From the Guidelines
During an ulcerative colitis flare while taking Pentasa (mesalamine), you should contact your healthcare provider promptly rather than stopping your medication. Continue taking your prescribed Pentasa as it helps reduce inflammation in the colon. Your doctor may increase your Pentasa dosage (typically up to 4.8g daily) or add additional treatments such as corticosteroids (like prednisone), immunomodulators, or biologics depending on the severity of your flare, as suggested by the AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis 1.
In the meantime, avoid NSAIDs like ibuprofen which can worsen symptoms, stay hydrated, and consider a low-residue diet (avoiding high-fiber, spicy, and dairy foods) to reduce bowel irritation. Track your symptoms including frequency of bowel movements, presence of blood, abdominal pain, and fever to report to your doctor. Pentasa works by delivering anti-inflammatory medication directly to the intestinal lining, but sometimes flares occur despite maintenance therapy due to various triggers including stress, certain foods, or infections. If you experience severe symptoms like high fever, extreme pain, or significant bleeding, seek emergency care immediately.
Some key points to consider:
- The AGA recommends using either standard dose mesalamine (2–3 grams/day) or diazo-bonded 5-ASA rather than low dose mesalamine, sulfasalazine or no treatment for patients with extensive mild-moderate ulcerative colitis 1.
- For patients with mild-moderate ulcerative colitis with suboptimal response to standard-dose mesalamine or diazo-bonded 5-ASA or with moderate disease activity, the AGA suggests using high-dose mesalamine (>3gm/d) with rectal mesalamine 1.
- The use of probiotics or curcumin is not recommended due to lack of evidence, as stated in the AGA guidelines 1.
- Fecal microbiota transplantation (FMT) should be performed only in the context of a clinical trial for patients with mild-moderate UC who do not have Clostridium difficile infection, according to the AGA guidelines 1.
It is essential to follow the guidance of your healthcare provider and adhere to the recommended treatment plan to manage your ulcerative colitis effectively and prevent complications.
From the FDA Drug Label
Mesalamine delayed-release tablets are an aminosalicylate indicated for the: (1) induction and maintenance of remission in adult patients with mildly to moderately active ulcerative colitis. For induction of remission: 2.4 g to 4.8 g (two to four 1.2-g tablets) once daily. For maintenance of remission: 2.4 g (two 1.2-g tablets) once daily.
Pentasa is another name for mesalamine, so if someone is taking Pentasa and experiences an ulcerative colitis flare, the dosage for induction of remission should be considered, which is 2.4 g to 4.8 g once daily.
- The patient should be evaluated by a healthcare provider to determine the best course of action.
- It is essential to follow the healthcare provider's instructions and not adjust the dosage without consultation. 2
From the Research
Ulcerative Colitis Flare and Pentasa Treatment
- Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by continuous mucosal inflammation of the colon, with a relapsing and remitting course 3.
- The goals of treatment in UC are to improve quality of life, achieve steroid-free remission, and minimize the risk of cancer 3.
- Pentasa, a 5-aminosalicylic acid (5-ASA) compound, is used to treat mild-to-moderate UC, and is effective in inducing and maintaining clinical remission 4, 5.
- For patients with more extensive or severe disease, a combination of oral and topical 5-ASA drugs, such as Pentasa, and corticosteroids may be used to induce remission 3, 6.
- In cases of severe UC, hospitalization may be necessary, and treatment options may include intravenous steroids, calcineurin inhibitors, or tumor necrosis factor-α antibodies 3, 7.
Management of Ulcerative Colitis Flare
- The management of UC flare involves a multidisciplinary team approach, including gastroenterologists and surgeons, to provide prompt evaluation and treatment 7.
- Corticosteroids, such as systemic or poorly absorbed steroids, may be used to induce remission in mild-to-moderate flares not responding to combined oral and topical mesalazine 6.
- Topical administration of corticosteroids may be an effective alternative to topical mesalazine in mild-moderate distal disease 6.
- Mesalamine, including Pentasa, has been demonstrated to induce and maintain clinical remission in patients with mild-to-moderate UC, with few serious adverse effects 4, 5.