Asacol (mesalamine) is a prescription medication specifically formulated for the treatment of mild to moderate ulcerative colitis. It belongs to the class of drugs known as 5-aminosalicylates (5-ASAs), which work locally in the colon to reduce inflammation, thereby alleviating symptoms such as diarrhea, rectal bleeding, and abdominal pain. By targeting the site of inflammation directly, Asacol helps induce and maintain remission, improving the quality of life for individuals with this chronic condition. Its delayed-release formulation ensures that the active ingredient is delivered precisely where it is needed most.

Features

• Active ingredient: Mesalamine (also known as 5-aminosalicylic acid or 5-ASA)
• Formulation: Delayed-release tablets designed to bypass stomach acid and dissolve in the terminal ileum and colon
• Available strengths: 400 mg and 800 mg delayed-release tablets
• Mechanism: Acts topically on colonic mucosa to inhibit inflammatory pathways, including cyclooxygenase and lipoxygenase
• FDA-approved for induction of remission and maintenance therapy in ulcerative colitis
• Coated with a pH-dependent acrylic-based resin (Eudragit S) for targeted delivery

Benefits

• Reduces inflammation directly in the colon, minimizing systemic exposure and side effects
• Helps achieve clinical remission, decreasing frequency of bowel movements and rectal bleeding
• Supports mucosal healing, which is critical for long-term disease management
• Maintains remission, reducing the risk of flare-ups and hospitalizations
• Improves overall quality of life by enabling better symptom control
• Offers flexible dosing options to tailor treatment to individual patient needs

Common use

Asacol is primarily indicated for the treatment of mild to moderate active ulcerative colitis in adults. It is used both to induce remission during acute flares and to maintain remission once achieved. The medication is particularly effective for distal disease, including proctosigmoiditis and left-sided colitis, though it may also be used for more extensive colitis. It is often considered a first-line therapy due to its favorable safety profile and efficacy. Off-label uses are limited but may include other forms of inflammatory bowel disease under specialist supervision.

Dosage and direction

For the induction of remission in active ulcerative colitis, the typical adult dosage is 2.4 grams per day, administered orally in divided doses (e.g., two 400 mg tablets three times daily or one 800 mg tablet three times daily). For maintenance of remission, the dosage is generally 1.6 grams per day, given in divided doses (e.g., two 400 mg tablets twice daily or one 800 mg tablet twice daily). Tablets should be swallowed whole with water; they must not be crushed, chewed, or broken, as this would compromise the delayed-release mechanism. Dosage should be individualized based on disease severity, patient response, and tolerability. Always take as prescribed by a healthcare provider.

Precautions

Patients with renal impairment should use Asacol with caution, as mesalamine and its metabolites are excreted renally; periodic monitoring of renal function is recommended. Those with pre-existing liver disease may require dose adjustments or closer supervision. Use during pregnancy should be carefully considered, weighing potential benefits against risks—though mesalamine is generally regarded as low risk, it crosses the placenta. Breastfeeding is usually acceptable, as mesalamine is excreted in milk in small amounts. Patients with sulfasalazine sensitivity should be monitored for potential cross-reactivity, though this is rare. Sun exposure should be limited due to potential photosensitivity reactions.

Contraindications

Asacol is contraindicated in patients with known hypersensitivity to mesalamine, salicylates, or any component of the formulation. It should not be used in individuals with severe renal impairment (e.g., glomerular filtration rate <30 mL/min) unless the potential benefit justifies the risk. Patients with a history of pancreatitis related to mesalamine should avoid Asacol. Concurrent use with drugs that confer a high risk of nephrotoxicity is generally contraindicated.

Possible side effects

Most side effects are mild and transient. Common adverse reactions include headache, nausea, abdominal pain, diarrhea, and flatulence. Less frequently, rash, fever, and dizziness may occur. Rare but serious side effects include acute interstitial nephritis, pancreatitis, hepatitis, pericarditis, and blood dyscrasias such as leukopenia or thrombocytopenia. Pulmonary toxicity, including eosinophilic pneumonia and fibrosing alveolitis, has been reported in isolated cases. Any signs of renal dysfunction (e.g., elevated creatinine), persistent fever, or unexplained bruising should prompt immediate medical evaluation.

Drug interaction

Mesalamine may interact with nephrotoxic agents such as NSAIDs, increasing the risk of renal impairment. Concurrent use with azathioprine or 6-mercaptopurine may elevate the risk of blood disorders. Anticoagulants like warfarin could potentially see enhanced effects due to mesalamine’s weak protein-binding displacement, though clinical significance is variable. Probiotics and antibiotics might theoretically influence gut flora and mesalamine metabolism, though evidence is limited. Always inform your healthcare provider of all medications, including over-the-counter drugs and supplements.

Missed dose

If a dose is missed, take it as soon as remembered, unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular schedule. Do not double the dose to make up for a missed one. Consistency in dosing is important to maintain therapeutic drug levels in the colon, but occasional missed doses are unlikely to significantly impact efficacy if the overall regimen is adhered to.

Overdose

Symptoms of mesalamine overdose may include severe nausea, vomiting, diarrhea, sweating, tinnitus, and hyperventilation. In severe cases, renal failure, metabolic acidosis, or CNS toxicity such as confusion or seizures could occur. There is no specific antidote; treatment is supportive and symptomatic. Gastric lavage or activated charcoal may be considered if ingestion was recent, though the delayed-release formulation may limit absorption. Immediate medical attention is essential; contact a poison control center or emergency department.

Storage

Store Asacol tablets at room temperature (20–25°C or 68–77°F), in a dry place, protected from light and moisture. Keep the bottle tightly closed and out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Avoid storing in bathrooms or areas prone to humidity or temperature fluctuations.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis, treatment decisions, and personalized recommendations. Do not discontinue or alter your medication regimen without medical supervision. Individual responses to Asacol may vary based on health status, comorbidities, and other factors.

Reviews

Clinical studies and patient reports generally reflect positive experiences with Asacol, particularly noting its efficacy in reducing symptoms and maintaining remission. Many users appreciate the targeted action and lower incidence of systemic side effects compared to corticosteroids. However, some report gastrointestinal discomfort or find the pill burden challenging. Overall, it remains a well-regarded option in the management of ulcerative colitis, supported by extensive clinical evidence and long-term use.