DIVIDE AND CONQUER?

What solution would you offer this patient?

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1. Counselling Conundrum: a real question from a patient

2. Concise Conclusion: a straight-forward patient-friendly answer 

3. Quick Wrap-up 

Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.

Counselling Conundrum: ""I've been on Pentasa three times a day for my colitis for years. It's such a pain to remember the lunch dose. Is there anything better out there?"

Concise Conclusion: Good news: you likely don't need three doses a day at all. Every oral 5-ASA, including Pentasa, is safe and effective dosed once daily. Pentasa is labeled for divided dosing, but the once-daily approach is just as effective and may be easier to stick with.

Quick Wrap-up: The divided dosing convention is a holdover from sulfasalazine, where splitting doses limited sulfapyridine-related side effects. That reasoning never applied to 5-ASA alone, and product monographs haven't caught up with the evidence. Mezavant (MMX mesalazine) is the outlier: it's actually approved for once-daily dosing. For everything else labeled as divided dosing, from Pentasa to Salofalk to Asacol, once-daily use is an evidence-based, guideline-supported option worth discussing with the prescriber if adherence is a concern.

Dive Deeper

1) Oral 5‐aminosalicylic acid for maintenance of remission in ulcerative colitis - Murray, A - 2020 | Cochrane Library

2) Once-Daily Dosing of Delayed-Release Oral Mesalamine (400-mg Tablet) Is as Effective as Twice-Daily Dosing for Maintenance of Remission of Ulcerative Colitis - ScienceDirect

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