What Is Mesalamine?
Mesalamine is a medicine for ulcerative colitis (UC) and other types of inflammatory bowel disease (IBD). It belongs to a group of anti-inflammatory medicines called aminosalicylates or 5-aminosalicylic acids (5-ASA). These medicines reduce swelling in the intestine lining and help it heal.
Sulfasalazine (Azulfidine) was the first type of 5-ASA drug used to treat IBD, but it can cause lots of side effects. Most people who can't take sulfasalazine can safely take mesalamine.
Mesalamine, also called mesalazine, is often the first drug prescribed for mild-to-moderate ulcerative colitis.
Mesalamine Mechanism of Action
It's not clear exactly how mesalamine works to lower inflammation in the colon (large intestine). It's thought to interfere with the action of certain chemicals in your body that cause inflammation. It may also act as an antioxidant to reduce damage to the tissues of your intestine.
Who Should Take Mesalamine?
Mesalamine is prescribed for adults and children age 5 and older who have mild-to-moderate ulcerative colitis. It may be the first medicine your doctor prescribes to prevent and treat symptom flare-ups.
This medicine could also be an option if you have a milder form of ulcerative colitis called ulcerative proctosigmoiditis. And it's a treatment for ulcerative colitis in the sigmoid colon, the lower part of your colon that attaches to your rectum.
This medicine also treats Crohn's disease, although it's less effective than it is for ulcerative colitis.
How to Take Mesalamine
You take mesalamine by mouth in pill form or use it as a suppository or enema you insert into your rectum. The medicine in each brand of mesalamine is the same, but the delivery method is different.
Delayed-release tablets and capsules don't release the medicine until they reach your intestine, so they're more targeted to certain parts of the intestine. Extended-release capsules let out the medicine slowly so the effects last longer. Mesalamine tablets and capsules have a coating on the outside to help the medicine reach your intestine.
You take each type and brand of mesalamine in a different way.
Delayed-release tablets
Extended-release tablets
- Apriso. Take it with or without food once a day in the morning.
- Delzicol. Adults take it two to four times a day with or without food. Children take it twice a day.
- Pentasa. Take it with or without food four times a day.
Mesalamine suppositories
- Canasa. Place this medicine directly into your rectum once or twice a day. Taking both a suppository and a pill may ease your symptoms better than pills alone.
Mesalamine enema
- Rowasa. This medicine comes as a fluid that you put into your rectum and colon. You take Rowasa once a day and leave it in for 20 to 40 minutes. An enema may help with inflammation in the left side of your colon.
Read the medicine label for more complete directions on how to take your type of mesalamine. Follow the instructions and take only the amount your doctor prescribed.
Try to drink extra fluids while you take mesalamine. Staying hydrated will protect your kidneys.
Don't stop taking the medicine, even if you feel better, without checking with your doctor. If you have any questions about how to use mesalamine for UC, ask your doctor or pharmacist.
How Well Does Mesalamine Work for Ulcerative Colitis?
If you have mild-to-moderate ulcerative colitis, mesalamine could help put you into remission and keep you there. Remission means you have few or no symptoms. About 40%-70% of people who take mesalamine see an improvement in their symptoms, and up to 20% go into remission.
Most people start to improve within 1 to 3 weeks after they start taking mesalamine for ulcerative colitis. If you don't get relief from symptoms that quickly, be patient. It can take up to 6 weeks for the medicine to put you into full remission.
If your UC symptoms don't improve after a month on mesalamine, your doctor might add a steroid, TNF inhibitor, or other medicine to help it work better.
Who Shouldn't Take Mesalamine?
Mesalamine may not be safe if you have certain medical conditions, including:
- An allergy to aspirin or sulfasalazine
- Heart, liver, or kidney disease
- A blockage in your stomach or intestines
- Swelling of the heart muscle (myocarditis)
- Swelling of the sac around the heart (pericarditis)
- Skin problems such as eczema or atopic dermatitis
Mesalamine may cause more liver, kidney, and heart risks in older adults. Your doctor might need to adjust the dose to prevent these problems.
You'll need to avoid Apriso if you have the inherited condition phenylketonuria (PKU). This medicine contains the artificial sweetener aspartame, which people with PKU must avoid.
