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What is mesalamine, and how does it work (mechanism of action)?
Mesalamine is a drug used for treating ulcerative colitis and mild to moderate Crohn's disease. The exact mechanism of mesalamine is not known but is believed to be by reducing inflammation in the colon. Ulcerative colitis and other inflammatory diseases cause excessive production of chemicals, for example, prostaglandins, that produce inflammation in the colon. Prostaglandins are produced by the enzymes, cyclooxygenase and lipoxygenase. These enzymes are over-active in individuals with ulcerative colitis. Mesalamine may work by blocking the activity of cyclooxygenase and lipoxygenase, thereby, reducing the production of prostaglandins. Reduced production of prostaglandins decreases inflammation in the colon and the symptoms associated with ulcerative colitis. Available forms of mesalamine differ in their route of administration and how often they are administered. Mesalamine was approved by the FDA in December 1987.
What are the side effects of mesalamine?
The most common side effects of mesalamine are:
Infrequent side effects include:
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.
Quick GuideUlcerative Colitis Symptoms, Causes, and Treatment
What is the dosage for mesalamine?
(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.
Which drugs or supplements interact with mesalamine?
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).
Is mesalamine safe to take if I'm pregnant or breastfeeding?
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.
What else should I know about mesalamine?
Generic forms of mesalamine are available for mesalamine rectal and suppository.
You need a prescription from your doctor or other health care professional for this medication.
Mesalamine is available as:
- Tablets (delayed release): 800 mg (Asacol), 1.2 g (Lialda).
- Capsules (extended or delayed release): 375 mg (Apriso); 250, 500 mg (Pentasa); 400 mg (Delzicol)
- Rectal enema (Rowasa, SfRowasa): 4 g per 60 mL.
- Rectal suppositories (Canasa): 1000 mg.
Pentasa, Rowasa, Asacol HD, Lialda, Canasa, Apriso, SfRowasa, and Delzicol are the brand names available for mesalamine in the US.
The tablets, capsules, and enemas should be stored at room temperature, 15 C - 30 C (59 F - 86 F). The suppositories should be stored below 25 C (77 F) without freezing.
Mesalamine (Pentasa, Rowasa, SfRowasa, Lialda, Canasa, Apriso, Delzicol) is a medication prescribed for ulcerative colitis and mild to moderate Crohn's disease. Side effects, drug interactions, warnings and precautions, and safety during pregnancy information should be reviewed prior to taking this medication.
Multimedia: Slideshows, Images & Quizzes
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Treatment & Diagnosis
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Medications & Supplements
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
FDA Prescribing Information
Top mesalamine Related Articles
ColitisColitis refers to inflammation of the inner lining of the colon. Symptoms of the inflammation of the colon lining include diarrhea, pain, and blood in the stool. There are several causes of colitis, including infection, ischemia of the colon, inflammatory bowel disease (Crohn's disease, ulcerative colitis, infectious colitis like C. difficile, or microscopic colitis). Treatment depends on the cause of the colitis.
Crohn's DiseaseCrohn's disease is a chronic inflammatory disease, primarily involving the small and large intestine, but which can affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are common symptoms.
Crohn's Disease QuizWhat causes Crohn's disease? What are the symptoms of Crohn's disease? How is Crohn's treated? Take this quiz to get the facts about Crohn's.
Crohn's SlideshowWhat is Crohn's disease? Get more information on this digestive disorder and how Crohn's can affect your diet. Learn more about tests to diagnose Crohn's disease, as well as treatments for Crohn's.
Crohns Disease vs Ulcerative Colitis UC
Crohn's disease and ulcerative colitis are diseases that cause inflammation of part of or the entire digestive tract (GI). Crohn's affects the entire GI tract (from the mouth to the anus), while ulcerative colitis or UC only affects the large and small intestine and ilium. Researchers do not know the exact cause of either disease. About 20% of people with Crohn's disease also have a family member with the disease. Researchers believe that certain factors may play a role in causing UC. Both Crohn's disease and ulcerative colitis are a type of inflammatory bowel disease, or IBD.
Crohn's disease and ulcerative colitis both have similar symptoms and signs, for example:
- Loss of appetite
- Weight loss
- Episodic and/or persistent diarrhea
- Abdominal pain and cramping
- Rectal bleeding
- Bloody stools
- Joint pain and soreness
- Eye redness or pain
Symptoms unique to Crohn's disease include:
- Skin changes
Symptoms of unique to ulcerative colitis include:
- Certain rashes
- An urgency to defecate (have a bowel movement)
Doctors diagnose both diseases with similar tests and procedures. While there is no cure for either disease, doctors and other health care professionals can help you treat disease flares, and manage your Crohn's or UC with medication, diet, nutritional supplements, and/or surgery.
