Alternatives to Apriso If You Can't Fill Your Prescription

When your pharmacy tells you Apriso is unavailable, it's easy to feel stuck. Ulcerative colitis doesn't wait for supply chain problems to resolve, and skipping your maintenance medication can trigger a flare-up within weeks. The good news? Apriso isn't your only option.

Several other medications contain the same active ingredient — Mesalamine — and can keep your ulcerative colitis in remission just as effectively. In this article, we'll explain what Apriso is, how it works, and walk through the best alternatives so you can have an informed conversation with your doctor.

What Is Apriso?

Apriso is a brand-name medication containing Mesalamine (also known as 5-aminosalicylic acid or 5-ASA). It belongs to a class of drugs called 5-aminosalicylates, which are the first-line treatment for mild to moderate ulcerative colitis.

Apriso is specifically FDA-approved for the maintenance of remission of ulcerative colitis in adults. The standard dose is four capsules (1.5 g total) taken once daily in the morning. Each capsule contains 0.375 g of Mesalamine in a delayed- and extended-release formulation designed to deliver the medication directly to the colon.

For a complete overview, see our guide: What is Apriso? Uses, dosage, and what you need to know.

How Does Apriso Work?

Mesalamine works locally in the lining of your colon. It reduces inflammation by blocking the production of prostaglandins and leukotrienes — chemicals your body makes that cause swelling, pain, and tissue damage in the intestinal wall. It also acts as an antioxidant, scavenging free radicals that contribute to colonic inflammation.

The extended-release design of Apriso means the Mesalamine is released gradually as the capsule travels through your digestive system, with a special pH-dependent coating that ensures most of the drug reaches the colon where ulcerative colitis occurs.

For a deeper dive, read: How does Apriso work? Mechanism of action explained.

Alternatives to Apriso

All of the medications below contain Mesalamine as their active ingredient. The main differences are in how the drug is formulated, how many pills you take, and where in your GI tract the medication is released. Your doctor can help you choose the best option based on your specific needs.

1. Generic Mesalamine ER (Direct Generic)

The most straightforward alternative is generic Mesalamine extended-release capsules (0.375 g). This is the direct generic equivalent of Apriso — same active ingredient, same dose, same release mechanism.

• Dose: Four capsules (1.5 g) once daily in the morning
• Availability: Widely available at most pharmacies
• Cost: As low as $42–$55 per month with a coupon, compared to $500+ for brand-name Apriso
• Best for: Patients currently on Apriso who want the same medication at a lower cost

2. Lialda (Mesalamine Delayed-Release Tablets)

Lialda is another once-daily Mesalamine option, but it comes as a 1.2 g delayed-release tablet instead of capsules. It's approved for both the induction and maintenance of remission in mild to moderate ulcerative colitis.

• Dose: Two to four tablets (2.4–4.8 g) once daily with food for induction; two tablets (2.4 g) once daily for maintenance
• Key difference: Higher total daily dose option and approved for treating active flares, not just maintenance
• Cost: Brand-name Lialda can be expensive ($400–$800/month), but generic Mesalamine DR tablets are available for less
• Best for: Patients who prefer a once-daily tablet or need a medication approved for both induction and maintenance

3. Pentasa (Mesalamine Controlled-Release Capsules)

Pentasa uses a different release mechanism — ethylcellulose-coated granules that release Mesalamine throughout the entire GI tract, starting in the small intestine. It's approved for both induction and maintenance of remission.

• Dose: 1 g (four 250 mg capsules or two 500 mg capsules) four times daily for a total of 4 g per day
• Key difference: Releases medication throughout the entire GI tract, not just the colon. Requires multiple daily doses.
• Cost: Brand Pentasa is expensive; generic Mesalamine controlled-release capsules are available
• Best for: Patients with inflammation in the upper GI tract or small intestine, or those who don't respond to colon-targeted formulations

4. Delzicol (Mesalamine Delayed-Release Capsules)

Delzicol is essentially the capsule replacement for the discontinued Asacol product. It uses a pH-dependent coating to release Mesalamine in the terminal ileum and colon. It's approved for mild to moderate UC induction and maintenance.

• Dose: 800 mg (two 400 mg capsules) three times daily for induction (total 2.4 g/day); 1.6 g/day in divided doses for maintenance
• Key difference: Targets the terminal ileum and colon specifically. Requires three-times-daily dosing.
• Cost: Generic versions available, making it an affordable option
• Best for: Patients who previously used Asacol or who need ileal and colonic delivery

5. Asacol HD (Mesalamine Delayed-Release Tablets)

Asacol HD is a higher-strength Mesalamine tablet (800 mg) with a pH-dependent coating. It's specifically designed for treating moderately active ulcerative colitis.

• Dose: 1.6 g (two 800 mg tablets) three times daily for a total of 4.8 g/day
• Key difference: Higher dose per tablet, specifically for active disease rather than maintenance
• Cost: Brand-name only, tends to be expensive
• Best for: Patients with active mild to moderate UC who need a higher-dose oral option

What About Non-Mesalamine Options?

If you can't take Mesalamine (for example, due to an allergy to salicylates), your doctor may consider other drug classes:

• Sulfasalazine (Azulfidine): An older 5-ASA prodrug that's converted to Mesalamine in the colon. Less expensive but more side effects.
• Corticosteroids (Uceris, Prednisone): For short-term flare control, not long-term maintenance
• Immunomodulators (Azathioprine, 6-Mercaptopurine): For patients who don't respond to Mesalamine alone
• Biologics (Humira, Entyvio, Stelara): For moderate to severe UC that doesn't respond to first-line therapies

These options have different side effect profiles and monitoring requirements, so they should only be considered with your doctor's guidance.

How to Switch Safely

Never switch medications on your own. Here's how to do it the right way:

1. Talk to your doctor about why Apriso is unavailable and which alternative makes sense for you
2. Get a new prescription — your pharmacist can't automatically substitute a different Mesalamine formulation (though they can substitute generic Mesalamine ER for brand-name Apriso)
3. Understand the new dosing schedule — switching from once-daily Apriso to a three- or four-times-daily medication requires adjustment
4. Monitor for changes — track your symptoms for the first few weeks after switching and report any concerns to your doctor

Final Thoughts

Not being able to fill your Apriso prescription is stressful, but it doesn't mean you're out of options. Several effective Mesalamine alternatives are available, and your doctor can help you find the best fit. In many cases, switching to generic Mesalamine ER is the simplest solution — same medication, wider availability, lower cost.

Before making any changes, use Medfinder to check if Apriso is available at a different pharmacy near you. If it's truly unavailable, bring this list of alternatives to your next appointment and discuss which one is right for your situation.

For more on managing costs, see: How to save money on Apriso in 2026.