Lialda or Mesalamine is an expensive drug used for the treatment of the pain and inflammation caused by ulcerative colitis. This drug is more popular than other drugs in the aminosalicylates. It works by

Lialda works inside the bowels to reduce inflammation and other symptoms of the disease. It helps to reduce the symptoms of ulcerative colitis such as rectal bleeding, diarrhoea, and stomach pain. Lialda can be purchased only with a doctor’s prescription.

Since the 1950s, corticosteroids have been the drug of choice for ulcerative colitis as it puts the disease in remission. However, corticosteroids do come with problems. About half of the patients taking steroids, such as prednisone, for ulcerative colitis experience side effects. In the short term, steroids can cause:

• Weight gain
• Acne
• Moon face
• Insomnia
• Irritability

The use of steroids even just for three months, even at low dosages, can affect bone strength and increase the risk of osteoporosis, especially in the hips. Continued steroid use can:

• Cause you to bruise easily
• Impair healing
• Increase blood pressure
• Affect blood glucose, a condition called steroid-induced diabetes

For maintenance medication for ulcerative colitis, patients need to be prescribed with a long-term maintenance medication that is not a steroid, such as Lialda, which can take time to kick in. As Lialda begins to manage ulcerative colitis, your doctor will likely taper off your dosage of steroids until you are off it completely.

A generic form of Lialda will become available this 2020. It is covered by some Medicare and insurance plans, but pharmacy coupons or cash prices may be lower. The lowest price for the most common version of Generic Lialda is about $94.07, which is about 76% off the average retail price of $404.25.

How does Lialda work?

Lialda or mesalamine is an oral drug used for the treatment of ulcerative colitis. It is in a form that is slowly released in the intestine, making it a once-a-day drug. There are other drugs that contain mesalamine on the market such as Apriso, Asacol, and Pentasa. Asacol and Pentasa are given as multiple daily doses.

The exact mechanism of mesalamine is not yet known but it is believed to be by reducing inflammation in the colon. Ulcerative colitis, as well as other inflammatory diseases, can cause excessive production of chemicals, such as prostaglandins, that cause inflammation in the colon. Prostaglandins are produced by cyclooxygenase and lipoxygenase enzymes.  These enzymes can be overactive in patients with ulcerative colitis. 

Mesalamine works by blocking the activity of lipoxygenase and cyclooxygenase, thus reducing the production of prostaglandins. Reduced production of prostaglandins reduces inflammation of the colon and other symptoms of ulcerative colitis.

Lialda is used for inducing remission in patients with active, mild to moderate ulcerative colitis. Clinical studies have shown that patients who were given mesalamine achieved remission compared to patients administered with placebo. 

Side Effects

Get emergency medical help if you experience any signs of an allergic reaction to Lialda, such as difficulty breathing, hives, swelling of the face, lips, tongue, or throat. 

Stop taking Lialda and call your doctor immediately if you have:

• severe stomach pain, bloody diarrhea, cramping
• headache, fever, skin rash
• bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds
• signs of kidney problems, such as little or no urination, difficult or painful urination, swelling in the feet or ankles, shortness of breath, or feeling tired
• signs of liver problems such as loss of appetite, tiredness, upper stomach pain, easy bruising or bleeding, clay-coloured stools, dark urine, jaundice

The common side effects of Lialda include:

• stomach pain, nausea, constipation, diarrhea, or excessive gas
• headaches
• flu-like symptoms
• runny or stuffy nose, sore throat, sinus pain
• back pain
• abnormal liver function tests
• rash

Other side effects may occur. Report to your doctor any side effects that may be associated with your use of Lialda.

Dosage and Administration

Lialda is a medication to be taken by mouth with a meal as directed by your doctor, usually once daily. 

The tablet is to be swallowed whole. Do not crush, chew, or break the tablets to keep the drug from being released properly into the colon. 

The dosage of Lialda is based on your medical condition and your response to treatment.

This medication must be used regularly to get the most benefit from it. It will help you remember to take your dose of Lialda by taking it at about the same time each day. 

Tell your doctor if your condition does not improve or if it worsens after taking Lialda.

