IV. General

  1. Rectal forms are preferred for Proctitis
  2. Use oral and rectal forms combined for better results where pancolitis is present

V. Dosing: Ulcerative Colitis

  1. Oral
    1. Active disease: 2.4 to 4.8 grams/day divided 3 times daily
    2. Maintenance: 1.2 to 2.4 grams/day divided 3 times daily
  2. Suppository
    1. Active disease: 1000 mg once daily
    2. Maintenance: 500 mg once to twice daily
  3. Enema
    1. Active disease: 1 to 4 grams daily
    2. Maintenance: 2-4 grams daily to every third day

VI. Dosing: General

  1. Oral
    1. Asacol 800 mg orally three times daily
    2. Pentasa 1000 mg orally four times daily
    3. Mesalamine MMX (e.g. Lialda) 1200 mg orally twice daily (up to 2-4 tabs orally once daily or in divided dosing)
    4. Apriso 1.5 grams orally every morning
    5. Balsalazide Disodium (Giazo, Colazal) 750 mg orally three times daily
  2. Rectal (Provides high distal colon concentrations)
    1. Rowasa 500 mg suppository per Rectum twice daily
    2. Rowasa 4g in 60 ml Enema at bedtime
    3. Canasa 1000 mg rectal suppository at bedtime

VII. Adverse Effects

  1. Interstitial Nephritis
  2. Suppositories and enemas may cause rectal irritation

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Cost: Medications

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 $2.19 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
balsalazide disodium (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BALSALAZIDE DISODIUM 750 MG CP Generic $0.42 each