Asacol HD, Lialda, and Delzicol for Ulcerative Colitis: What’s the Difference?

If you’re living with ulcerative colitis (UC), you know how flare-ups can impact your quality of life. Luckily, there are several medications available to help keep your symptoms under control. One option your healthcare provider may recommend is mesalamine.

Mesalamine (also called 5-aminosalicylic acid, or 5-ASA) is an anti-inflammatory medication. It was first FDA-approved back in 1987. Today, there are several oral versions of mesalamine available, including Asacol HD, Lialda, Delzicol. You can also find mesalamine as a rectal enema (Rowasa) and suppository (Canasa).

But what’s the difference between the oral products? And which one is right for you?

What is Asacol HD?

Asacol HD is a delayed-release (DR) version of mesalamine that’s FDA-approved to treat moderately active UC in adults. It’s available as 800 mg DR tablets.

Previously, there was another brand-name product called Asacol. It was available as 400 mg DR tablets. But this product was discontinued in 2013.

Why was Asacol discontinued?

Years ago, Asacol and Asacol HD both contained an inactive ingredient called dibutyl phthalate (DBP). DBP has the potential to be toxic, especially in young children and pregnant women. In 2009, the FDA asked the manufacturer of these products to develop new versions without DBP.

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In 2013, the manufacturer stopped making Asacol 400 mg DR tablets and the product was removed from the market. 

Then, in 2016, a new version of Asacol HD, which doesn’t contain DBP, was approved. This is the product that’s available on the market today.

What is Lialda?

Lialda is another version of mesalamine that’s FDA-approved to induce and maintain remission of mildly to moderately active UC in adults. It’s also approved to treat mildly to moderately active UC in children weighing at least 24 kg (about 53 lbs). Lialda is available as a 1.2 g DR tablet.

What is Delzicol?

The third mesalamine option is Delzicol. It’s FDA-approved to treat mildly to moderately active UC in adults and children at least 5 years old. It can also help maintain UC remission in adults.

Delzicol is available as 400 mg DR capsules. Each capsule contains four 100 mg tablets inside. But Delzicol shouldn’t be used interchangeably with Asacol HD. 

How does mesalamine work for ulcerative colitis?

Mesalamine is the active ingredient in Asacol HD, Lialda, and Delzicol. It's an aminosalicylate, and you’ll sometimes see it called 5-aminosalicylic acid (5-ASA). If that name sounds familiar, It’s because it’s related to aspirin (acetylsalicylic acid, or ASA). 

We don’t exactly know how mesalamine works. But it’s believed to reduce inflammation in the gut, which helps relieve the irritation, damage, and pain experienced with UC. 

These mesalamine products all have a delayed-release action. This allows the medication to reach the end of your small intestine (ileum) and/or colon, where UC is the most bothersome. 

Each medication uses a protective outer coating to control the medication’s release based on pH (acidity) levels specific to the colon. But there are some differences between the three medications. For example, Asacol HD uses a combination of outer and inner protective coatings for added control. And Lialda uses a water-absorbing matrix to allow the medication to slowly release along the entire colon.

How are Asacol HD, Lialda, and Delzicol dosed and given?

Even though all three medications contain the same active ingredient, there are some differences with how they’re taken. 

Asacol HD dosing

Asacol HD is usually dosed as 1,600 mg (two 800 mg tablets) 3 times a day for 6 weeks to treat an active UC flare. Since they’re DR tablets, you can’t crush, chew, or cut them. If you do, the medication won’t release properly. 

Asacol HD should be taken on an empty stomach. This means at least 1 hour before or 2 hours after a meal.

Lialda dosing

For adults, Lialda’s dosage is 2.4 g to 4.8 g (two to four 1.2 g tablets) once a day to induce remission. Then, 2.4 g (two 1.2 g tablets) is taken once a day to maintain remission. The dosage for children is based on their body weight. 

Lialda should be taken with food. Don’t not crush, chew, or cut the tablets or the medication won’t release properly.

