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Feb 10, 2023

Gut Health

MesalamineUlcerative Colitis

Pharmacist Review on Mesalamine

What is Mesalamine?

Mesalamine is a generic prescription medication for Apriso, an anti-inflammatory drug, that’s part of a drug class called 5-aminosalicylates (5-ASA). The specific mechanism of action is unknown, however, mesalamine appears to function by preventing your body from generating a specific substance that could lead to inflammation.

What is Mesalamine used for?

Mesalamine extended-release (ER) capsules are used to treat mild to moderate ulcerative colitis (UC), which is a medical condition that affects the lining of your colon (large intestine) and rectum and results in swelling and sores. This medication is also used to stop the recurrence of ulcerative colitis symptoms.

Only adults (18 years and older) should use certain mesalamine brands, while others are only meant for kids who are at least 5 years old.

How is Mesalamine administered?

Typically, mesalamine oral (by mouth) therapy is used for 6–8 weeks, and/or rectal therapy is used for 3–6 weeks. Your medical condition and therapy response will determine your dosage.

Mesalamine is supplied in numerous dosage forms, strengths, and brand prescription medications.

  • Apriso ER (extended-release) capsule: Take 1.5 grams (four 375 mg extended-release capsules) by mouth daily in the morning with or without food.
  • Asacol HD (delayed-release) tablet: Take 1.6 grams by mouth 3 times a day (800 mg delayed-release tablets)
  • Delzicol DR (delayed-release): Take 800 mg (two 400 mg capsules) by mouth 3 times a day or 1.6 grams taken by mouth in 2-4 divided doses
  • For pediatrics aged 5 years or older:
    • 37 lbs–70 lbs: Take up to 1.2 grams by mouth per day, separated into 2 doses during the day, for 6 weeks
    • 73 lbs–116 lbs: Take up to 2 grams by mouth per day, separated into 2 doses during the day, for 6 weeks.
    • 119 lbs–198 lbs: Take up to 2.4 grams by mouth per day, separated into 2 doses during the day, for 6 weeks.
  • Lialda DR (delayed-release) tablets: 2.4 grams (two 1,200 mg tablets) or 4.8 grams by mouth daily with food
  • Pentasa ER (extended-release) capsule: 1 gram (250 or 500 mg extended-release capsules) by mouth 4 times a day.
  • Canasa suppository: 1 gram (or 1,000 mg) administered rectally daily at bedtime (retain for at least 1&ndah;3 hours)

It’s recommended to completely ingest this medication. Do not chew, break, or crush. By doing this, mesalamine may not be properly released into your colon. However, if the capsule is difficult for you to swallow, try opening it and sprinkling the components on yogurt or applesauce before taking it.

While on Asacol HD or Delzicol, you might notice a ghost tablet (empty shell) in your feces, however, these medications have already been absorbed by your body, so no need to worry because the tablet is empty.

What are the side effects of Mesalamine?

  • Stomach pain and/or cramping
  • Nausea
  • Diarrhea or constipation
  • Headache
  • Dizziness
  • Flatulence (gas)
  • Fever
  • Sore throat
  • Flu-like symptoms, including runny and/or stuffy nose
  • Fatigue


If you experience severe abdominal pain and/or cramps, diarrhea with blood (which may lead to a fever, headache, and/or skin rash), dark urine and/or changes in the amount of urine, jaundice (includes yellowing in your skin, and/or eyes), stop using mesalamine and contact your healthcare provider right away.

Mesalamine may also cause renal impairment (may occur when your kidneys have stopped working; may also result in kidney failure)

What other medications can interact with Mesalamine?

If you additionally take certain medications for infections, cancer, osteoporosis, organ transplant rejection, bowel disorders, high blood pressure, pain (such as Advil, Motrin, and Aleve), or arthritis, mesalamine can damage your kidneys.

Inform your physician about all other medications, herbal products, and/or vitamins that you are taking, particularly azathioprine.

What happens if I miss a dose?

If you forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

Speak with your doctor

Mesalamine is considered safe, effective, and best tolerated over other aminosalicylates. It is also available in many forms including oral as well as rectal formulations. Talk to your doctor today about using Mesalamine and send your prescription to Marley Drug.

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