Alternatives to Mesalamine XR If You Can't Fill Your Prescription

If you've been unable to find Mesalamine XR (extended-release capsules) at your pharmacy, you have options. Depending on why you take Mesalamine XR — whether for inducing remission during a flare or for long-term maintenance — your doctor may be able to switch you to a different formulation or related medication that's currently more available. This guide walks through the main alternatives and what you need to know about each one.

Important: Never switch medications on your own without your doctor's guidance. Mesalamine formulations differ in their release mechanisms, dosing schedules, and FDA-approved indications. Your prescriber can advise on the safest switch for your specific situation.

Other Mesalamine Formulations: Same Drug, Different Delivery

The most straightforward alternatives to Mesalamine XR are other mesalamine-based products. These contain the same active ingredient (5-aminosalicylic acid) but use different delivery mechanisms and may have different availability at your local pharmacy.

Lialda (Mesalamine Delayed-Release Tablets, 1.2 g)

Lialda is a once-daily delayed-release mesalamine tablet taken with food. It's FDA-approved for both induction of remission and maintenance in adults and children. The typical dose is 2.4 g/day (two 1.2 g tablets) for maintenance or 4.8 g/day (four tablets) for active disease. Lialda and its generic equivalents are widely stocked and are generally considered one of the most available mesalamine options in 2026.

Best for: Patients who want once-daily convenience and broader availability.

Delzicol (Mesalamine Delayed-Release Capsules, 400 mg)

Delzicol is a delayed-release capsule with 400 mg of mesalamine per capsule. For active UC, it's typically taken as 800 mg (two capsules) three times daily. For maintenance, the dose is 1.6 g/day (two capsules twice daily). It's approved for adults and children age 5 and older.

Best for: Patients, especially children, who need delayed-release mesalamine and cannot swallow large capsules.

Asacol HD (Mesalamine Delayed-Release Tablets, 800 mg)

Asacol HD is an 800 mg delayed-release tablet approved for moderately active UC in adults. Taken on an empty stomach three times daily, it delivers mesalamine to the terminal ileum and colon. Amneal Pharmaceuticals launched a generic version of Asacol HD in early 2025, improving availability.

Best for: Adults with moderately active UC who need targeted delivery to the ileum and colon.

Apriso (Mesalamine Extended-Release Capsules, 0.375 g)

Apriso is an extended-release capsule at a different strength (0.375 g) than the 500 mg capsules that are under ASHP back order. It's specifically approved for maintenance of remission in adults (not for induction/treatment of active flares). The standard dose is 1.5 g (four 0.375 g capsules) once daily in the morning. As of early 2026, Apriso is not on the FDA's official shortage list, though localized availability issues persist.

Best for: Patients currently in remission who need maintenance therapy and prefer once-daily ER capsules.

Non-Mesalamine Aminosalicylate Alternatives

If all mesalamine formulations are unavailable, your doctor may consider other aminosalicylate drugs that work through similar mechanisms.

Balsalazide (Colazal)

Balsalazide is a prodrug that is converted to mesalamine directly in the colon. It's FDA-approved for mild to moderately active ulcerative colitis and delivers 5-ASA specifically to the site of inflammation. Some patients tolerate balsalazide better than other aminosalicylates. However, note that balsalazide can also have localized availability issues at some pharmacies.

Sulfasalazine (Azulfidine)

Sulfasalazine is the oldest aminosalicylate and the parent compound that mesalamine was derived from. It's effective and significantly less expensive, but it causes more side effects (nausea, headache, skin reactions) in some patients. It can also reduce folate absorption, so supplementation may be needed. It's widely available and covered on most insurance plans.

Key Questions to Ask Your Doctor Before Switching

Am I currently in active flare or in remission? (This affects which formulations are appropriate)

Does my insurance cover the alternative formulation?

Do I have any kidney or liver conditions that affect which mesalamine product is safest?

How long will I need to be on the alternative before switching back to Mesalamine XR?

Before Switching, Try to Find Your Medication First

Before giving up on Mesalamine XR, it's worth using medfinder.com to search nearby pharmacies. Your medication may be available at an independent pharmacy or through mail order, even if your usual chain pharmacy is out. medfinder will call pharmacies in your area and report back which ones can fill your prescription.

For detailed steps on locating your medication, see: How to find Mesalamine XR in stock near you.