Delzicol dosing

The typical Delzicol dosage for mildly to moderately active UC in adults is 800 mg (two 400 mg capsules) 3 times a day for 6 weeks. For children, the dosage is based on their body weight and is only given to them 2 times a day. To maintain remission in adults, the total daily dose 1.6 g (four 400 mg capsules) is divided throughout the day. 

You can take Delzicol with or without food. Again, you shouldn’t crush, chew, or cut the capsules. But if you can’t swallow the capsules, it’s OK to open them and swallow the four tablets inside. 

How effective are Asacol HD, Lialda, and Delzicol for ulcerative colitis?

Asacol HD, Lialda, and Delzicol are three different formulations of mesalamine. But does one work better than the others?

A 2020 systematic review compared several different mesalamine formulations. Researchers didn’t find significant differences in safety and effectiveness. And, once-daily dosing (like Lialda) was just as effective as taking multiple doses per day. So, the best option for you may depend on your preferences, areas of the colon involved, and other factors.

Remember: All three of these medications are approved to treat active UC symptoms in adults. But only Lialda and Delzicol are used to maintain remission.

What are the known side effects of Asacol HD, Lialda, and Delzicol?

The common side effects of Asacol HD, Lialda, and Delzicol are similar. Examples of common side effects include: 

• Headache

• Nausea

• Abdominal pain

• Diarrhea

• Gas

• Joint or muscle pain

Let your healthcare provider know if any side effects become bothersome, or if they seem to be getting worse.

What are the serious side effects of Asacol HD, Lialda, and Delzicol?

There are a few serious side effects that are possible with mesalamine. For example, some people develop a rare but serious reaction to the medication. This is called mesalamine-induced acute tolerance syndrome.

Symptoms of mesalamine-induced acute tolerance syndrome include cramping, abdominal pain, and bloody diarrhea. Headache, fever, and rash can also occur. Contact your healthcare provider right away if these symptoms develop.

Other serious side effects can include:

• Kidney problems, especially if you have kidney disease

• Kidney stones

• Liver failure, especially if you have liver disease

• Allergic reactions, including anaphylaxis

• Severe skin reactions (like Stevens-Johnson syndrome)

• Sensitivity to light (photosensitivity)

What interactions do Asacol HD, Lialda, and Delzicol have?

The risk of kidney problems can go up if you’re taking mesalamine with other medications that can also cause kidney damage. This includes medications like nonsteroidal anti-inflammatory drugs (NSAIDs). Check with your healthcare provider first before combining these medications.

Mesalamine can also interact with azathioprine (Imuran) and 5-mercaptopurine (Purinethol). This combination can affect your bone marrow’s ability to make different blood cells. Your healthcare provider may order regular blood tests to monitor for these effects. 

To avoid potential interactions, have your healthcare provider and pharmacist review your current medication list. They can check if combining other medications with mesalamine is safe.

How to save on Asacol HD, Lialda, and Delzicol

All three medications are available as brand and generic versions. But they’re still pretty expensive without using additional discounts.

Luckily, GoodRx can help you save over 60% off the average retail cost of the generic versions. Generic Asacol HD’s price is as low as $230 at certain pharmacies with a free GoodRx discount. Generic Lialda’s price is as low as $140. And generic Delzicol’s price is as low as $190.

If you have commercial insurance, you may be eligible to pay as little as $10 for brand-name Delzicol using a savings card through the manufacturer. There currently aren’t any copay cards for Asacol HD or Lialda.

If you’re uninsured or underinsured, you may be eligible for Takeda’s Help at Hand program for Lialda or myAbbVie Assist for Delzicol. Eligible participants may receive their medication at no cost. 

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Written by:

Brian Leonard, PharmD, BCACP, BCGP

Brian Leonard earned his doctorate in pharmacy from the University of Florida College of Pharmacy and is board certified in Ambulatory Care and Geriatric Pharmacy.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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