Pentasa alternatives: What can I take instead of pentasa?

Compare pentasa alternatives | Canasa | Rowasa | Colazal | Azulfidine | Uceris | Natural alternatives | How to switch meds

Pentasa (mesalamine extended-release) is a prescription medication used to treat ulcerative colitis, a type of inflammatory bowel disease (IBD). Ulcerative colitis is a chronic disease of the large intestine, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers. Pentasa belongs to a group of medications called 5-aminosalicylic acid (5-ASA) derivatives/aminosalicylates and works as an anti-inflammatory to lower inflammation of the colon and allow for tissues to heal. Typically, Pentasa is used for mildly to moderately active ulcerative colitis. Pentasa is a brand name dosage form of mesalamine and is available as extended-release capsules. These capsules can be swallowed whole, or alternatively, the capsules may be opened and sprinkled onto applesauce or yogurt.

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While an effective treatment option for some people, Pentasa may not be the best and safest option for all people treating ulcerative colitis. Mesalamine is available in a variety of dosage forms including oral options of delayed-release capsules, extended-release capsules, and delayed-release tablets. The rectal formulations include enemas and suppositories. Typically, rectal formulations are preferred for people with mild to moderate ulcerative colitis in the rectum or lower parts of the colon. Treatment options depend on where the disease is located in the colon (for example, suppositories are effective only for disease limited to the rectum). People with an allergy to salicylates or aminosalicylates should not use Pentasa or other forms of mesalamine.

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What can I take in place of Pentasa?

There are other options available to treat mild to moderate ulcerative colitis that do not improve with Pentasa. These alternative prescription medications include other types of mesalamine, other aminosalicylates, corticosteroids, immunomodulators, targeted synthetic small molecules, and biologics. Exposure in the body to 5-aminosalicylic acid (5-ASA) is similar for all oral mesalamine preparations, so switching between oral mesalamine products may not have a significant impact on treatment. Therapeutic efficacy and safety are also similar with different 5-ASA formulations. Choosing an alternative treatment may depend on the location of the disease in the colon, the severity of the disease, and the ability or willingness to use rectal products. These alternative options may be more suitable for certain individuals due to their different uses, side effect profiles, and dosages.

Other alternatives to Pentasa

For people seeking other prescription drug options to treat ulcerative colitis, there are a variety of oral, rectal, and injectable options.

Aminosalicylates (5-ASA)

• Dipentum (olsalazine)

Biologics

• Humira Pen (adalimumab)
• Simponi ARIA (golimumab)
• Infliximab (remicade)
• Stelara (ustekinumab)
• Entyvio (vedolizumab)

Corticosteroids

• Uceris (budesonide)
• Cortef (hydrocortisone)
• Medrol (methylprednisolone)
• Rayos (prednisone)
• Prednisolone

Immunomodulators

• Azasan (azathioprine)
• Sandimmune (cyclosporine)
• Purixan (6-mercaptopurine)
• Protopic (tacrolimus)

Targeted Synthetic Small Molecules

• Zeposia (ozanimod)
• Xeljanz (tofacitinib)
• Rinvoq (upadacitinib)

Top 5 Pentasa alternatives

The following are some of the most common alternatives to Pentasa.

1. Canasa (mesalamine rectal suppository)

Canasa is a brand name medication that is available as a generic called mesalamine suppository. Mesalamine suppository is a topical rectal form of the same medication found in Pentasa. As a suppository, the administration of this medication involves inserting a solid form of the drug into the rectum. The American Gastroenterological Association (AGA) suggests using mesalamine enemas or suppositories rather than oral mesalamine in people with mild to moderate ulcerative colitis in the rectum or lower parts of the colon. Canasa should be inserted at bedtime so that the medication can be retained throughout the night. Mesalamine suppositories are generally well tolerated with few treatment-related adverse effects and have better retention than enemas. Mesalamine suppositories may be a suitable alternative for people with disease located lower in the colon who are willing to try rectal treatment.

2. Rowasa (mesalamine enema)

Rowasa is a brand name medication that is available as a generic called mesalamine enema. Mesalamine enema is a topical rectal form of the same medication found in Pentasa. This is also available as a sulfate-free formulation, SfRowasa, for people who have a sulfate allergy. As an enema, the administration of this medication involves inserting liquid into the rectum with an applicator tip. The American Gastroenterological Association (AGA) suggests using mesalamine enemas or suppositories rather than oral mesalamine in people with mild to moderate ulcerative colitis in the rectum or lower parts of the colon. Additionally, rectal 5-ASA medications like mesalamine are more effective than rectal steroids. Rowasa should be inserted at bedtime so that the medication can be retained throughout the night. Rectal therapy is not as convenient as oral therapy. People may experience discomfort with enemas or be unable to retain them adequately. Mesalamine enemas may be a suitable alternative for people with disease located lower in the colon.

3. Colazal (balsalazide) 

Colazal is a brand name medication that is available as a generic called balsalazide. Like Pentasa, balsalazide is also a 5-aminosalicylic acid (5-ASA) derivative and works to lower inflammation. Colazal is an oral capsule that is taken by mouth three times daily. According to the American Gastroenterological Association (AGA), both mesalamine and balsalazide are generally well tolerated without significant adverse events. The AGA also states that if people need to switch from mesalamine to a different 5-ASA medication, balsalazide is preferred and has better tolerability. Additionally, balsalazide has similar effectiveness to the standard dose of mesalamine at the start of treatment and better efficacy for maintenance.

