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I am both an expecting mother and medical doctor (emergency medicine). In my last pregnancy I stopped mesasalazine (Pentasa) at 36 weeks given the theoretical risk of closure of the ductus arteriosus. What is the current opinion on this ? (currently on 2g orally of pentasa + 50mg 6-mp) From a fetus point of view is it safer to use PR enemas?
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Anna:
The current data still suggests that the teratologic risk of mesalamine is minimal and no data yet indicates birth defects of any kind.
As for whether you should stop immediately before birth, maybe, but not for bleeding problems. While it is as prostaglandin inhibitor, 5-aminosalicylic acid does not inhibit platelet function, like aspirin.
That said, these products are converted to equimolar amounts of sulfapyridine and mesalamine. Remember, that sulfonamides early postnatally, might bind to albumin, and reduce bilirubin binding, thus increasing the risk of kernicterus.
I'd suggest you stop it the last week of pregnancy if you can, so that there is less risk your infant will have higher levels of unbound bilirubin. Then assuming you are going to breastfeed, restart it postpartum after about 22 days.
And yes, the rectal administration of mesalamine does apparently produce more local effects and less systemic absorption, but I'm not sure its worth the trouble.
Tom Hale Ph.D.
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