Let your doctor know if you're pregnant, could become pregnant, or are nursing. There haven't been enough studies to show that mesalamine is safe to take during pregnancy. You can safely use this medicine while nursing, but let your doctor know if your baby has diarrhea or other side effects.
Mesalamine Side Effects
This medication is considered safe overall. Serious side effects are rare, but some people do have mild side effects when they take mesalamine for ulcerative colitis. You could have:
- Muscle pain
- Achy joints
- Nausea and vomiting
- Belly pain
- Headache
- Rash or itching
- Cold-like symptoms such as sore throat, runny nose, sneezing, and congestion
- Back pain
- Heartburn
- Burping or gas
- Constipation
- Dizziness
- Hair loss
- Loss of appetite
- Dark or bloody pee
Tell your doctor about any side effects that bother you or that don't improve. You may need to change the dose or take a different medicine.
Don't be surprised if you see an empty shell from the capsule in your stool. This is normal and usually not a problem. But if you see the whole capsule, it means the medicine isn't getting into your intestine. You may need to switch to another brand.
Mesalamine can make your skin more sensitive to the sun. Try to avoid sun exposure while you're taking this drug. If you do have to be outdoors during the day, wear UV-protective clothes, sunscreen, and sunglasses to shield your skin.
Rarely, this medicine can cause a serious reaction called mesalamine-induced acute intolerance syndrome. The symptoms can be confusing because they look like ulcerative colitis. Tell your doctor if you're taking mesalamine and you have:
- Stomach pain or cramps
- Bloody diarrhea
- Fever
- Headache
- Weakness
- Rash
Pancreatitis is another rare side effect of mesalamine. It's swelling of the pancreas that causes symptoms such as severe belly pain, nausea, vomiting, and a fast heartbeat.
Get medical help right away if you have symptoms of a severe allergic reaction, such as:
- Rash, hives, or skin blisters
- Swelling of your face, eyes, lips, tongue, or throat
- Sores or blisters in your mouth
- Trouble breathing or swallowing
- Wheezing
Because mesalamine sometimes harms the liver or kidneys, your doctor might test your liver and kidneys to make sure they're healthy before prescribing this medicine. Once you start taking mesalamine, your doctor should schedule regular visits to ensure that the medicine is helping you and isn't causing side effects.
Mesalamine Drug Interactions
Mesalamine can interact with other medicines. Some interactions increase side effects. Others make one or both of the drugs stronger or less effective.
These are some of the medicines that interact with mesalamine:
- Nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen
- Antacids
- Bismuth subsalicylate
- Digoxin, a blood pressure medicine
- Azathioprine, an immune-suppressing drug that prevents rejection after an organ transplant
- Mercaptopurine (Purixan), a chemo drug
- Blood thinners such as warfarin (Coumadin) and heparin
- Proton pump inhibitors, used to treat gastroesophageal reflux disease (GERD)
- H2 receptor blockers, also used for GERD
- The varicella (chickenpox) vaccine
Tell your doctor and pharmacist about any other medicines (including any over-the-counter supplements and medicines) that you take with mesalamine.
Takeaways
Mesalamine is a prescription drug used to treat mild to moderate ulcerative colitis (UC). It works by reducing inflammation inside the bowel. It may be the first medicine your doctor prescribes to prevent and treat UC flare-ups.
Mesalamine for Ulcerative Colitis FAQs
How long does it take mesalamine to work for ulcerative colitis?
If you take it according to your doctor's directions, mesalamine can start working as soon as within 1-3 weeks. But it can take up to 6 weeks for the drug to put you into full remission.
How long is it safe to take mesalamine?
Mesalazine can be safely prescribed long-term to manage the inflammation and prevent flare-ups. How long your doctor wants you to take it depends on how serious your symptoms are.
If you take it long-term, your doctor will check your kidneys regularly to make sure the drug isn't causing any issues. They'll probably check your kidney function every 3 months the first year you take mesalazine, then once a year after that.
Does mesalamine cause weight gain?
Weight gain has not been reported as a side effect of mesalamine.
Can you stop mesalamine abruptly?
Don't stop taking the drug without talking to your doctor first. If you do, your ulcerative colitis symptoms may return. Tell your doctor if you're having medication side effects. They may want to change your treatment plan.