Induction of remission means curing the ulcerative colitis until it gets better and completely goes away. The maintenance of ulcerative colitis is consuming Lialda for a prolonged time, even if you are well and don’t experience any symptoms anymore. Maintenance prevents health complication and its symptoms from coming back.

The recommended dosage for the induction of remission in adult patients with active, mild to moderate ulcerative colitis is two to four 1.2-g tablets taken once daily with a meal for a total dose of 2.4 g or 4.8.g.  the recommended dosage for the maintenance of remission is two 1.2-g tablets taken once daily with a meal for a total dose of 2.4 g.

Lialda is manufactured as a delayed-release tablet. It has a unique coating that lets it pass through the stomach before completely dissolving. 

Warning and Precautions

Before taking Lialda, inform your doctor if you are allergic to mesalamine, other aminosalicylates such as olsalazine or balsalazide, to salicylates such as aspirin or salsalate, to sulfasalazine, or if you have other forms of allergies. Lialda may contain inactive ingredients that can trigger an allergic reaction or other problems. 

Before you start taking Lialda, share with your doctor your medical history, especially of liver disease, kidney disease, a stomach blockage, or skin problems.

Inform your doctor or dentist that you are taking Lialda before having any surgical procedure. 

Lialda has a great similarity to aspirin. Children and teenagers must not be taking aspirin or aspirin-related medications such as salicylates if they have flu, chickenpox, or any undiagnosed illness, or if they have recently received a vaccine. Taking aspirin in these cases will increase the risk of Reye’s syndrome, a rare but serious illness.

You should be aware of the following when taking Lialda and other mesalamine-based drugs:

• Do not take with lactulose or any drug with lower intestinal pH
• Coagulation abnormalities, pyloric stenosis, sulfasalazine hypersensitivity, and renal insufficiency
• Use with caution if you have active peptic ulcer disease or severe renal failure
• Watch out for chest pain or breathing problem even if pericarditis is not common
• Liver failure might occur, especially in patients with underlying liver problems
• Low sperm concentration and rectal issues have been discovered among males
• Initial therapy may result in worsening of inflammatory bowel disease or colitis
• Renal impairment such as renal failure, chronic and acute interstitial nephritis, and minimal change nephropathy reported
• Risks among individuals with renal impairment or consuming nephrotoxic drugs

People taking Lialda might experience acute intolerance syndrome. Symptoms might be difficult to determine if they are from the exacerbation of ulcerative colitis. Look out for aggravating symptoms and stop using the medicine if you suspect acute intolerance syndrome.

Some patients are found to develop hypersensitivity reactions such as pericarditis and myocarditis. Inspect patients right away and stop them from taking the drug if hypersensitivity reaction is determined.

Ask your doctor before you start taking an antacid while taking Lialda. Use only the type of antacid that your doctor recommends. Some types of antacids can make it harder for your body to absorb Lialda.

Lialda and kidney problems

In rare cases, Lialda may cause or worsen kidney problems, such as kidney inflammation or kidney failure. It is not established yet how often these problems may occur. Your doctor will check for any problems with your kidney before you start taking Lialda.

Pregnancy and Breastfeeding

Lialda should be used with caution if you are pregnant. Discuss with your doctor if the advantages of using Lialda are greater than the risk of possible side effects.

Lialda passes through breast milk. Talk to your doctor before you start taking this medication if you are lactating.

Additional Information

Always remember to keep Lialda and all other medicines out of the reach of children. Lialda is a prescription-only medication. Your doctor issued a prescription of Lialda exclusively for your use only. Do not share this medicine with others, and use Lialda only for the indication prescribed.

Drug Interactions

Drug interactions may alter the way your medications work or increase your risk for serious side effects. Share with your doctor a list of all the medications you are currently taking, including prescription medicines, nonprescription medicines, and herbal products. Your doctor will check the list to find out if any of those drugs you are taking will interact with Lialda. Do not start, stop, or change the dosage of any medicines without first getting the approval of your doctor.

Mesalamine is highly similar to olsalazine, balsalazide, , and sulfasalazine. Do not use any medication that contains olsalazine, balsalazide, or sulfasalazine while taking Lialda or mesalamine.

