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The Drug-Induced Cardiotoxicity Website and App

Mesalazine-Mesalamine-5-aminosalicylic acid (5ASA)

Specialities: Gastroenterology · Pulmonary medicine

Mesalazine, mesalasine or 5-aminosalicylate. Several patterns or respiratory involvement caused by this drug can also be observed in the course of untreated inflammatory bowel disease UC and CD. Causality in cases with exposure to mesalazine and anti-TNF agents can be difficult to disentangle from IBD-related ILD (PMID: 23983443). Drug-induced involvement in IBD is against the specific respiratory and cardiovasculare manifestations of the IBD UC and CD (PMID: 8502168, 22958334, 42719527).

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

I - Myocardial dysfunction - Heart failure

I.a

Left or biventricular dysfunction/failure
I.d

Cardiovascular collapse - Cardiogenic shock - Hypotension

III - Myocardial ischemia - Coronary artery disease

III.a

Coronary artery disease (acute) - Myocardial ischemia/infarction

V - Myocarditis

V.a

Myocarditis (can be fulminant)
V.b

Eosinophilic myocarditis
V.f

Myopericarditis (see under XIIc/d/g)

X - Pulmonary edema - ALI/ARDS

X.a

Pulmonary edema, cardiogenic

XII - Pericardial involvement

XII.a

Pericarditis (see also under XIIc)
XII.b

Pericardial effusion (w/wo tamponade)
XII.n

Pleuropericarditis - Pleuropericardial effusion (ANA unknown or negative)

XIV - Pleural involvement

XIV.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)
XIV.d

Eosinophilic pleural effusion

XV - Chest pain

XV.a

Chest pain (acute or subacute), lone or prominent

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (interstitial lung disease/ILD)
XXIV.b

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)
XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)
XXIV.d

Acute eosinophilic pneumonia (AEP)
XXIV.k

Organizing pneumonia pattern (an area or areas of consolidation on imaging)
XXIV.q

An area or areas of consolidation
XXIV.t

ILD with a granulomatous component

XXVIII - Large airway involvement including UAO

XXVIII.m

Bronchiectasis

XXIX - Small airway involvement

XXIX.e

Obliterative bronchiolitis (a pattern consistent with) (see also IVn, XVx)
XXIX.l

Bronchiolitis (a clinical-imaging pattern suggestive of)

XXX - Imaging features

XXX.e

Imaging: An area or areas of consolidation
XXX.l

Imaging: Ground-glass opacities (GGO) / shadowing
XXX.p

Imaging: Asymmetrical, predominantly unilateral involvement

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.b

Lupus - Lupus syndrome (see also Vd)
XXXVI.m

DRES syndrome - DRESS-like reaction