- Ulcerative Colitis
- Crohns Disease (off-label use)
- 5-Aminosalicylic Acid Derivative
- Mesalamine is the active agent of the antiinflammatory Sulfasalazine
- Mesalamine decreases gastrointestinal inflammation via inhibition of cyclooxygenase and Prostaglandin
- Minimal absorption and acts locally within the bowel
- Ulcerative Colitis (Adults)
- Background
- Rectal forms are preferred for Proctitis
- Use oral and rectal forms combined for better results where pancolitis is present
- Oral
- Active disease: 2.4 to 4.8 grams/day divided 1 to 3 times daily for 6 to 8 weeks (depending on agent)
- Delzicol 800 mg orally three times daily
- Pentasa 1 g orally four times daily (may be opened and mixed with water or applesauce)
- Mesalamine MMX (e.g. Lialda) 2.4 to 4.8 g orally daily with meals
- Asacol HD 1.6 g orally three times daily
- Maintenance: 1.2 to 2.4 grams/day divided 1 to 3 times daily (depending on agent)
- Delzicol 800 mg orally twice daily
- Apriso 1.5 g orally daily
- Mesalamine MMX (e.g. Lialda) 2.4 g orally daily
- Asacol HD 2.4 to 4.8 g/day orally divided three times daily
- Active disease: 2.4 to 4.8 grams/day divided 1 to 3 times daily for 6 to 8 weeks (depending on agent)
- Diazo-Bonded 5-ASA product Formulations (oral agents activated in colon)
- See Balsalazide
- See Olsalazine
- Suppository (e.g. Cantasa, for Ulcerative Proctitis)
- Active disease: 1000 mg once daily at bedtime
- Maintenance: 500 mg once to twice daily
- Enema (e.g. Rowasa 4 g in 60 ml, provides high descending colon concentrations)
- Active disease: 1 to 4 grams daily
- Maintenance: 2-4 grams daily to every third day
- Child
- Indicated in age 5 years and older
- Weight 17 to 32 kg
- Mesalamine 36 to 71 mg/kg/day (maximum 1.2 g/day)
- Weight 33 to 53 kg
- Mesalamine 37 to 61 mg/kg/day (maximum 2.0 g/day)
- Weight 54 to 90 kg
- Mesalamine 27 to 4 mg/kg/day (maximum 2.4 g/day)
- Most common
- Other
- Interstitial Nephritis
- Hepatic failure (risk in preexisting liver disease)
- Suppositories and enemas may cause rectal irritation
- Phenylketonuria Risk (Apriso)
- Apriso contains Phenylalanine
- Digoxin
- Mesalamine may decrease levels
- Urine Color change
- Yellow-brown discolored urine
- False positive Urine Metanephrines
- Pregnancy Category C
- Unknown safet in Lactation
- Mesalamine Delayed Release Tablet (DailyMed)
- Mesalamine Delayed Release Capsule (DailyMed)
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- (2022) Treatment of Mild to Moderate Ulcerative Colitis, Presc Lett, #350406
- (2023) Drugs for Inflammatory Bowel Disease, Med Lett Drug Ther 65: 105-12
- Adams (2013) Am Fam Physician 87(10): 699-705 [PubMed]
- Adams (2022) Am Fam Physician 105(4): 406-11 [PubMed]
- Kornbluth (2010) Am J Gastroenterol 105(3): 501-23 [PubMed]