mesalamine
Mesalamine (Canasa) is an aminosalicylate that's used to treat adults with ulcerative proctitis (inflammation of the rectum from ulcerative colitis). Mesalamine (Canasa) is a suppository that's inserted into the rectum at bedtime for 3 to 6 weeks. Side effects aren't common, but they can include dizziness and rectal pain. Mesalamine (Canasa) also has some safety warnings, like a risk for kidney stones and serious skin reactions.
What is Mesalamine (Canasa)?
What is Mesalamine (Canasa) used for?
Mild-to-moderate ulcerative proctitis (inflammation of the rectum caused by ulcerative colitis)
How Mesalamine (Canasa) works
Mesalamine (Canasa) is an aminosalicylate. The exact way the medication works isn't well understood. But it's thought to block certain proteins and chemicals in the gut that typically cause inflammation from turning on. This might help lessen inflammation in the gut.
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What are the side effects of Mesalamine (Canasa)?
Common Side Effects
- Dizziness (3%)
- Pain in rectum (2%)
Other Side Effects
- Fever
- Rash
- Acne
- Inflammation in colon (leading to possible diarrhea)
Serious Side Effects
- Kidney damage: urinating less often than usual; dry and itchy skin; muscle cramps; swelling in your feet, ankles, or hands
- Kidney stone: difficulty urinating, bloody urine, fever, chills, back or side pain
- Liver problems: stomach bloating, right-sided stomach pain, yellowing of your skin or the whites of your eyes, dark urine
- Serious allergic reactions: hives, swelling of the lips or tongue, difficulty breathing
- Serious skin reactions: hives, blisters, peeling skin, skin reddening, fever, sore throat, swollen lymph nodes
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Dry cough, shortness of breath or trouble breathing
- Heart muscle inflammation—unusual weakness or fatigue, shortness of breath, chest pain, fast or irregular heartbeat, dizziness, swelling of the ankles, feet, or hands
- Kidney injury—decrease in the amount of urine, swelling of the ankles, hands, or feet
- Kidney stones—blood in the urine, pain or trouble passing urine, pain in the lower back or sides
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Mesalamine intolerance syndrome—stomach pain or cramping, bloody diarrhea, nausea, vomiting, headache, muscle pain, fever, rash
- Rash, fever, and swollen lymph nodes
- Redness, blistering, peeling, or loosening of the skin, including inside the mouth
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Diarrhea
- Headache
- Nausea
- Runny or stuffy nose
- Sensitivity to light
- Sore throat
- Stomach pain
Pros and cons of Mesalamine (Canasa)
Pros
Works directly in your rectum to lower swelling and treat ulcers there
Good alternative if you have trouble swallowing pills
Available as a lower-cost generic medication
Cons
Can be uncomfortable or difficult to use for some people
Must keep inserted in the rectum for at least 1 to 3 hours
Might cause unpleasant side effects, such as rectal pain and dizziness
Pharmacist tips for Mesalamine (Canasa)
Place mesalamine (Canasa) into the rectum only. Don't put the medication into your mouth or any other area of your body. Also, don't cut, split, or break the suppository because this can affect how much medication you get and how well it'll work.
Make sure you know how to insert mesalamine (Canasa) into the rectum. This helps lessen the risk of accidentally hurting yourself or wasting the medication. Ask your care team or pharmacist if you have questions about how to insert the suppository.
It's best to use mesalamine (Canasa) at bedtime. You'll have the greatest effect from the medication if you leave the suppository in your rectum all night while you're sleeping. At a minimum, you should leave it in your rectum for at least 1 to 3 hours.
Drink plenty of fluids while you're taking mesalamine (Canasa). Staying hydrated lessens your risk for kidney stones during treatment with mesalamine (Canasa).
While you're taking mesalamine (Canasa), it's normal for your urine to look reddish-brown when it comes in contact with surfaces or water that's been treated certain types of bleach. But it's not normal for the urine leaving your body to be a reddish-brown color before it hits the toilet; contact your prescriber if you see this.
Mesalamine (Canasa) suppositories can stain items made from fabric, such as clothing or linens. The suppositories can also stain floors, painted surfaces, and any hard surfaces made from marble, granite, or vinyl. Avoid letting mesalamine (Canasa) touch these surfaces to prevent staining.
Share an up-to-date medication list with your care team and pharmacist so they can check that your medications are safe to take together. Mesalamine (Canasa) can interact with a few medications. For example, taking mesalamine (Canasa) with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) can put you at high risk for kidney problems because they can both harm the kidneys.
Speak with your healthcare team about the risks and benefits of taking mesalamine (Canasa) if you're pregnant. It's not clear whether this medication can raise the risk for complications to your pregnancy or for harm to your baby.
Discuss with your healthcare team about the risks and benefits of breastfeeding while you're taking mesalamine (Canasa). It's generally safe to nurse during treatment, but some babies have had diarrhea after they were breastfed by people who were taking mesalamine (Canasa).
Store mesalamine (Canasa) suppositories at room temperature up to 77 degrees Fahrenheit. You can also keep the suppositories in the refrigerator. Keep them away from direct heat, light, or moisture.
