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Lialda vs Sulfasalazine

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Overview

Lialda

Sulfasalazine

Comparative Analysis

Introduction

For patients with ulcerative colitis or other types of inflammatory bowel diseases (IBD), certain drugs that alter the immune response and decrease inflammation in the colon can help manage symptoms. Lialda and Sulfasalazine are two such drugs that are commonly prescribed for these conditions. They each impact different pathways in the body but both have anti-inflammatory effects in patients with IBD. Lialda, also known as mesalamine, works by affecting a substance in the body that causes inflammation, tissue damage, and diarrhea. On the other hand, Sulfasalazine is classified as an aminosalicylate anti-inflammatory drug and sulfonamide antibiotic which reduces inflammation and suppresses immunity to slow down progression of disease primarily affecting levels of intestinal inflammation.

Lialda vs Sulfasalazine Side By Side

AttributeLialdaSulfasalazine
Brand NameLialdaSulfasalazine
ContraindicationsAllergy to aspirin or any other salicylate drug. Caution in patients with kidney disease.Allergy to aspirin or any other salicylate drug, sulfa allergy. Regular blood tests required due to potential effects on blood cells.
CostThe price of 60 tablets of Lialda (1.2 g) averages around $1300. Generic mesalamine costs between $0.50 and $1 per day.The price for 120 tablets of Azulfidine (500 mg) is about $250. Generic sulfasalazine costs can range from about $.20/day to $.90/day.
Generic NameMesalamineSulfasalazine
Most Serious Side EffectSigns of an allergic reaction, severe stomach or abdominal pain, cramping, burning, or bloating; bloody diarrhea, unusual bleeding or bruising, dark urine, yellowing eyes/skin (jaundice), unexpected weight gain due to fluid retention and swelling, symptoms related to liver problems.Signs of a severe skin reaction, blurred vision and other eye problems, low sodium levels, signs of an allergic reaction such as skin rashes, itching or hives, unusual bleeding or bruising, severe nausea or vomiting, pale stools and dark urine indicating liver problems, symptoms related to changes in blood count, yellowing eyes/skin, severe stomach/abdominal pain, persistent sore throat/fever.
Severe Drug InteractionsNot explicitly mentioned in the text, but patients are advised to inform their physician about all medications they're taking.Not explicitly mentioned in the text, but patients are advised to inform their physician about all medications they're taking.
Typical DoseOral dosages range from 2.4–4.8 g/day, taken once daily with a meal.Treatment generally begins with a dosage of 500 mg/day, increasing to 1 g/day, divided into two doses. Maximum of 3 g/day divided into three doses.

What is Lialda?

Mesalamine (the generic name for Lialda) is a first-line drug in the treatment of inflammatory bowel disease, particularly ulcerative colitis. Like Fluoxetine was to antidepressants, Mesalamine marked a significant development upon earlier treatments such as Sulfasalazine. The FDA first approved it in 2007. Lialda works by reducing inflammation in the colon, effectively "calming" it down for longer than usual periods. It is prescribed predominantly for the maintenance of remission in patients with ulcerative colitis. Unlike Sulfasalazine which affects multiple pathways involving inflammation and immune response, Mesalamine has selective influence primarily on prostaglandins which are involved in inflammation within the colon lining specifically - thereby resulting in fewer side effects compared to drugs like Sulfasalazine that have broader actions.

What conditions is Lialda approved to treat?

Lialda is approved for the treatment of different variations of inflammatory bowel diseases:

  • Ulcerative colitis, a chronic disease that causes inflammation and sores in the inner lining of the large intestine
  • Maintenance of remission in ulcerative colitis to prevent flare-ups or relapses
  • Treatment for patients with mild to moderate active ulcerative colitis.

How does Lialda help with these illnesses?

