When you search for Asacol vs alternatives, you want a clear side‑by‑side view of the options on the market. This guide breaks down the most common ulcerative colitis (UC) medicines, compares their key attributes, and helps you figure out which one fits your situation.
Asacol is a mesalamine (5‑aminosalicylic acid) tablet designed for once‑daily dosing. It uses a pH‑dependent coating that releases the drug in the terminal ileum and colon, where inflammation usually occurs. Approved by the FDA in 1996, Asacol is indicated for mild to moderate UC and works by reducing local inflammation.
Typical dosing ranges from 2.4g to 4.8g per day, taken as a single tablet or split into two doses. Because it stays in the gut and is minimally absorbed, systemic side effects are rare, but some patients experience nausea, headache, or a mild rash.
Pentasa is a mesalamine granule that can be swallowed or mixed with food, offering flexible dosing throughout the day. It’s often chosen for patients who have trouble swallowing tablets.
Lialda delivers mesalamine in a delayed‑release tablet taken once daily, similar to Asacol but with a different coating technology that targets the colon more uniformly.
Apriso provides a multimatrix system that releases mesalamine continuously over 24hours, allowing for a single daily dose without the need for a pH‑triggered coating.
Salofalk is the European brand name for mesalazine, available in tablets, granules, and rectal forms; it’s frequently prescribed outside the United States.
If symptoms persist despite optimal mesalamine therapy, physicians may step up to biologics or oral small‑molecule agents.
Remicade (infliximab) is an intravenous anti‑TNF‑alpha antibody administered every 8weeks after induction. It’s effective for moderate‑to‑severe UC and for patients with fistulizing disease.
Humira (adalimumab) is a subcutaneous anti‑TNF agent given every 2 weeks, offering the convenience of home injection.
Entyvio (vedolizumab) is an integrin blocker given intravenously; it specifically targets gut‑homing lymphocytes, reducing systemic infection risk.
Xeljanz (tofacitinib) is an oral Janus kinase inhibitor taken twice daily, approved for UC patients who have failed conventional therapy.
Price is a major factor. Generic mesalamine (often sold as “mesalamine” without a brand name) can be as low as $0.10 per 500mg tablet when using discount programs. Branded Asacol typically costs $3‑$5 per 800mg tablet, translating to $1,200‑$2,400 per year.
Biologics are significantly more expensive: Remicade and Humira average $30,000‑$35,000 annually, while Entyvio sits around $28,000. Xeljanz, despite being oral, can still cost $20,000 per year.
Insurance formularies, patient assistance programs, and pharmacy savings cards can dramatically lower out‑of‑pocket expenses. It’s worth checking each manufacturer’s copay‑assist portal.
| Brand | Formulation | Typical Daily Dose | FDA Approval Year | Average Wholesale Price (USD) | Primary Use | Common Side Effects |
|---|---|---|---|---|---|---|
| Asacol | pH‑dependent tablet | 2.4‑4.8g | 1996 | $1,800‑$2,400/yr | Mild‑moderate UC | Headache, nausea |
| Pentasa | Granules (oral/food) | 2.0‑4.0g | 1990 | $1,500‑$2,200/yr | Mild‑moderate UC | Abdominal pain |
| Lialda | Delayed‑release tablet | 2.4‑4.8g | 2004 | $1,900‑$2,600/yr | Mild‑moderate UC | Headache, constipation |
| Apriso | Multimatrix tablet | 2.4‑4.8g | 2003 | $2,000‑$2,800/yr | Mild‑moderate UC | Nausea, flatulence |
| Salofalk | Tablet / granule / enema | 2.0‑4.0g | 1995 (EU) | $1,200‑$2,000/yr | Mild‑moderate UC | Diarrhea, headache |
| Remicade | IV infusion | 5mg/kg at weeks 0,2,6 then q8w | 1998 | $30,000‑$35,000/yr | Moderate‑severe UC | Infection, infusion reaction |
| Humira | Subcutaneous injection | 40mg q2w | 2002 | $32,000‑$36,000/yr | Moderate‑severe UC | Injection site pain, infection |
| Entyvio | IV infusion | 300mg q8w after induction | 2014 | $28,000/yr | Moderate‑severe UC | Liver enzymes, headache |
| Xeljanz | Oral tablet | 10mg bid | 2018 | $20,000/yr | UC refractory to other therapy | Shingles, clot risk |
Think of the decision as a flowchart:
For example, a young professional who dislikes injections may stay on Asacol or Lialda as long as disease control is adequate. Conversely, a patient with frequent flares despite maximum mesalamine will likely need Remicade or Humira.
Yes, but you should do it under a doctor's supervision. Different brands have distinct release mechanisms, so the dose may need adjustment to maintain the same level of colon exposure.
Take the missed tablet as soon as you remember, unless it’s almost time for the next dose. Then skip the missed one-don’t double up, because a higher local concentration can increase irritation.
Biologics, especially anti‑TNF agents, raise infection risk. Your doctor will screen for latent TB, hepatitis, and current infections before starting therapy and will monitor you regularly.
Indicators include frequent bloody stools (more than 4per day), anemia, weight loss, or steroid dependence. Endoscopic findings of extensive inflammation also push clinicians toward biologics.
Coverage varies. Generic mesalamine is usually covered with low copays. Branded mesalamine may be tier‑2 or tier‑3. Biologics often require prior authorization and may have higher out‑of‑pocket costs, but many manufacturers offer assistance.
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