Lialda can interfere with some laboratory tests, such as urine normetanephrine levels, which may cause false test results. Inform the laboratory personnel and all your healthcare professionals that you are taking Lialda.

Lialda interacts with other medications

Severe Interactions

These medications are not usually taken together. Consult your doctor for more information:

• Aspirin; salicylates/dichlorphenamide

Tell your doctor about every prescription, illegal, over-the-the-counter, nutritional, herbal, or vitamin-containing supplements drug you are consuming. The following drugs might severely interact with mesalamine:

• Magnesium hydroxide or milk of magnesia and aluminium hydroxide such as Amphojel or Alternagel
• Polymyxin B
• Rabeprazole or Aciphex, esomeprazole or Nexium, dexlansoprazole or Dexilant, and lansoprazole or Prevacid
• Nizatidine or Axid, cimetidine or Tagamet, and famotidine or Pepcid
• Live varicella vaccine
• Live measles, rubella vaccine, and mumps
• Bacitracin or Bacilim

Serious Interactions

These medications may interact and cause very harmful effects. Consult your doctor for more information:

• Selected salicylates/methotrexate (oncology-injection)
• Select salicylates/methotrexate – low strength injection or oral

Moderate Interactions

These medications may cause some risk when taken together. Consult your doctor for more information:

• Amino salicylate derivates; mercaptopurine
• Aspirin >81 mg; salicylates; acetazolamide; methazolamide
• Aspirin >81 mg; salicylates/antidiabetics, oral
• Aspirin >81 mg; salicylates/uricosurics
• Selected salicylates/heparin

In addition to prescription drugs, alcohol can also interact with mesalamine. Alcohol can irritate your stomach and intestines, and could potentially aggravate your health condition if you have already developed ulcerative colitis. Avoid your intake of alcohol as much as possible when consuming mesalamine. 

Additionally, you should refrain from drinking grapefruit juice or eating grapefruit while taking mesalamine. Grapefruit can interact with the medication since it impedes the ability of the body to dissolve mesalamine. When this happens, it could result in a high accumulation of the medicines in the bloodstream.

Overdose and Contraindications

Lialda is an aminosalicylate. Some of the symptoms of salicylate overdose include confusion, headache, sweating, drowsiness, dyspnea, hyperventilation, vertigo, vomiting, seizures, diarrhea, and tinnitus. An extreme overdose may result in unbalanced blood pH and electrolyte, as well as hyperthermia, dehydration, and end-organ hazards. 

Lialda must be kept away from the reach of children. In the event of an overdose, call emergency medical help right away or call your local Poison Control Center.

The following are the contraindications when taking Lialda:

• Hypersensitivity to mesalamine or salicylates
• Breastfeeding
• Children with chickenpox or flu-like symptoms
• Rectal suspension: hypersensitivity to aminosalicylates, salicylates, or any ingredients in the suppository vehicle

Clinical Pharmacology

The whole concept of the mechanism of action of Lialda is not yet fully understood. This drug tends to deliver topical anti-inflammatory impact on the epithelial cells of the colon. Generally, the production of mucus of the cyclooxygenase acid metabolites passes through the lipoxygenase and cyclooxygenase passages. An increase may be experienced among those with chronic inflammatory bowel disease. There is also the possibility that mesalamine may remove inflammation by preventing cyclooxygenase and preventing the production of prostaglandin in the colon.

Medication Guide

Induction of remission refers to the curing of the ulcerative colitis until it gets better and completely goes away. The essential dosage for inducing is 2 to 4 tablets of Lialda daily with food. It is highly recommended that the medication be taken at a similar time each day.  Continue taking the prescribed dose every day unless ordered to stop by your doctor.

The maintenance of ulcerative colitis requires the consumption of Lialda for a prolonged period, even you feel well and do not experience any symptoms anymore. Maintenance prevents health complications and the return of the symptoms. The necessary dosage of support is two tablets of Lialda per day with food. It is highly recommended that you take Lialda at about the same time each day. Continue taking the prescribed dosage every day unless ordered to stop by your doctor.

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