4. Azulfidine (sulfasalazine)

Azulfidine is a brand name medication that is available as a generic called sulfasalazine. Like Pentasa, sulfasalazine is also a 5-aminosalicylic acid (5-ASA) derivative and works to lower inflammation. Azulfidine is an oral tablet that is taken by mouth every 6 hours. Additionally, Azulfidine is also available as a delayed-release tablet (Azulfidine EN) that is designed to dissolve slower in the body and reduce potential irritation of the GI tract. Sulfasalazine may be more difficult for people to tolerate because of its common side effects (headache, nausea, diarrhea, and skin rash) and the need for laboratory monitoring (complete blood counts and liver function tests). Sulfasalazine is commonly prescribed for rheumatologic disorders, including spondyloarthropathies, rheumatoid arthritis, and psoriatic arthritis. Sulfasalazine may be a suitable alternative in people who can tolerate it or in people with prominent arthritic symptoms.

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5. Uceris (budesonide rectal foam)

Uceris is a brand name medication that is budesonide rectal foam. Budesonide is a corticosteroid that works to lower inflammation. Uceris is a rectal foam that is administered into the rectum with an applicator at bedtime. The American Gastroenterological Association (AGA) suggests using rectal corticosteroid therapy in people with ulcerative proctitis who have failed or are intolerant of mesalamine suppositories (such as Canasa). Additionally, some people with prominent proctitis (inflammation of rectum) symptoms may tolerate a foam preparation with less discomfort and improved retention compared to a suppository.

Natural alternatives to Pentasa

Alternative remedies for Pentasa include supplements, lifestyle changes, and diet modifications to keep flare-ups controlled. The Crohn’s and Colitis Foundation has several recommendations for alternative remedies to use along with medication treatment.

Probiotics for ulcerative colitis therapy has been studied and currently the American Gastroenterological Association (AGA) has no recommendation for probiotic use. Although probiotics are popular among people with ulcerative colitis, their benefit for either inducing or maintaining remission is unclear. In general, probiotics are well-tolerated with low rates of adverse effects. However, if they are used instead of other proven therapy, people are at risk for progressive symptoms and disease complications.

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Diet can play a role in management of ulcerative colitis. Eating certain foods can help ease symptoms, while other foods may make symptoms worse. Ulcerative colitis symptoms of abdominal pain/cramping and fever can cause loss of appetite and weight loss, while diarrhea and rectal bleeding can rob the body of fluids, nutrients, and electrolytes. A well-balanced diet is necessary to prevent nutritional deficiency.

In general, when experiencing a flare, it is best to avoid greasy and fried foods, which can cause gas and diarrhea. Some people find that foods high in fiber, such as fruits, vegetables and whole grains, can be problematic. Rather than eliminating these necessary foods, it may be helpful to eat only thoroughly-cooked fruits and vegetables. People may also want to avoid foods that are likely to cause gas, such as beans, cabbage, broccoli, caffeine, and carbonated drinks. Eating smaller, more frequent meals may be helpful. Alcohol intake, whether moderate or in excess, may also make symptoms worse. Alcohol abstinence may not be required, but moderation is advised.

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How to switch to a Pentasa alternative

1.    Discuss all health conditions with a healthcare provider

Before switching from Pentasa to an alternative, it’s important the prescribing doctor has reviewed all health conditions. Alternative prescription drugs like oral corticosteroids (such as prednisone and methylprednisolone) have several associated major adverse effects including an increased risk of infection, osteoporosis, insomnia, and increased blood sugar. It’s best to seek medical advice prior to changing medication therapy. If cost is a variable in looking for a Pentasa alternative, presenting a SingleCare discount card at a local pharmacy can help with savings.

2.    Do not suddenly stop taking Pentasa

Before stopping Pentasa, make a care plan with the prescribing doctor to avoid ulcerative colitis flare-ups. Stopping treatment can set off inflammation in the colon and rectum. This can lead to more symptoms and serious complications. Once a plan has been established, Pentasa can safely be discontinued and replaced with the new treatment of ulcerative colitis.

3.    Learn how to insert rectal enemas or rectal suppositories

Some alternatives are administered differently than taking a pill by mouth. Rectal enemas and suppositories are effective treatment options for ulcerative colitis. It’s important to know how to administer rectal formulations when starting new rectal treatment.

For rectal suppository administration, make sure hands are washed thoroughly before starting. If the suppository is soft, hold it under cool water or place it in a refrigerator for a few minutes to harden it before removing the wrapper. Remove the wrapper, if present. If desired, put on a finger cot or disposable glove that are available at most pharmacies. Lie on side with lower leg straightened out and upper leg bent forward toward the stomach. Lift upper buttock to expose the rectal area. Insert the suppository, pointed end first, with the finger until it passes the muscular sphincter of the rectum, about 1/2 to 1 inch in infants and 1 inch in adults. Hold the buttocks together for a few seconds. Remain lying down for about 5 minutes to avoid having the suppository come out.

4.    Continue to manage ulcerative colitis symptoms

It is important to track ulcerative colitis symptoms between medical appointments so that the doctor can understand how the disease is impacting daily activities and determine if any therapy changes need to be made. The Crohn’s & Colitis Foundation of America (CCFA) has a number of tools and templates that can be used to track various aspects of ulcerative colitis.