Mesalamine

About Mesalamine

Mesalamine works on the lining of the bowel, so each product is built to release it in a particular stretch of gut. Lialda and its generics are once-daily delayed-release tablets for inducing and keeping remission; the 800 mg delayed-release tablet (the generic of the discontinued Asacol HD) is for moderately active disease; the 400 mg delayed-release capsule replaces the discontinued Delzicol; Pentasa releases the drug continuously throughout the gut and is used for active disease; Apriso is a once-daily capsule for keeping remission. Canasa suppositories treat ulcerative proctitis, and Rowasa enemas treat colitis of the lower bowel, both for three to six weeks.

Headache, gas, abdominal pain, nausea and diarrhea are common. The serious concerns are kidney injury, so kidney function is checked before starting and periodically afterward, and an acute intolerance syndrome of cramping, abdominal pain and bloody diarrhea that can look like a flare and means stopping the drug. Hypersensitivity reactions can involve the heart, kidneys or liver, the skin becomes more sensitive to sunlight, and kidney stones have occurred. People who have reacted to sulfasalazine may react to mesalamine too, and anyone allergic to salicylates must not take it. There is no boxed warning.

Because the oral products use different coatings and were approved separately, a pharmacy can substitute only a generic rated equivalent to the same brand, so switching from Pentasa to Lialda or Apriso needs a new prescription. Suppositories and enemas stain fabric and surfaces, and Rowasa contains a sulfite that can trigger reactions in sulfite-sensitive people.

Taking Mesalamine

How to take it

Swallow tablets and capsules whole: Lialda with food once a day, the 800 mg tablet three times a day on an empty stomach, the 400 mg capsule two to four times a day, Pentasa four times a day, and Apriso once a day in the morning; Pentasa capsules can be opened onto applesauce or yogurt. Suppositories and enemas go in at bedtime and stay in, one to three hours for a suppository and about eight hours for an enema.

If you miss a dose

Take it as soon as you remember, unless it is nearly time for the next dose; in that case skip the missed dose and carry on as usual. Do not take a double dose.

Storage

Tablets and capsules at room temperature, tightly closed, out of reach of children. Suppositories below 25°C, refrigerated if you prefer; enemas in their foil at room temperature, discarded if they have turned dark brown.

Interactions to know about

NSAIDs such as ibuprofen and naproxen add to the risk of kidney injury, and azathioprine or mercaptopurine with mesalamine can lower blood counts. Antacids interfere with the coating on Apriso, so the two are not taken together. Protect your skin from the sun.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Mesalamine differs from pharmacy to pharmacy

Mesalamine is taken for years, often several units a day, so a month’s quantity is large and small differences in what a pharmacy charges per unit add up. The 1.2 g tablets and 0.375 g capsules have several generic makers, the 800 mg tablets and 400 mg capsules very few, and a prescription that names a brand and blocks substitution is quoted at the brand price.

Ways to pay less for Mesalamine without insurance

• Make sure the prescription allows generic substitution.
• Ask the prescriber whether a once-daily product would suit you.
• Ask for a ninety-day supply once you are stable on a maintenance dose.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Mesalamine

1. 1.Which mesalamine product is this, and how often do I take it?
2. 2.Should I take it with food, on an empty stomach, or away from antacids?
3. 3.When should my kidney function be checked?
4. 4.I reacted to sulfasalazine once: is mesalamine safe for me?

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