Mesalamine (5‑ASA) Delayed‑Release Tablets 1.2 g
Brand names (examples): Asacol, Pentasa, Lialda, Delist.
Form: Oral delayed‑release tablet, 1.2 g each.
1. What It Is and How It Works
Mesalamine (5‑aminosalicylic acid) is a topical anti‑inflammatory agent.
- Mechanism: It is released in the large intestine where it scavenges free radicals, inhibits prostaglandin and leukotriene synthesis, and down‑regulates pro‑inflammatory cytokines.
- Why delayed‑release: The tablet coating protects the drug from stomach acid and ensures it reaches the ileum and colon intact—exactly where it’s needed.
2. Approved Uses
| Condition |
Typical Goal |
| Ulcerative colitis (UC) |
Induction of remission (initial flare‑up) and maintenance of remission. |
| Crohn’s disease (CD) (limited data) |
Some use in mild to moderate disease, especially involving the terminal ileum and colon. |
Note: The 1.2 g strength is most commonly used for maintenance therapy in UC, but dosing can be individualized.
3. Typical Dosage Regimen
| Purpose |
Common Dose |
Frequency |
| Maintenance (UC) |
1.2 g – 2.4 g per day |
Once or twice daily |
| Induction (UC) |
2.4 g – 4.8 g per day |
Once or twice daily, usually for 1–2 weeks |
- Start low, go slow: Many clinicians start at the lower end of the range and titrate up if needed.
- Duration: For maintenance, treatment can last for months to years, depending on disease course.
- Monitoring: Regular colonoscopies or fecal calprotectin may guide whether therapy can be tapered.
4. How to Take It
- Swallow whole with a full glass of water.
- Avoid crushing or chewing the tablet; the coating must stay intact.
- Timing: Can be taken with or without food. Some patients find taking it after meals reduces GI upset.
- Missed dose: Take as soon as remembered; do not double dose.
5. Common Side Effects
| Symptom |
Frequency |
Management |
| Nausea / vomiting |
5–10 % |
Take with food or at bedtime |
| Diarrhea / loose stools |
3–7 % |
Hydration; consider dose adjustment |
| Abdominal cramps |
5 % |
Over‑the‑counter antispasmodics (e.g., peppermint oil) after consulting a provider |
| Headache |
<5 % |
Acetaminophen (avoid NSAIDs) |
| Rarely: kidney dysfunction, rash, or eosinophilic colitis – report promptly. |
6. Serious but Rare Risks
- Kidney injury – especially with prolonged high‑dose use or in patients with pre‑existing renal disease.
- Hypersensitivity reactions (rash, itching, swelling).
- Eosinophilic colitis – presents with severe abdominal pain and eosinophil infiltration; requires medical evaluation.
If you notice persistent fever, rash, swelling, or sudden worsening of GI symptoms, seek medical care right away.
7. Drug Interactions
| Drug |
Effect |
What to Watch |
| Non‑steroidal anti‑inflammatory drugs (NSAIDs) |
↑ kidney risk |
Use cautiously, monitor renal function |
| Methotrexate |
↑ toxicity |
Monitor liver enzymes & blood counts |
| Warfarin |
↑ bleeding risk |
Monitor INR |
| Sulfasalazine |
Additive GI side effects |
Dose adjustment may be needed |
| Cimetidine |
↑ plasma levels |
Monitor for side effects |
Always tell your pharmacist/physician about all medications, supplements, and herbal products you’re taking.
8. Contraindications & Precautions
| Situation |
Reason |
| Allergy to sulfa drugs |
Mesalamine is a sulfa derivative. |
| Severe renal impairment |
Dose adjustment or avoidance. |
| Pregnancy / breastfeeding |
Generally considered low risk, but discuss with provider. |
| Active infections (e.g., HIV, tuberculosis) |
Can mask symptoms; evaluate carefully. |
9. What to Tell Your Healthcare Provider
- Symptom diary: Track stool frequency, blood, urgency, pain, and any side effects.
- Lab monitoring: CBC, CMP, and urinalysis at baseline and periodically.
- Vaccinations: Update flu and pneumococcal shots—some anti‑inflammatories may affect immune responses.
10. Quick Reference
| Feature |
Detail |
| Generic |
Mesalamine (5‑ASA) |
| Dose |
1.2 g tablets |
| Route |
Oral, delayed‑release |
| Common uses |
Maintenance of ulcerative colitis |
| Key side effects |
GI upset, headache, rare kidney injury |
| Interaction alert |
NSAIDs, warfarin, methotrexate |
Bottom line
Mesalamine delayed‑release 1.2 g tablets are a cornerstone for keeping ulcerative colitis in remission. They’re generally well tolerated but require periodic monitoring for renal function and any unusual GI or systemic symptoms. If you’re starting, missing a dose, or noticing new side effects, reach out to your gastroenterologist or pharmacist for guidance.
Feel free to ask if you’d like more detail on any aspect—dose titration, side‑effect management, or how it fits into a broader UC treatment plan!