Lialda (mesalamine) helps to manage ulcerative colitis by reducing inflammation in the colon. It accomplishes this by inhibiting the production of inflammatory chemicals, so levels can be managed and maintained for longer periods of time. Inflammation is a response triggered by the body's immune system that plays an important role in protecting against harmful stimuli, including damaged cells and pathogens. However, in conditions like ulcerative colitis where the immune system mistakenly targets its own tissues, excessive inflammation can lead to damage and discomfort in various parts of the body - especially the colon. Therefore, by reducing inflammation, Lialda can limit negative symptoms associated with ulcerative colitis such as diarrhea or rectal bleeding and help patients manage their condition more effectively.

What is Sulfasalazine?

Sulfasalazine, marketed under brand names such as Azulfidine and Sulfazine, is a sulfa drug that combines sulfapyridine and 5-aminosalicylic acid (5-ASA), and it acts as an anti-inflammatory agent in the gut. It has been used since the 1950s for treating various forms of arthritis, inflammatory bowel diseases like ulcerative colitis and Crohn's disease, as well as certain skin disorders. Unlike drugs such as Lialda which only contain 5-ASA, sulfasalazine can also inhibit folic acid, which may lead to additional side effects including nausea or loss of appetite; however these are typically mild. The side-effect profile for this class of medications differs from those which only contain 5-ASA due to its unique dual-action mechanism. This is particularly beneficial for patients who do not respond well to "typical" anti-inflammatory drugs like Lialda.

What conditions is Sulfasalazine approved to treat?

Sulfasalazine is a medication used to manage and treat conditions such as:

  • Ulcerative colitis
  • Crohn's disease
  • Rheumatoid arthritis

It can be especially beneficial for individuals with flare-ups in these diseases by reducing inflammation, pain, and ultimately improving their quality of life.

How does Sulfasalazine help with these illnesses?

Sulfasalazine is an anti-inflammatory drug that has been utilized for decades in the management of chronic inflammatory conditions such as rheumatoid arthritis and ulcerative colitis. It works by reducing inflammation and swelling, thereby alleviating some of the symptoms associated with these disorders. Its action on immune system cells may also play roles in the therapeutic effects of Sulfasalazine. Unlike Lialda, which primarily acts locally within the intestines, Sulfasalazine is absorbed into the bloodstream and can therefore exert systemic effects throughout the body. As a result, it may be prescribed when a patient's condition involves areas beyond just their intestines (such as joints in rheumatoid arthritis), or if they do not respond well to other medications like Lialda.

How effective are both Lialda and Sulfasalazine?

Both mesalamine (Lialda) and sulfasalazine have been used for decades in the treatment of ulcerative colitis, a type of inflammatory bowel disease. Mesalamine was approved by the FDA in 1987, while sulfasalazine has been available since the 1950s. These two medications work differently to manage inflammation in the gut: mesalamine is an anti-inflammatory drug that works directly at the site of inflammation in the colon, whereas sulfasalazine is both an antibiotic and anti-inflammatory.

Their effectiveness was compared directly in a randomized controlled trial conducted over 12 weeks; both drugs were found to be similarly effective at inducing remission in mild to moderate ulcerative colitis. However, when considering side effects, Lialda may be more appealing for some patients as it tends to cause fewer reported adverse events than sulfasalazine due its specific targeting of inflamed tissue within the colon.

A review from 2008 revealed that mesalamine is effective even with once-daily dosing which can improve patient compliance compared to other treatments requiring multiple daily doses. It also showed promising safety profiles especially among elderly populations who might be susceptible to gastrointestinal disturbances caused by non-steroidal anti-inflammatory drugs (NSAIDs).

On another hand, a meta-analysis published in 2016 confirmed that while Sulfasalazine has demonstrated efficacy equal or superior to placebo or other treatments for inducing remission in ulcerative colitis patients but its use can bring about numerous side effects such as nausea, headache and rash due its systemic absorption after oral administration. Nonetheless, given its lower cost relative to newer formulations like Lialda and long history of usage offering ample data on safety profile it could still remain a first-line treatment option particularly where affordability matters.

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At what dose is Lialda typically prescribed?

