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Asacol vs. Humira
- Both Asacol (mesalamine) and Humira (adalimumab) are used to treat different kinds of inflammatory bowel diseases.
- Asacol (mesalamine is an anti-inflammatory medication used to treat inflammatory bowel disease [IBD] including ulcerative colitis [UC]).
- Asacol is different from Humira (adalimumab) which is an injectable protein (antibody) that is an immune modulator drug used to treat different autoimmune conditions including arthritis, psoriasis, ulcerative colitis, and Crohn’s disease.
- Common side effects of Asacol include:
- mild nausea
- vomiting
- stomach cramps
- diarrhea
- gas
- fever
- sore throat
- flu-like symptoms
- constipation
- headache
- dizziness
- tired feeling
- skin rash
- Common side effects of Humira are different and include
- Asacol may interact with azathioprine or mercaptopurine, pentamidine, tacrolimus, amphotericin B, antibiotics, antiviral medicines, cancer medicine, or aspirin or other NSAIDs (nonsteroidal anti-inflammatory drugs). Humira may interact with other drugs.
What are Asacol and Humira?
Asacol (mesalamine) is an anti-inflammatory drug used to treat ulcerative colitis, proctitis, and proctosigmoiditis, and is also used to prevent the symptoms of ulcerative colitis from recurring.
Humira (adalimumab) is an injectable protein (antibody) used to treat rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, and plaque psoriasis. Humira is also used to treat ulcerative colitis and Crohn's disease after other drugs have been tried without successful treatment of symptoms.
What are the side effects of Asacol and Humira?
Asacol
The most common side effects of mesalamine are:
- headache,
- flatulence,
- hair loss, and
- itching.
Infrequent side effects include:
- increased heart rate,
- acne,
- pancreatitis,
- back pain,
- fatigue,
- tremor,
- ear pain, and
- blood disorders.
Kidney dysfunction has been associated with mesalamine. Kidney function should be evaluated prior to and periodically during mesalamine therapy.
Mesalamine may cause an acute intolerance syndrome that resembles a flare of inflammatory bowel disease (Crohn's disease or ulcerative colitis) with cramping, abdominal pain, and bloody diarrhea. Fever, headache, itching, and rash also may occur. Symptoms usually subside once mesalamine is discontinued.
Mesalamine enemas contain sulfites and should be avoided in persons who are sensitive to sulfites.
Since mesalamine is related to aspirin in structure, individuals who are allergic to aspirin should not take mesalamine.
Humira
The most common side effects are:
- headache,
- rash,
- nausea and
- stomach upset.
Adalimumab may cause swelling, redness, pain and itching at the site of injection. Adalimumab suppresses the immune system and is therefore associated with minor infections of the urinary tract, respiratory tract, and sinuses. Like other drugs that block TNF, use of adalimumab also has been associated with serious infections such as tuberculosis, sepsis (bacteria in the blood) and fungal infections. Individuals with active infections should not be treated with adalimumab.
Adalimumab also may worsen the symptoms of diseases of the nervous system. In studies some patients who used adalimumab or other TNF blocking drugs developed cancer. Since patients with rheumatoid arthritis have a higher rate of cancers than the general population, the connection between cancer and use of adalimumab is unclear.
Other side effects of adalimumab include:
- hypersensitivity reactions (including anaphylaxis) and
- reduced levels in the blood of platelets and red cells (aplastic anemia).
Adalimumab may increase the risk of reactivating hepatitis B virus in chronic carriers of the virus.
What is the dosage of Asacol vs. Humira?
Asacol
(see dosing instructions provided by manufacturer)
- Lialda: 2.4-4.8 g once daily with food
- Apriso: 1.5 g orally once daily
- Pentasa: 1 g four times daily
- Asacol HD: 1.6 g 3 times daily
- Delzicol: 800 mg 3 times daily (has replaced Asacol; also available in extended release tablets)
- Rowasa: One rectal application (4 g per 60 mL enema) once a day, preferably at bedtime, and retained for approximately 8 hours.
- Canasa: One suppository (1,000 mg) daily at bedtime. The suppository should be retained in the rectum for one to three hours or more if possible to achieve maximum benefit.
Humira
Adalimumab is injected under the skin. The recommended dose for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis is 40 mg every other week, but some patients may need weekly administration.
Crohn's disease is treated with 160 mg initially, followed by 80 mg two weeks later, then 40 mg every 2 weeks.
Juvenile idiopathic arthritis is treated with 20 or 40 mg every other week and plaque psoriasis is treated with 80 mg followed by 40 mg every other week.
What drugs interact with Asacol and Humira?
Asacol
Oral mesalamine formulations are associated with several drug interactions. Combining mesalamine with drugs that affect kidney function, for example, nonsteroidal antiinflammatory drugs (NSAIDs) or ibuprofen may increase the likelihood of reduced function of the kidneys. Concurrent use of mesalamine and 6-mercaptopurine or azathioprine (Imuran) may increase the likelihood of disorders of the blood cells, particularly reduced numbers of cells. Mesalamine may increase the blood thinning effect of warfarin (Coumadin).
Humira
Adalimumab is injected under the skin. The recommended dose for rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis is 40 mg every other week, but some patients may need weekly administration.
Crohn's disease is treated with 160 mg initially, followed by 80 mg two weeks later, then 40 mg every 2 weeks.
Juvenile idiopathic arthritis is treated with 20 or 40 mg every other week and plaque psoriasis is treated with 80 mg followed by 40 mg every other week.
Are Asacol and Humira safe to take while pregnant or breastfeeding?
Asacol
There are no adequate human studies of mesalamine during pregnancy. Mesalamine is known to cross the placenta into the fetus, but animal studies revealed no evidence of harm to the fetus. Mesalamine should only be used during pregnancy if it is felt that the benefit of its use justifies the unknown risks.
Mesalamine is excreted in breast milk. Mesalamine should only be used by nursing mothers if it is felt that the benefit of its use justifies the potential but unknown risk to the infant.
Humira
Adalimumab has not been adequately studied in pregnant women.
Use of adalimumab by nursing mothers has not been adequately evaluated.