Apriso. Asacol. Canasa. Delzicol. Lialda. Pentasa. No, these are not names of Pokémon, they are brand names for the drug mesalamine, surprisingly. Mesalamine is a drug used to ease inflammation related to Ulcerative Colitis, and the way the mesalamine is packaged actually produces significant differences in terms of the dosing regimen you use.
First and foremost, mesalamine (known chemically as 5-aminosalicylic acid) finds its roots in aspirin (acetylsalicylic acid), hence the name meSALamine – to represent its salicylic acid properties. When you think of topical salicylic acid, hopefully acne is what comes to mind. I tend to think of salicylic acid as a treatment for the inflammation portion of acne (I know that’s not entirely the case, but it’s for the sake of argument) — I then extrapolate this to mesalamine and the relief of local irritation as it relates to the pathophysiology of UC. Let’s dig into each of these brand names, how they’re dosed/supplied, and why that’s important.
APRISO:
-Dose/Formulation: 0.375g extended-release capsules. 4 capsules (1.5g) orally once daily (could increase to 8 capsules [3.0g] once daily)
-Important Information: Apriso capsules are blue and are not see-through, the importance of which will become more apparent alter. Essentially, I like to imagine Apriso as a true extended-release capsule, which is why it's dosed once daily
ASACOL HD:
-Dose/Formulation: 800mg delayed-release tablets. Take 2 tablets (1.6g) orally three times daily
-Important Information: Asacol HD also has a sister tablet: regular Asacol (with no "HD"), which comes as 400mg tablets. However, most people only use the HD tablets to decrease pill burden. Note how these are DELAYED release tablets, therefore they are dosed multiple times daily. I like to think of the frequency as dosing it with each meal, to make sure we don't get the colon all fired up and inflamed as we eat
CANASA:
-Dose/Formulation: 1000mg suppositories. 1 suppository (1000mg) rectally once daily at bedtime
-Important Information: These suppositories MUST be retained for at least one hour to work, preferably three hours or more, hence why the suppository is usually dosed at bedtime - this gives the suppository the time overnight to produce its effect.
DELZICOL:
-Dose/Formulation: 400mg delayed-release capsules. 2 capsules (800mg) orally three times daily
-Important Information: Delayed-release capsules means multiple times a day dosing. though, if we look at these capsules, they are actually just tablets within a clear capsule which is pretty neat. Dose it three times a day (for the three meals a day you're supposed to eat) and you're golden.
LIALDA:
-Dose/Formulation: 1.2g delayed-release tablets. Take two tablets (2.4g) orally once daily (may be increased to 4 tablets [4.8g] once daily)
-Important Information: Lialda is the highest dose delayed-release tablet available, which is why it is the ONLY delayed-release tablet that is dosed once daily. That's something you're going to want to remember.
PENTASA:
-Dose/Formulation: 250mg or 500mg extended-release capsules. Take 1g orally four times daily
-Important Information: An extended-release capsule dosed 4 times a day? This is why mesalamine makes very little sense. However, you can remember this bit of information because Pentasa comes in 250mg capsules, which is the SMALLEST of the available mesalamine oral formulations. Therefore, it only makes sense that it's dosed most frequently.
There are, of course, other ways that mesalamine is supplied, but I find these to be the most common in my practice. If that brief run through isn’t enough, here is a neat table to summarize each brand name based on formulation, dosage increments, and delayed-release vs. extended-release:
