Mesacol OD

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What Is Mesacol OD?

Mesacol OD is an oral aminosalicylate (5-ASA) medicine containing mesalamine (1.2 g once-daily), supplied as MMX multi-matrix once-daily tablets. Manufactured by Sun Pharma in packs of 30, 60 or 90 tablets. Mesalamine is the active metabolite of older sulfasalazine — without the sulfapyridine moiety that caused most of sulfasalazine’s systemic side effects.

Mesalamine has been a first-line therapy for mild-to-moderate ulcerative colitis since the 1980s and is recommended as induction and maintenance therapy by ACG, ECCO, and BSG guidelines. The original mesalamine brand Asacol was approved in 1987; today there are several delivery systems (Eudragit-coated, ethylcellulose microgranule, MMX multi-matrix) each designed to release mesalamine at a different point in the gastrointestinal tract.

What Is Mesacol OD Used For?

• Induction of remission in active mild-to-moderate ulcerative colitis
• Maintenance of remission in ulcerative colitis
• Some mild Crohn’s colitis cases (off-label in many countries; evidence is weaker than for UC)
• Ulcerative proctitis and left-sided colitis (often combined with rectal mesalamine formulations)

Mesacol OD is not a treatment for:

• Irritable bowel syndrome (IBS) — a functional disorder without mucosal inflammation. IBS is treated with antispasmodics (mebeverine), gut-selective antibiotics for IBS-D (rifaximin), dietary intervention (low-FODMAP), and central modulators (low-dose TCAs/SSRIs)
• Infectious colitis (e.g. C. difficile, Salmonella, Shigella)
• Microscopic colitis — budesonide is preferred

How Does Mesacol OD Work?

Mesalamine is a topical intestinal anti-inflammatory. Its exact mechanism is multifactorial, involving several anti-inflammatory pathways in the colonic mucosa:

• Inhibition of cyclooxygenase and lipoxygenase pathways — reduces local prostaglandin and leukotriene synthesis
• Scavenging of reactive oxygen species produced by neutrophils in inflamed mucosa
• Inhibition of NF-κB — dampens the transcription of pro-inflammatory cytokines
• PPAR-γ agonism in colonocytes — contributes to resolution of inflammation
• Reduces neutrophil chemotaxis into the colonic mucosa

Because mesalamine’s target is the colonic mucosa, delivery is critical. The MMX multi-matrix once-daily tablets of Mesacol OD is designed to release active drug in the colon rather than being absorbed prematurely in the small intestine. Eudragit-S coating dissolves at pH ≥ 7 (terminal ileum/colon); Eudragit-L at pH ≥ 6 (duodenum/jejunum); ethylcellulose microgranules release continuously; MMX uses a lipophilic/hydrophilic matrix for controlled colonic release.

Dosage and Administration

Once-daily dosing: Mesacol OD is a high-strength MMX (multi-matrix) once-daily formulation. Typical dose: one 1.2 g or 2.4 g tablet taken in the morning with or after food; up to 4.8 g/day for active moderate UC.

• Take with or shortly after food (reduces GI upset and may improve colonic delivery).
• Swallow tablets whole — do not crush or chew Eudragit-coated or MMX tablets; the coating is the delivery system.
• Seeing intact tablet shells in stool can happen with some formulations (particularly MMX “ghost” tablets) — this is expected and does not mean the drug failed to absorb.
• Maintain good hydration — supports renal clearance.
• Adherence is critical. Mesalamine is a daily maintenance drug; missing doses is the single biggest predictor of UC relapse.
• Miss a dose — take it as soon as you remember, unless close to the next dose; do not double up.

Side Effects

Mesalamine is usually well-tolerated compared with sulfasalazine and immunomodulators.

