5-Aminosalicylic Acid-Associated Myocarditis and Pericarditis: A Narrative Review
1, PharmD, FCSHP, BCPS(AQ), BCCCP, is with the Pharmacy, St Paul's Hospital, Vancouver, British Columbia. He is also an Associate Editor with the Canadian Journal of Hospital Pharmacy.
The Canadian Journal of Hospital Pharmacy
|January 27, 2017
Summary
Medications containing 5-aminosalicylic acid (5-ASA) can cause heart inflammation. Early recognition and stopping the drug typically resolves symptoms, but rechallenge poses a high risk of recurrence.
Area of Science:
- Cardiology
- Pharmacology
- Gastroenterology
Background:
- 5-aminosalicylic acid (5-ASA) medications can rarely cause severe cardiac inflammation, including myocarditis and pericarditis.
- Early identification of 5-ASA as the causative agent is crucial to prevent disease progression.
Purpose of the Study:
- To equip clinicians with knowledge to recognize 5-ASA-induced cardiac inflammation.
- To outline treatment strategies for suspected 5-ASA-related cardiac toxicity.
Main Methods:
- A narrative review of published case reports was conducted.
- Embase database was searched from 1974 to July 2015 for cardiac inflammation linked to 5-ASA drugs.
- Articles in any language were included.
Main Results:
- No single symptom, sign, or test definitively diagnoses 5-ASA cardiac toxicity.
- Most patients present with chest pain, shortness of breath, and fever within 28 days of starting 5-ASA.
- Discontinuation of 5-ASA leads to rapid symptom resolution without further treatment; rechallenge is risky.
Conclusions:
- Patients with chest pain, shortness of breath, or fever within 28 days of 5-ASA initiation should be evaluated for drug-induced inflammation.
- Immediate discontinuation of the suspected 5-ASA drug is recommended pending exclusion of other causes.
- Restarting 5-ASA should be avoided if no alternative cause for the inflammation is found.