Oral dosages of Lialda for adults range from 2.4–4.8 g/day, taken once daily with a meal for treating ulcerative colitis. There is no established dosage regimen for children and adolescents; it's based on weight and age hence should be determined by a healthcare provider. If there is insufficient response after several weeks, the dosage can be increased under medical supervision but should not exceed the maximum recommended dose of 4.8 g/day in any case.

Sulfasalazine dosages for adults begin at 3-4g per day divided into smaller doses, then may be reduced to a maintenance dose if needed while managing inflammatory bowel diseases like Crohn's disease or ulcerative colitis. Children's dosing will vary depending on their weight and disease severity and must always be overseen by a physician.

At what dose is Sulfasalazine typically prescribed?

Sulfasalazine treatment generally begins with a dosage of 500 mg/day. The dose can then be increased to 1 g/day, divided into two doses, taken 12 hours apart. If needed and tolerated, the daily dose may be further increased to a maximum of 3 g/day divided into three doses of 1 g each and spaced roughly 8 hours apart. This escalation in dosage could be considered if there is no response to treatment at the lower dosages after several weeks.

What are the most common side effects for Lialda?

Common side effects of Lialda may include:

  • Headache
  • Gas, stomach pain, or cramps
  • Diarrhea
  • Flu symptoms (fever, chills)
  • Sinusitis (inflammation of the sinus cavities in the head)
  • Cold symptoms such as stuffy nose, sneezing, sore throat
  • Nausea and vomiting

Sulfasalazine on the other hand is associated with a different set of potential side effects including:

  • Loss of appetite
  • Upset stomach or throwing up
  • Diarrhea
  • Skin rash or itching -Hair loss
    -Yellow skin or eyes
    -Liver problems

Please remember that every individual can react differently to medication and you should consult your healthcare provider if any severe reactions occur.

abstract image of a patient experiencing side effect

Are there any potential serious side effects for Lialda?

While taking Lialda, it is important to be aware of potential serious side effects which may require immediate medical attention. These include:

  • Signs of an allergic reaction such as difficulty breathing or swelling in your face or throat.
  • Severe stomach or abdominal pain, cramping, burning, or bloating; bloody diarrhea
  • Unusual bleeding or bruising
  • Dark urine
  • Yellowing eyes/skin (jaundice)
  • Unexpected weight gain due to fluid retention and swelling
  • Symptoms related to liver problems such as persistent nausea/vomiting and loss of appetite

Meanwhile Sulfasalazine has its own set of potentially serious side effects like:

  • Signs of a severe skin reaction: fever, sore throat, burning eyes, skin pain followed by a red/purple rash that spreads and causes blistering/peeling.
  • Blurred vision along with other eye problems including eye pain/swelling or seeing halos around lights.
  • Low sodium levels leading to symptoms like headache/confusion/slurred speech/severe weakness/vomiting/unsteadiness etc.

If you experience any such concerns while on either medication consult your healthcare provider immediately.

What are the most common side effects for Sulfasalazine?

Sulfasalazine, a medication often used to manage symptoms of inflammatory bowel disease and rheumatoid arthritis, can have varying side effects. These may include:

  • Dry mouth or sore throat
  • Unusual ringing in the ears
  • Trouble sleeping or insomnia
  • Nausea, vomiting, loss of appetite or stomach pain which could sometimes be due to the drug's effect on the digestive system
  • Headaches and dizziness are also common.
  • Some patients might experience rashes on their skin.
  • Occasionally there may be an increase in heart rate or feelings of confusion and agitation.
  • In some rare instances, you might observe weight changes (loss) as well as increased frequency of urination.
    Remember that these side effects do not occur in everyone taking Sulfasalazine; they're possible but not guaranteed outcomes. Always consult with your healthcare provider for personalized advice when considering this medication.

Are there any potential serious side effects for Sulfasalazine?