CDC. "What is inflammatory bowel disease IBD?" Updated June 21, 2017.
NIH. National Institute of Diabetes and Digestive and Kidney Diseases. "Ulcerative Colitis." September 2014.
NIH. National Institute of Diabetes and Digestive and Kidney Diseases. "Symptoms and Causes of Crohn's Disease." November 2016.
NIH. National Human Genome Research Institute. "Learning About Crohn's Disease." Updated: Sep 27, 2011.
PubMed Health. "Ulcerative Colitis." Accessed Jul 24, 2017.
Drug InteractionsDrug interactions occur frequently. Get facts about the types of drug interactions, what substances or other things that may interact with drugs such as OTC drug and prescription drugs, vitamins, food(s) (grapefruit), and laboratory tests. Find out how to protect yourself from potential drug interactions.
Drugs: What You Should Know About Your DrugsImportant information about your drugs should be reviewed prior to taking any prescription drug. Side effects, drug interactions, warnings and precauctions, dosage, what the drug is used for, what to do if you miss a dose, how the drug is to be stored, and generic vs. brand names.
IBD SlideshowWhat is inflammatory bowel disease? IBD can include Crohn's disease and ulcerative colitis. Learn more about testing, treatments, and the home care needed to manage inflammatory bowel disease.
Inflammatory Bowel Disease: Intestinal ProblemsThe inflammatory bowel diseases (IBD) are Crohn's disease (CD) and ulcerative colitis (UC). The intestinal complications of Crohn's disease and ulcerative colitis differ because of the characteristically dissimilar behaviors of the intestinal inflammation in these two diseases.
Is Colitis Contagious
Colitis is a term that us used to describe inflammation of the colon. The terms enteritis, proctitis, and inflammatory bowel disease (IBD) now include colitis. Colitis has many different causes. Some types of colitis are contagious and some are not contagious. Symptoms of colitis include
- abdominal discomfort,
- pain, and
- blood in the stools.
Treatment for colitis depends on the cause and type of colitis.
Is Crohn's Disease Contagious
Crohn's disease, a form of inflammatory bowel disease (IBD), and is characterized by symptoms and signs that include
- weight loss,
- vomiting, and
- abdominal pain.
Though Crohn's disease is not contagious it can spread throughout a person's gastrointestinal tract. An increase in the above symptoms and signs warrants a visit to a doctor's office.
Lymphocytic ColitisMicroscopic colitis (lymphocytic colitis and collagenous colitis) is a disease of inflammation of the colon. Microscopic colitis is only visible when the colon's lining is examined under a microscope. The cause of microscopic colitis is not known. Symptoms of microscopic colitis are chronic watery diarrhea and abdominal pain or cramps. Microscopic colitis is diagnosed through biopsies of several areas of the colon. There is no standardized treatment for microscopic colitis; however, eliminating NSAIDs, and treatment medications such as Imodium, Lomotil, Petpo-Bismol, Entocort EC, and mesalamine (Asacol) have been helpful in some individuals.
olsalazineOlsalazine (Dipentum) is an oral medication prescribed for maintaining remission of ulcerative colitis who do not tolerate sulfasalazine (Azulfidine). Side effects, drug interactions, and pregnancy safety information should be reviewed prior to taking this drug.
sulfasalazineSulfasalazine (Azulfidine) is a drug prescribed for the treatment of mild to severe ulcerative colitis and the treatment of rheumatoid arthritis. Sulfasalazine (Azulfidine) has also been prescribed "off label" for Crohn's disease and ankylosing spondylitis. Side effects, warnings and precautions, drug interactions, and safety during pregnancy should be reviewed prior to taking this medication.
Ulcerative ColitisUlcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
Ulcerative Colitis QuizWhat is ulcerative colitis and what risks are associated with suffering over the long term? Take this Ulcerative Colitis Quiz to learn causes, symptoms, and treatments for this painful digestive disorder.
Ulcerative Colitis Diet
An ulcerative colitis diet plan can help a person with the disease avoid foods and drinks that trigger flares. There also are foods that can soothe ulcerative colitis symptoms during a flare. Types of ulcerative colitis plans include
- a high-calorie diet,
- a lactose-free diet,
- a low-fat diet,
- a low-fiber diet (low-residue diet), or
- a low-salt diet.
Self-management of ulcerative colitis using healthy lifestyle habits and a nutrient rich diet can be effective in management of the disease. Learn what foods to avoid that aggravate, and what foods help symptoms of the disease and increase bowel inflammation.
Ulcerative ColitisUlcerative Colitis is a form of inflammatory bowel disease and is slightly different than Crohn's disease. Your diet can impact the severity of your symptoms. Learn the causes, symptoms, and treatment options associated with ulcerative colitis.