Mesalamine Dosing for Ulcerative Colitis
For patients with ulcerative colitis, the standard dose of oral mesalamine is 2-3 grams per day for induction of remission, and 2.4 grams per day for maintenance of remission. 1
Dosing Recommendations by Disease Extent and Severity
Extensive Mild-Moderate Disease
- Standard dose: 2-3 grams/day of oral mesalamine 1
- For suboptimal response: Increase to high-dose mesalamine (>3 grams/day) plus add rectal mesalamine 1
- For maintenance of remission: 2.4 grams/day 2
Proctosigmoiditis or Proctitis
- Preferred approach: Mesalamine enemas or suppositories rather than oral therapy 1
- For proctitis specifically: Mesalamine 1 gram suppository once daily 3
- For combination therapy: Add oral mesalamine 2-4 grams/day to topical therapy for enhanced efficacy 3
Administration Guidelines
- Administer oral mesalamine with food 2
- Once-daily dosing is preferred over multiple daily doses (similar efficacy with better adherence) 1, 4, 5
- Swallow tablets whole; do not split or crush 2
- Drink adequate fluids while taking mesalamine 2
Dosing for Special Populations
- Pediatric patients (FDA approved dosing) 2:
- 24-35 kg: 2.4 g daily for induction (weeks 0-8), then 1.2 g daily for maintenance
35-50 kg: 3.6 g daily for induction, then 2.4 g daily for maintenance
50 kg: 4.8 g daily for induction, then 2.4 g daily for maintenance
Dose Adjustments Based on Response
- For patients who relapse on low-dose maintenance therapy (1.5-2.25 g/day): Increasing to 4.0 g/day is safe and effective 6
- For frequently relapsing disease (>3 relapses/year): Higher maintenance doses (2.4 g/day) perform better than lower doses (1.2 g/day) 1, 7
Monitoring
- Evaluate renal function prior to initiation and periodically during therapy 8, 2
- Monitor liver function tests periodically, especially if abnormalities are detected 8
Common Pitfalls to Avoid
- Using inadequate doses for patients with moderate disease or frequent relapses 1, 6
- Not considering combination therapy (oral plus topical) when response to single therapy is suboptimal 1, 3
- Dividing doses unnecessarily, which may reduce adherence 4, 5
- Failing to monitor renal function in patients on long-term therapy 8, 2