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What's the difference between different Mesalamine meds?

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Ulcerative Colitis
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Posted 5/24/2016 12:16 PM (GMT 0)
I look at the forum and see many different brands; Lialda, Canasa, Pentasa, Salofalk. Any difference between them? So far I only used Salofalk. Pentasa only once when they didn't have Salofalk in stock.

Post Edited (solitudent) : 5/24/2016 6:19:55 AM (GMT-6)

Posted 5/24/2016 12:44 PM (GMT 0)
My understanding is the major differences between the medicines are:

1. Amount of the mesalamine per pill
2. Dosing instructions (ex: I take 4 Lialda a day in the morning. For Asacol it was 2 pills 3x a day)
3. Inactive ingredients

Oddly enough, some people do better with one over another. For me Asacol didn't work though Lialda did (for about a year).
Posted 5/24/2016 12:54 PM (GMT 0)
Some RX have coating on pill so that it dissolves at certain areas of the colon.
Certain RX meds work better on different UC locations (left-sided, right-sided).
Generally it's trial and error to find what works for you.
Posted 5/24/2016 12:56 PM (GMT 0)
Thanks.
Posted 5/24/2016 1:39 PM (GMT 0)
Different manufacturers have different and proprietary delayed-release coatings that deliver mesalamine to the intended target. Slight variations in delivery mechanism impact where the medication delivery begins and it's dispersal rate. The coating is activated and begins dissolving when exposed to different PH-levels with your digestive tract. There's slight differences between them, some claim one works better for them than another, but I've never seen a study comparing each directly or providing recommendations. So, unless you're pooping whole pills then I'd likely stay with what your prescribed.

Generally, 4,800 milligrams a day is the maximum recommended dose. Although apriso has a much lower dose due to it's efficacy at lower doses during the clinical trials.
Posted 5/24/2016 1:42 PM (GMT 0)
The basic difference is the release mechanism/location. But the inactive ingredients may play some role. Many here complain of doing well on one tablet and then doing very poorly on another. While some of this might be the delivery location, and some might be placebo effect, there does seem to be more complaints than you would expect. It is possible the inactive buffers in the tablets affect some people poorly, but this is only speculation.
Posted 5/24/2016 1:46 PM (GMT 0)
Yeah all we can do is speculate without any research to back it up. The mesalamine is the same. The coating and inert (inactive) ingredients are not the same, so allergic reactions are possible. A few variables at play...
Posted 5/24/2016 4:16 PM (GMT 0)
Some of the "inactive" ingredients have been shown to be active. Lialda contains carboxymethyl cellulose, an emulsifier known to exacerbate colitis in mice.

Unfortunately most manufacturers do not tell patients or doctors the amounts of the inactive ingredients, so it is difficult to tell if they could be significant. And of course they could vary.
Posted 5/24/2016 4:34 PM (GMT 0)
This is from the resources thread on the top of the forum. This info + dose.

Apriso® - Eudragit-L (pH6) coating of 5-ASA-polymer coated beads, small bowel and colonic release
Asacol® - Eudragit-S coating that releases at pH7, ileocolonic release - replaced with delzicol.
Asacol-HD® - Eudragit-S and Eudragit-L coating, ileocolonic release
Canasa® suppositories – topical rectal release
Colazal® - diazo bond to inert polymer, colonic release
Delzicol®
Lialda® - Eudragit-S coating of metallomatrix 5-ASA, ileocolonic release
Olsalazine (Dipentum®) - diazo bond of two 5-ASAs, colonic release
Pentasa® - ethylcellulose/5-ASA beads, small bowel and colonic release
Rowasa®, sfRowasa®, or Melamine Rectal Suspension (generic) enemas – topical rectosigmoid releases (sfRowasa is sulfate free for those with sulfa allergies)
Sulfasalazine (generic) – diazo bond with sulfapyradine, colonic release.
Posted 5/25/2016 4:55 AM (GMT 0)
Good find nssg. I recently read about the release of Apriso, and didn't realise its small intestinal release.

Some are released in a PH level, some are released in a bacterial level, and some are time released after the initial coating has been broken or dissolved.

q
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