Frequently asked questions about Mesalamine (Canasa)
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What are the risks and warnings for Mesalamine (Canasa)?
Mesalamine (Canasa) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Kidney damage and kidney stones
Risk factors: Kidney problems | Taking other medications that can cause kidney problems
Mesalamine (Canasa) can sometimes damage your kidneys. Your risk for kidney damage is higher if you already have kidney problems or if you take medications that can harm the kidneys, like nonsteroidal anti-inflammatory drugs (NSAIDs) and diuretics (water pills). You might need blood work or urine tests done every so often so your prescriber can check your kidney function. Call your care team if you have any signs or symptoms of kidney problems, including changes in your need to urinate, tiredness, low appetite, and muscle cramps.
Some people who use mesalamine (Canasa) can also get kidney stones. Make sure to stay hydrated each day while you're taking this medication to prevent kidney stones. Tell your prescriber if you have difficulty urinating, have a fever or chills, have blood in the urine, or feel back or side pain. These can be signs of a kidney stone.
Acute intolerance syndrome
Although rare, some people who take mesalamine (Canasa) can have a reaction to the medication called acute intolerance syndrome. If it does happen, it typically occurs 1 to 3 weeks after starting mesalamine (Canasa). And it usually goes away within a few days after stopping mesalamine (Canasa) or after starting corticosteroid treatment.
Symptoms of acute intolerance syndrome can be hard to tell apart from a flareup of ulcerative colitis (UC). Let your prescriber know if you have symptoms like stomach cramping or pain, bloody diarrhea, and sometimes fever, headache, and rash. You might need to stop treatment with mesalamine (Canasa) to help these symptoms go away.
Severe allergic reactions
Severe allergic reactions to mesalamine (Canasa) are possible, including life-threatening reactions like facial swelling, shock, and anaphylaxis (e.g., closing of the throat). Call 911 right away if you notice hives, rash, swelling of the lips or tongue, or difficulty breathing after you use mesalamine (Canasa).
Severe skin reactions
Mesalamine medications can cause rare but serious skin reactions, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Stop taking mesalamine (Canasa) and get medical attention as soon as possible if you notice unusual changes in your skin, such as rash, blisters, peeling skin, or skin reddening. Skin reactions can sometimes come along with fever, sore throat, fatigue, and swollen lymph nodes, so keep an eye out for these symptoms as well.
Liver problems
Risk factors: History of liver problems
Some people with liver problems had liver failure when they took medications containing mesalamine. Let your prescriber know if you have a history of liver problems before you start taking this medication so they can weigh the risks and benefits of treatment. Get medical help right away if you notice severe nausea, vomiting, right-sided stomach pain, fatigue, low or no appetite, or yellowing of the skin or eyes while you're taking mesalamine (Canasa). These can be signs of liver damage.
Skin that's sensitive to sun and light
Risk factors: Skin problems (e.g., eczema)
People with skin problems like eczema who take mesalamine (Canasa) are at higher risk of having skin that's more sensitive to the sun or ultraviolet (UV) light. This means that they can get sunburns more easily than usual, even during the winter and on overcast days.
To lower your risk for sunburn, make sure to wear sunscreen and wear long-sleeved clothing to protect your skin when you're outside. Also avoid being exposed to the sun for too long (find shade if possible) and avoid too much exposure to UV light (e.g., tanning beds).
Mesalamine (Canasa) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 1000mg | 30 suppositories | $1124.39 | $37.48 |
Typical dosing for Mesalamine (Canasa)
The typical dose is 1 suppository (1,000 mg of mesalamine) inserted into the rectum once every night at bedtime for 3 to 6 weeks.
How much does Mesalamine (Canasa) cost?
Mesalamine (Canasa) contraindications
Allergy to aspirin or other salicylates
What are alternatives to Mesalamine (Canasa)?
Mild-to-moderate ulcerative proctitis (inflammation of the rectum caused by ulcerative colitis)
Certain types of ulcerative colitis (UC), including proctosigmoiditis and proctitis
Mesalamine (Canasa) images
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References
Best studies we foundAllergan, Inc. (2024). Canasa- mesalamine suppository [package insert]. DailyMed.
Crohn’s & Colitis Foundation. (n.d.). Malnutrition and IBD.
Drugs and Lactation Database (LactMed®). (2024). Mesalamine. National Institute of Child Health.
Feuerstein, J. D., et al. (2020). AGA Clinical Practice Guidelines on the management of moderate to severe ulcerative colitis. Gastroenterology.
Iacucci, M., et al. (2010). Mesalazine in inflammatory bowel disease: A trendy topic once again? Canadian Journal of Gastroenterology.
Mikami, Y., et al. (2023). Significance of 5-aminosalicylic acid intolerance in the clinical management of ulcerative colitis. Digestion.
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Definition & facts for proctitis.
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Symptoms & causes of proctitis.
National Kidney Foundation. (2020). 10 signs you may have kidney disease.
National Kidney Foundation. (2023). Tests to check your kidney health.
Si, Y., et al. (2021). Suppository treatment in ulcerative proctitis. European Journal of Inflammation.
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