While Sulfasalazine is generally well-tolerated, it's important to be aware that certain severe side effects can occur. If you experience any of the following symptoms while taking sulfasalazine, seek medical attention immediately:

  • Signs of an allergic reaction such as skin rashes, itching or hives, swelling of the face or throat, difficulty breathing
  • Unusual bleeding or bruising
  • Severe nausea or vomiting
  • Pale stools and dark urine indicating liver problems
  • Symptoms related to changes in blood count like constant fatigue and weakness
  • Yellowing eyes/skin which could represent jaundice
  • Severe stomach/abdominal pain Persistent sore throat/fever

In rare cases neurological complications may arise leading to seizures and mood changes. Always consult your healthcare provider if these symptoms persist.

Contraindications for Lialda and Sulfasalazine?

Both Lialda and Sulfasalazine are medications often used to treat inflammatory bowel disease. If you notice worsening of your symptoms, such as increased abdominal pain, bleeding or sudden weight loss, please seek immediate medical attention.

Neither Lialda nor Sulfasalazine should be taken if you have an allergy to aspirin or any other salicylate drug. Always inform your physician about all the medications you're taking; some drugs could interact with these two and cause unwanted side effects.

Sulfasalazine may not be suitable for people with a sulfa allergy, while those with kidney disease need to use caution when using Lialda due to potential toxicity. Both medications can affect blood cells so regular blood tests will likely be required during treatment. It's also recommended that both men and women discuss fertility and pregnancy issues related to these medicines with their healthcare provider.

How much do Lialda and Sulfasalazine cost?

For the brand name versions of these drugs:

  • The price of 60 tablets of Lialda (1.2 g) averages around $1300, which works out to $21–42/day, depending on your dose.
  • The price for 120 tablets of Azulfidine, a brand-name version of sulfasalazine (500 mg), is about $250 working out to approximately $4/day.

Thus, if you are in the higher dosage range for Lialda (i.e., 4.8 g/day or higher), then brand-name Azulfidine is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which drug may be right for you.

The generic versions offer more affordability:

  • Generic mesalamine (the active ingredient in Lialda) costs between $0.50 and $1 per day at typical daily doses ranging from 800mg to 2400mg.
  • Sulfasalazine comes in packs from 15 up to several hundred tablets (500 mg each). Your cost can range from as low as about $.20 /day if buying larger quantities upfront and could go up to about $.90/ day based on regional variations and store pricing strategies.

Popularity of Lialda and Sulfasalazine

Mesalamine, commonly known by the brand name Lialda, was prescribed to about 600,000 people in the US in 2020. This medication is mainly used for treating ulcerative colitis and it accounted for approximately 45% of aminosalicylate prescriptions in the US last year. Mesalamine has been steadily increasing in prescription rates since its introduction.

In comparison, sulfasalazine was prescribed to just over 200,000 individuals during the same time frame. Sulfasalazine accounts for nearly 15% of aminosalicylate prescriptions and is also primarily used for treating ulcerative colitis and rheumatoid arthritis. The prevalence of sulfasalazine use has remained relatively steady over the past decade due to its efficacy as well as affordability compared with newer drugs like mesalamine.

Conclusion

Both Lialda (mesalamine) and Sulfasalazine have a long-standing record of usage in patients with inflammatory bowel diseases such as ulcerative colitis, backed by numerous clinical studies indicating that they are more effective than placebo treatments. In some cases, these drugs may be combined for a synergistic effect, but this requires careful consideration by a physician due to their different mechanisms of action. With Lialda acting primarily on the inflammation process through inhibiting prostaglandin production in the colon, and sulfasalazine being split into two components: 5-aminosalicylic acid (which reduces inflammation) and sulfapyridine (an antibiotic), they tend to be prescribed under different circumstances.

Lialda is usually considered first-line treatment due its lower side-effect profile compared to Sulfasalazine. However, Sulfasalazine can be used as an adjuvant therapy or in patients who did not respond well to first-line treatments with mesalamine derivatives like Lialda.

Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both Lialda and Sulphasalzine may require an adjustment period meaning that effects might not be noticeable right away.

The side effect profile is similar between the two drugs but with sulfasalazine having more potential adverse effects such as nausea, headache or rash. For both medications, it's important for patients to closely monitor their symptoms when starting treatment and should seek medical attention immediately if they notice any severe allergic reactions or worsening abdominal pain.

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