4%)
Fatigue (2%)
Insomnia (2%)
Cough (2%)
Pharyngitis (2%)
Rhinitis (2%)
Dyspepsia (2%)
Anorexia (2%)
Flatulence (2%)
Fever (2%)
Constipation (1%)
Cramps (1%)
Ulcerative colitis exacerbation (1%)
Flu like syndrome (1%)
Myalgia (1%)
UTI (1%)
Xerostomia (1%)
1-10% (Pediatrics)
Diarrhea (9%)
Fever (6%)
Ulcerative colitis exacerbation (6%)
Pharyngitis (6%)
Fatigue (4%)
Flu like syndrome (4%)
Nausea (4%)
Hematochezia (4%)
Cough (3%)
Dysmenorrhea (3%)
Stomatitis (3%)
Postmarketing Reports
Cardiovascular and vascular: Myocarditis, pericarditis, vasculitis
Respiratory/pulmonary: Eosinophilic pneumonia, interstitial pneumonitis, asthma exacerbation, pleurisy/pleuritis, alveolitis, pleural effusion, pneumonia (with and without eosinophilia)
Gastrointestinal: Pancreatitis
Renal: Interstitial nephritis, renal failure, nephrolithiasis
Hepatobiliary disorders: Elevated liver enzymes (AST, ALT, GGT, LDH, alkaline phosphatase), elevated bilirubin, jaundice, cholestatic jaundice, cirrhosis, hepatocellular damage including liver necrosis and liver failure, Kawasaki-like syndrome including hepatic dysfunction; some of these cases were fatal
Skin: Alopecia, psoriasis, pyoderma gangrenosum, dry skin, erythema nodosum, urticaria, SJS/TEN, DRESS, and AGEP
Warnings
Contraindications
Hypersensitivity to salicylates, balsalazide, mesalamine
Cautions
Risk of exacerbation of ulcerative colitis
Photosensitivity reported; advice patients with pre-existing skin conditions to avoid sun exposure, wear protective clothing, and use a broad-spectrum sunscreen when outdoors
Nephrolithiasis reported; stones containing mesalamine, the active moiety, are undetectable by standard radiography or computed tomography (CT). ensure adequate fluid intake during treatment
Severe cutaneous adverse reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP) reported with use, discontinue therapy at first signs or symptoms of severe cutaneous adverse reactions or other signs of hypersensitivity and consider further evaluation
Mesalamine-induced hypersensitivity reactions may present as internal organ involvement, including myocarditis, pericarditis, nephritis, hepatitis, pneumonitis, and hematologic abnormalities; evaluate patients immediately if signs or symptoms of hypersensitivity reaction present; discontinue therapy if alternative etiology cannot be established
There have been reports of hepatic failure in patients with pre-existing liver disease who have been administered mesalamine; because balsalazide is converted to mesalamine, evaluate risks and benefits of using this medication in patients with known liver impairment
Pyloric stenosis or other organic or functional obstruction in upper gastrointestinal tract may cause prolonged gastric retention of this drug, which would delay mesalamine release in the colon; avoid this drug in patients at risk of upper gastrointestinal tract obstruction
Use of mesalamine may lead to spuriously elevated test results when measuring urinary normetanephrine by liquid chromatography with electrochemical detection
Renal impairment
- Renal impairment, including minimal change disease, acute and chronic interstitial nephritis, and renal failure reported
- Assess renal function at beginning of treatment and periodically during treatment; evaluate risks and benefits in patients with known renal impairment or taking nephrotoxic drugs; monitor renal function
Mesalamine induced tolerance syndrome
- Balsalazide is converted to mesalamine, which has been associated with acute intolerance syndrome that may be difficult to distinguish from an exacerbation of ulcerative colitis
- Although exact frequency of occurrence not been determined, it has occurred in 3% of patients in controlled clinical trials of mesalamine or sulfasalazine
- Symptoms include cramping, acute abdominal pain, and bloody diarrhea, sometimes fever, headache, and rash
- Monitor patients for worsening of these symptoms while on treatment; if acute intolerance syndrome suspected, promptly discontinue treatment
Pregnancy & Lactation
Pregnancy
Published data from meta-analyses, cohort studies and case series on use of mesalamine, the active moiety of the drug, during pregnancy have not reliably informed an association with mesalamine and major birth defects, miscarriage, or adverse maternal or fetal outcomes
Published data suggest that increased disease activity is associated with risk of developing adverse pregnancy outcomes in women with ulcerative colitis; adverse pregnancy outcomes include preterm delivery (before 37 weeks of gestation), low birth weight (less than 2500 g) infants, and small for gestational age at birth
Animal data
- There are adverse effects on maternal and fetal outcomes associated with ulcerative colitis in pregnancy; in animal reproduction studies, there were no adverse developmental effects observed after oral administration in pregnant rats and rabbits during organogenesis at doses up to 2.4 and 4.7 times, respectively, the maximum recommended human dose (MRHD)
Lactation
Data from published literature report presence of mesalamine and metabolite, N acetyl-5 aminosalicylic acid, in human milk in small amounts with relative infant doses (RID) of 0.1% or less for mesalamine; there are case reports of diarrhea in breastfed infants exposed to mesalamine; there is no information on effects of drug on milk production
Lack of clinical data during lactation precludes a clear determination of risk of drug to an infant during lactation; therefore, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for drug and any potential adverse effects on breastfed child from drug or from underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Metabolized to mesalamine by intestinal flora
