Severe symptomatic sinus bradycardia associated with mesalamine use

A 29-yr old white woman was hospitalized with bloody diarrhea secondary to ulcerative colitis. Within 24 h of receiving intravenous steroids, loperamide, and mesalamine, she developed symptomatic hypotension, severe sinus bradycardia, sinus pauses, and junctional escape beats. The hypotension and sinus bradycardia resolved after discontinuing mesalamine. She had a family history of conduction tissue disease but her exercise ECG and Holter studies were normal. She was rehospitalized 6 wk later with an exacerbation of ulcerative colitis and, within 8 h of receiving mesalamine, developed hypotension and severe sinus bradycardia, which resolved after stopping mesalamine, Thus mesalamine should be used with caution, especially in patients predisposed to cardiac conduction tissue disease, (C) 1998 by Am. Cell. of Gastroenterology.