mesalamine (Lialda) for UC, Side Effects, and Dosage

What is mesalamine (Lialda), and how does it work (mechanism of action)?

• Mesalamine is an oral drug used for treating ulcerative colitis.
• Lialda is mesalamine in a form that is slowly released in the intestine so that it can be given just once-a-day.
• Other oral drugs containing mesalamine that are similar to Lialda include Asacol, Pentasa, and Apriso. 
• Asacol and Pentasa, however, are given as multiple daily doses.
• The exact mechanism of mesalamine is not known but is believed to be by reducing inflammation in the colon.
• Ulcerative colitis and other inflammatory diseases cause excessive production of chemicals (i.e., prostaglandins) that produce inflammation in the colon.
• Prostaglandins are produced by cyclooxygenase and lipoxygenase enzymes.
• These enzymes are over-active in individuals with ulcerative colitis.
• Mesalamine may work by blocking the activity of cyclooxygenase and lipoxygenase, therefore, reducing the production of prostaglandins.
• Reduced prostaglandin production reduces inflammation in the colon and other symptoms associated with ulcerative colitis.
• Lialda is the brand name available for mesalamine. 
• Mesalamine is not available is available in generic form.
• You need a prescription to obtain mesalamine.
• The FDA approved Lialda in January 2007.

What is mesalamine used for?

Lialda is used for inducing remission in patients with active, mild to moderate ulcerative colitis. In clinical studies which compared mesalamine against placebo for 8 weeks, more patients in the mesalamine group achieved remission.

What are the side effects of mesalamine?

The most common side effects are:

• headache,
• flatulence,
• hair loss, and
• itching.

Other less common side effects include:

• increased heart rate,
• acne,
• pancreatitis,
• back pain,
• fatigue,
• tremor,
• ear pain,
• blood disorders, and
• kidney dysfunction.

Possible serious side effects include an acute intolerance syndrome that resembles a flare of inflammatory bowel disease. Symptoms include:

• cramping,
• acute abdominal pain, 
• bloody diarrhea,
• fever,
• headache,
• itching, and
• rash.

These symptoms usually subside once mesalamine is discontinued. Since mesalamine is related chemically to aspirin, individuals who are allergic to aspirin should not take mesalamine.

What is the dosage for mesalamine?

The recommended dose is 2.4 g or 4.8 g once daily with a meal. Tablets should be swallowed whole without breaking the coating.

Which drugs or supplements interact with mesalamine?

Specific drug interaction studies have not been conducted with Lialda. Other mesalamine medications have been associated with several drug interactions. Combining mesalamine with drugs that affect kidney function, for example, nonsteroidal antiinflammatory drugs (for example, ibuprofen), may increase the likelihood of kidney dysfunction. Concurrent use of mesalamine and 6-mercaptopurine or azathioprine (Imuran) may increase the likelihood of blood disorders. Mesalamine may increase the blood thinning effect of warfarin (Warfarin).

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Is mesalamine safe to take if you pregnant or breastfeeding?

• There are no adequate human studies of mesalamine use during pregnancy. Mesalamine is known to cross the placenta into the fetus, but animal studies revealed no evidence of harm to the fetus. Mesalamine should only be used during pregnancy if it is felt that the benefit of its use justifies the unknown risks.
• Mesalamine is excreted in breast milk. Mesalamine should only be used by nursing mothers if it is felt that the benefit of its use justifies the risk.

What else should you know about mesalamine?

What preparations of mesalamine (Lialda) are available?

Tablets: 1.2 g

How should I keep mesalamine (Lialda) stored?

Store at room temperature, 15 C – 25 C (59 F – 77 F)