From the Research
The standard maintenance dosage of balsalazide (Colazal) for adults with ulcerative colitis is 1.5 grams per day, as higher doses do not appear to provide additional benefit for maintenance therapy, according to the most recent and highest quality evidence available 1.
Key Considerations for Balsalazide Maintenance Therapy
- Balsalazide works as a prodrug that delivers mesalamine (5-aminosalicylic acid) directly to the colon, where it acts locally to reduce inflammation by inhibiting prostaglandin synthesis and scavenging free radicals.
- This targeted delivery helps minimize systemic absorption and reduces potential side effects compared to other 5-ASA medications.
- Patients should be monitored periodically for kidney function while on long-term therapy, as rare cases of nephrotoxicity have been reported with 5-ASA compounds.
- If patients experience difficulty swallowing the capsules, they can be opened and the contents sprinkled on applesauce, though this should be consumed immediately.
Evidence Supporting the Recommended Dosage
- A study published in 2006 found that for maintenance therapy, existing data do not support a dose response above 1.5 g of mesalamine or equivalent 1.
- Another study from 2002 noted that balsalazide appears to have a faster onset of action than mesalazine and is as effective as delayed-release mesalazine and oral sulfasalazine in preventing relapse in ulcerative colitis in remission 2.
- While other studies suggest various dosages, the most recent and highest quality evidence supports the use of 1.5 grams per day for maintenance therapy 1.