Mesalamine (5-aminosalicylic acid) has anti-inflammatory effect; active component of sulfasalazine, specific MOA unknown; probably inhibits prostaglandin & leukotrienes synthesis & release in colon
Absorption
Bioavailability: Low absorption
Onset: 10 days to 2 wk
Peak plasma time: 1-2 hr
Distribution
Protein bound: 99%
Vd: mesalamine: 0.2 L/kg
Metabolism
Following oral administration, balsalazide passes intact into colon where it is cleaved by intestinal flora to form mesalamine and 4-aminobenzoyl-b-alanine
Mesalamine is rapidly acetylated in colon wall and liver, independent of pt. acetylator status, into N-acetyl-5-aminosalycylic acid
Metabolites: mesalamine (active), N-acetyl-5-aminosalycylic acid (inactive), 4-aminobenzoyl-b-alanine (inactive)
Elimination
Half-life: Undetermined due to large intersubjective variability
Excretion: Feces (as metabolites) >65%; urine (as metabolites) >25%
Administration
Colazal
Evaluate renal function before initiating therapy
Swallow whole
Do not cut, break, crush or chew the capsules
Drink an adequate amount of fluids
Take medication with or without food
For patients who cannot swallow intact capsules, may administer by opening capsule and sprinkling the capsule contents on applesauce
If capsules are opened for sprinkling, color variation of powder inside capsules ranges from orange to yellow and is expected due to color variation of active pharmaceutical ingredient
- Place a small amount (approximately 10 mL) of applesauce into a clean container
- Carefully open the capsules
- Sprinkle capsule contents on applesauce
- Mix capsule contents with applesauce; the contents may be chewed, if necessary
- Consume entire amount of applesauce mixture immediately; do not store applesauce mixture for future use
- Teeth and/or tongue staining may occur in some patients when administered sprinkled on applesauce
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| balsalazide oral - | 750 mg capsule |  | |
| balsalazide oral - | 750 mg capsule |  | |
| balsalazide oral - | 750 mg capsule |  | |
| balsalazide oral - | 750 mg capsule |  | |
| Colazal oral - | 750 mg capsule | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
balsalazide oral
BALSALAZIDE - ORAL
(bal-SAL-a-zide)
COMMON BRAND NAME(S): Colazal
USES: Balsalazide is used to treat a certain bowel disease (ulcerative colitis). It helps to reduce symptoms of ulcerative colitis such as diarrhea, rectal bleeding, and stomach pain. Balsalazide belongs to a class of drugs known as aminosalicylates. It works by decreasing swelling in the colon.
HOW TO USE: Take this medication by mouth with or without food as directed by your doctor, usually 3 times daily. The dosage is based on your age, medical condition, and response to treatment.Drink plenty of fluids during treatment with this medication unless otherwise directed by your doctor. This will help prevent kidney stones.If you have trouble swallowing the capsules, you may open them and sprinkle the contents onto a spoonful of applesauce. Swallow the food/medication mixture right away. Do not prepare a supply in advance.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition does not get better or if it gets worse.
SIDE EFFECTS: Headache, nausea, vomiting, joint pain, diarrhea, abdominal pain, fever, sore throat, trouble sleeping, or loss of appetite may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Rarely, balsalazide can worsen ulcerative colitis. Tell your doctor right away if your symptoms worsen after starting this medication (for example, if you have increased abdominal pain, rectal bleeding).Tell your doctor right away if you have any serious side effects, including: nausea/vomiting that doesn't stop, signs of kidney problems (such as change in the amount of urine), yellowing eyes/skin, dark urine, unusual/extreme tiredness, severe stomach/abdominal pain, burning/painful urination, fast/pounding heartbeat.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking balsalazide, tell your doctor or pharmacist if you are allergic to it; or to other aminosalicylates (such as mesalamine, olsalazine); or to salicylates (such as aspirin, salsalate); or to sulfasalazine; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain stomach/intestinal condition (pyloric stenosis), liver disease, kidney disease.This medication may make you more sensitive to the sun, especially if you have skin problems (such as atopic dermatitis, eczema). Limit your time in the sun. Avoid tanning booths and sunlamps. Use sunscreen and wear protective clothing when outdoors. Tell your doctor right away if you get sunburned or have skin blisters/redness.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).This medication contains sodium. Consult your doctor or pharmacist if you are on a salt-restricted diet or if you have a condition that could be worsened by an increase in salt intake (such as heart failure).This medication is similar to aspirin. Children and teenagers younger than 18 years should not take aspirin if they have chickenpox, flu, or any undiagnosed illness or if they have recently received a vaccine. In these cases, taking aspirin increases the risk of Reye's syndrome, a rare but serious illness.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication may pass into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: dichlorphenamide.Balsalazide is very similar to mesalamine. Do not use mesalamine medications taken by mouth while using balsalazide.This medication may interfere with certain lab tests (including urine normetanephrine levels), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as kidney/liver function) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised April 2022. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