Common:

• Headache
• Nausea, abdominal pain, flatulence
• Diarrhoea (ironic for a colitis drug, but real — 1–3% of users)
• Rash, itching
• Occasional hair loss (mild, reversible)

Uncommon but important:

• Renal impairment — interstitial nephritis is a rare but documented class effect. Check serum creatinine at baseline, at 3 months, then annually. Discontinue if eGFR drops by > 25%.
• Acute mesalamine intolerance syndrome — paradoxical worsening of colitis symptoms shortly after starting. Very rare; stop the drug.
• Blood dyscrasias — rare neutropenia, thrombocytopenia; check FBC if unexplained infection or bruising.
• Pancreatitis — very rare
• Myocarditis / pericarditis — very rare; new chest pain warrants evaluation
• Hepatitis — very rare, usually reversible

Drug Interactions

• Azathioprine / mercaptopurine / thiopurines — mesalamine inhibits TPMT and can raise thiopurine levels; monitor FBC more closely when the combination is used.
• NSAIDs — additive renal risk; avoid chronic use.
• PPIs and antacids — may alter gastric pH and disrupt pH-dependent coating dissolution; separate Eudragit-coated mesalamine from high-dose PPIs by 4 hours if possible, or choose a pH-independent formulation.
• Warfarin — possible increased anticoagulant effect; monitor INR when starting.
• Methotrexate — additive myelosuppression risk.
• Live vaccines — no meaningful interaction with mesalamine alone (unlike with sulfasalazine or biologics).

Who Should Not Take Mesacol OD?

• Known hypersensitivity to salicylates (including aspirin) or mesalamine
• Severe renal impairment (eGFR < 30 mL/min)
• Severe hepatic impairment
• Children below the label age cutoff (differs by formulation)
• Active peptic ulcer disease
• Pregnancy and breastfeeding — mesalamine has a reassuring safety record and is commonly continued through pregnancy when UC control requires it; discuss with your gastroenterologist and obstetrician

Storage

Store Mesacol OD below 25°C in a dry place, in the original blister. Keep out of reach of children. Protect from light and moisture.

Frequently Asked Questions

Is mesalamine the same as mesalazine or 5-ASA?

Yes — all three names refer to the same molecule (5-aminosalicylic acid). Mesalamine is the US adopted name (USAN); mesalazine is the international non-proprietary name (INN); 5-ASA is the chemical abbreviation. Different brands and regions label it differently.

Can I take Mesacol OD for IBS or general bloating?

No — mesalamine does not treat IBS. IBS is a functional disorder; there is no mucosal inflammation for mesalamine to work on. For IBS, first-line treatments are dietary changes (low-FODMAP diet, fibre modification), antispasmodics like mebeverine (Colospa) or hyoscine, and — for IBS-D specifically — short courses of rifaximin (Rifagut). Central modulators (low-dose amitriptyline) are used for refractory IBS pain.

How long until Mesacol OD works?

Symptom improvement typically begins within 1–2 weeks; full remission in 4–8 weeks at induction doses. Stool frequency and urgency usually improve first, followed by abdominal pain and finally mucosal healing (visible on colonoscopy at 8–12 weeks).

Do I need to take Mesacol OD forever?

Most patients with ulcerative colitis need long-term maintenance mesalamine to stay in remission — typically at least 1.6–2.4 g/day. Stopping after remission is achieved leads to relapse within 6–12 months in most studies. Mesalamine is safe for decades of use when renal function is monitored.

Why am I seeing intact tablet shells in my stool?

Several mesalamine formulations (particularly MMX “ghost” tablets) pass through largely intact in the stool. This is expected and the drug has been released inside the colon as designed. If you see the tablet unchanged with no coating damage, check your technique; otherwise no action is needed.

Can I take aspirin or NSAIDs with Mesacol OD?

Short paracetamol (acetaminophen) is preferred for pain in UC. Chronic NSAID use can both precipitate UC flares and increase the renal risk of mesalamine — avoid where possible. Occasional use is usually tolerated.

Where can I buy Mesacol OD online?

You can order Mesacol OD (1.2 g once-daily) from MedsBase in packs of 30, 60 or 90 tablets. We ship worldwide with discreet packaging and genuine WHO-GMP certified manufacturer stock.

Related IBS & IBD Medications

• Mesacol — Mesalamine 400/800 mg (Sun Pharma)
• Asacol — Mesalamine 400 mg (Win-Medicare)
• Mesacol OD — Mesalamine 1.2 g once-daily (MMX)
• Sazo — Sulfasalazine 500 mg
• Salazar — Sulfasalazine
• Colospa — Mebeverine 135 mg (IBS antispasmodic)
• Rifagut — Rifaximin (gut-selective antibiotic)
• Browse all IBS & IBD Medications

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