II. Indications: Inflammatory Bowel Disease
- Ulcerative Colitis
- Crohns Disease (off-label use)
III. Mechanism
- 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
IV. Dosing: 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
V. Dosing: 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)
VI. Adverse Effects
- 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
VII. Drug Interactions
- False positive Urine Metanephrines
VIII. Safety
- Pregnancy Category C
- Unknown safet in Lactation
IX. Resources
- Mesalamine Delayed Release Tablet (DailyMed)
- Mesalamine Delayed Release Capsule (DailyMed)
X. References
- 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]
Images: Related links to external sites (from Bing)
Related Studies
mesalamine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
MESALAMINE 1,000 MG SUPP | Generic | $2.21 each |
MESALAMINE 4 GM/60 ML ENEMA | Generic | $0.13 per ml |
MESALAMINE 4 GM/60 ML KIT | Generic | $116.13 each |
MESALAMINE 800 MG DR TABLET | Generic | $5.99 each |
MESALAMINE DR 1.2 GM TABLET | Generic | $2.22 each |
MESALAMINE DR 400 MG CAPSULE | Generic | $2.53 each |
MESALAMINE ER 0.375 GRAM CAP | Generic | $0.89 each |
MESALAMINE ER 500 MG CAPSULE | Generic | $4.64 each |
pentasa (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
PENTASA 250 MG CAPSULE | $2.91 each | |
PENTASA 500 MG CAPSULE | Generic | $4.64 each |
lialda (on 6/14/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
LIALDA DR 1.2 GM TABLET | Generic | $2.05 each |
delzicol (on 7/19/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
DELZICOL DR 400 MG CAPSULE | Generic | $2.11 each |
Ontology: mesalamine (C0127615)
Definition (NCI) | An agent derived from sulfasalazine, an antiinflammatory agent. Mesalamine may reduce inflammation through inhibition of cyclooxygenase and prostaglandin production. Following rectal or oral administration, only a small amount of mesalamine is absorbed; the remainder, acting topically, reduces bowel inflammation, diarrhea, rectal bleeding and stomach pain. (NCI04) |
Definition (MSH) | An anti-inflammatory agent, structurally related to the SALICYLATES, which is active in INFLAMMATORY BOWEL DISEASE. It is considered to be the active moiety of SULPHASALAZINE. (From Martindale, The Extra Pharmacopoeia, 30th ed) |
Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
MSH | D019804 |
SnomedCT | 387501005, 346319009, 317439005, 363629007, 86977007 |
English | Mesalamine, Mesalazine duplicate deleted, 5 Aminosalicylic Acid, 5-Aminosalicylic Acid, 5-Amino-2-hydroxybenzoic Acid, m Aminosalicylic Acid, m-Aminosalicylic Acid, meta Aminosalicylic Acid, meta-Aminosalicylic Acid, mesalamine (medication), mesalamine (Rowasa), MESALAMINE, Mesalamine [Chemical/Ingredient], 5 asa, m-aminosalicylic acid, 5-asa, asa 5, mesalazine, Mesalazine duplicate deleted (product), Mesalamine product (product), 5-aminosalicylic acid (substance), 5-ASA, 5-Aminosalicylic acid, Fisalamine, m-Aminosalicylic acid, Mesalamine (substance), 5-aminosalicylic acid, 5ASA - Mesalazine, Mesalamine (product), Mesalamine product, Mesalamine product (substance), Mesalazine duplicate deleted (substance), Mesalazine, mesalamine |
Swedish | Mesalamin |
Czech | mesalazin, mesalamin |
Finnish | Mesalatsiini |
Russian | MEZALAMIN, MEZALAZIN, 5-AMINOSALITSILAT, 5-АМИНОСАЛИЦИЛАТ, МЕЗАЛАЗИН, МЕЗАЛАМИН |
Spanish | mesalazina, mesalamina, mesalazina (sustancia), 5-ASA, mesalazina (producto), mesalazina (duplicado borrado) (producto), mesalamina, producto (producto), mesalamina, producto, mesalazina (duplicado borrado), mesalamina (producto), mesalamina (sustancia), fisalamina, ácido 5-aminosalicílico, ácido m-aminosalicílico, Mesalacina, Mesalamina |
Japanese | メサラミン, ペンタサ, 5-アミノサリチル酸, フィサラミン(メサラジン), メサラジン |
French | Acide 5-amino-salicylique, Acide 5-aminosalicylique, Mésalazine, Fisalamine, Mésalamine |
Polish | Mesalamina, Mesalazyna, 5-aminosalicylan, Kwas 5-aminosalicylowy, 5-ASA |
German | Mesalamine |
Italian | Mesalamina |
Portuguese | Mesalamina, Mesalazina |
Ontology: Pentasa (C0678171)
Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) |
MSH | D019804 |
English | pentasa, Pentasa, Allphar Brand of Mesalamine, Ferring Brand of Mesalamine, Yamanouchi Brand of Mesalamine |
Ontology: Asacol (C0678172)
Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) |
MSH | D019804 |
English | asacol, Asacol, Byk Brand of Mesalamine, Procter & Gamble Brand of Mesalamine |
Ontology: Rowasa (C0699623)
Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) |
MSH | D019804 |
English | rowasa, Rowasa, Solvay Brand of Mesalamine |
Ontology: Lialda (C1873792)
Concepts | Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) |
English | Lialda |