Recommended Dosage of Mesacol (Mesalamine) for Treating Ulcerative Colitis
For adults with mild-to-moderate ulcerative colitis, the recommended dosage of Mesacol (Mesalamine) is 2.4 g to 4.8 g once daily for induction of remission, and 2.4 g once daily for maintenance of remission. 1
Dosing Recommendations by Disease Severity and Phase
Induction of Remission
- Standard dose (mild disease): 2.4-3.0 g/day once daily 2, 1
- High dose (moderate disease or suboptimal response): 4.8 g/day once daily 2, 3
- Once-daily dosing is as effective as multiple daily doses and may improve adherence 2, 4
Maintenance of Remission
- Standard maintenance dose: 2.4 g/day once daily 1
- Patients who initially respond to high-dose therapy (4.8 g/day) can be stepped down to 2.4 g/day for maintenance 5
Dosing Based on Disease Location
- Extensive colitis: Oral mesalamine (2.4-4.8 g/day) with consideration of adding rectal mesalamine for enhanced efficacy 2
- Left-sided colitis/proctosigmoiditis: Consider combination of oral mesalamine with rectal formulations (enemas) 2, 6
- Proctitis: Mesalamine suppositories are strongly recommended as first-line therapy 1
Special Considerations
- Suboptimal response: For patients with suboptimal response to standard-dose mesalamine, increase to high-dose (>3 g/day) with addition of rectal mesalamine 2, 5
- Administration instructions:
Monitoring
- Evaluate renal function prior to initiation and periodically during therapy 6, 1
- Monitor liver function tests periodically, especially if abnormalities are detected 6
- Watch for signs of mesalamine-induced acute intolerance syndrome (symptoms may mimic UC flare) 1
Efficacy Considerations
- High-dose mesalamine (4.8 g/day) has shown significantly better treatment success (72%) compared to standard dose (2.4 g/day, 59%) in patients with moderate UC 3
- Patients receiving 4 g/day achieved significantly greater improvement in disease activity scores compared to those receiving 2.25 g/day 7
- For maintenance therapy, once-daily dosing (1.6-2.4 g/day) is as effective as twice-daily dosing with similar safety profiles 4
Common Pitfalls to Avoid
- Underdosing: Using low-dose mesalamine (<2 g/day) for moderate disease is less effective than standard or high doses 2
- Inadequate monitoring: Failing to monitor renal and hepatic function may lead to undetected adverse effects 6, 1
- Improper administration: Taking on empty stomach or crushing/splitting tablets reduces efficacy 1
- Premature discontinuation: Continuing maintenance therapy is essential to prevent relapse, even when symptoms resolve 2, 8