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Mesalazine dosage

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Ulcerative Colitis
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Posted 8/12/2018 1:10 AM (GMT -5)
I have been in a minor flare for the past 3 months with bleeding and mucus being the main problems. The tenesmus I had at the beginning has now gone and I am passing stools only twice a day. My medication which was at first only suppositories (2g) was added to by Pentasa 4g.

A month ago my medication was changed to Salofalk suppository 1gm AM, Pentasa slow release granules 4g (2g twice a day) and Salofalk foam enema 2g at night. The bleeding continues but has certainly lessened.

Is this a high dose of Mesalazine and if so how long can I safely stay on this amount without reducing it?
Posted 8/12/2018 9:17 AM (GMT -5)
As long as you get your liver and kidney function tested periodically, I don't see why you couldn't stay on that dose indefinitely.
Why are you taking Pentasa? For UC'ers, a lot of the mesalamine is wasted with Pentasa because it is released in the small intestine. Have you ever tried Salofalk (or in some countries it's called Canasa) tablets? They release a little earlier than other mesalamine formulations, but not as early as Pentasa.
What kind of U.C. do you have? Pan, left-sided, U.P.,...?
Posted 8/12/2018 10:18 AM (GMT -5)
mostly the oral counts towards dosage. it is semi-topical, but does in-part leave through kidney. The rectal is almost all topical.

in this respects it is an average dose that might be taken forever. But, it is common to taper a bit when in sustained remission. with 8 to 15 months of remission, tapering down to 2g oral is common.

in very rare cases, come concern for kindey or liver presents. This is usually detected early, and abates when the drug is reduced or removed. But be clear, if this happens, some other stronger drug may have to be used instead.
Posted 8/12/2018 11:45 AM (GMT -5)
All is good. I don't consider it a minor flare....but remember limited rectal inflammation can be a tough thing to treat.

Using supps during the day and foam at night is fine...it's a low dosage only of 2g enemas.

Stay on that regimen for at least 3 weeks. Blood and mucus ending doesn't mean no inflammstion. You will probably go through a constipation phase. See how you are at that point. If all is good, taper off the daily supps and stay on the enemas nightly. If all is perfect, then start that taper to maintenance of twice a week.

Nothing is written in stone regarding this treatment regimen. Your butt will tell you when to step up or to taper down.....it rules the game.

What I do suggest is that you never drop cold turkey or go off the rectals completely.....but to taper to a maintenance.

Keep us updated.

q
Posted 8/13/2018 12:17 AM (GMT -5)
Thank you all for your help and advice.
Posted 8/13/2018 7:50 AM (GMT -5)
You're fine at those dosages, perfectly safe. Mesalamine is a mild, 90% topical medication, well tolerated by most without side effects (the remaining 10% is peed out). The most mesalamine I've been on is 12.8-grams a day as prescribed by my doctor: 4.8-grams oral and 8.0-grams rectally (twice daily, 4.0-gram enemas).

A typical flareup dosage is 4-grams pentasa, and 4.0-grams mesalamine enemas.

Once you've achieved a sustained remission, then the mesalamines are reduced to maintenance dosages. It always takes a lot more medication to initially achieve a remission then to sustain a remission.
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