The mechanism of action of mesalamine (and sulfasalazine) is unknown, but appears to be topical rather than systemic . Mucosal production of arachidonic acid (AA) metabolites, both through the cyclooxygenase pathways, ., prostanoids, and through the lipoxygenase pathways, ., leukotrienes (LTs) and hydroxyeicosatetraenoic acids (HETEs) is increased in patients with chronic inflammatory bowel disease , and it is possible that mesalamine diminishes inflammation by blocking cyclooxygenase and inhibiting prostaglandin (PG) production in the colon.
A 4-week single-blind, randomized, reference-controlled, parallel-group study compared the clinical efficacy and safety of glucocorticosteroid enemas in 47 children with ulcerative colitis. 23 children (range 7-15 years) were randomized and treated with Entocort Enema and 24 children (range 6 -15 years) with Pred-Clysma enema. The primary efficacy variable was remission, defined by endoscopic improvement and absence of clinical symptoms of ulcerative colitis. The remission rate after 4 weeks was 50% in the Entocort group and 71% in the Pred-Clysma group. The difference was not statistically significant. The primary safety variable was adrenal suppression, defined by changes in plasma cortisol levels after ACTH-stimulation. There was a statistically significant difference in the percentage of patients with normal adrenal function at week 4 (Entocort 73%, Pred-Clysma 33%). (Study LD-008-0003).
Prostaglandin analogs may cause changes in iris color and eyelid skin, growth of eyelashes , stinging, blurred vision , eye redness, itching, and burning. Beta blockers' side effects include low blood pressure , reduced pulse rate , fatigue , shortness of breath, and in rare occasions, reduced libido and depression . Alpha agonists can cause burning or stinging, fatigue, headache , drowsiness , dry mouth and nose , and also they have a higher likelihood of allergic reaction. Carbonic anhydrase inhibitors may cause stinging, burning, and eye discomfort.