Colazal vs. Rowasa for Ulcerative Colitis: Important Differences and Potential Risks.

Key takeaways

Balsalazide (Colazal) and mesalamine (Rowasa) are both used to treat ulcerative colitis (UC), but they differ in their forms and how they are administered. Balsalazide is an oral medication that you swallow, while mesalamine is an enema that you insert into your rectum. Balsalazide is typically taken three times a day, whereas mesalamine is used once nightly. Balsalazide can be used in children as young as 5 years old, but mesalamine is only approved for used in adults. Both medications belong to the aminosalicylate class and help reduce inflammation in the colon, but mesalamine's exact mechanism is not fully understood. Balsalazide can cause kidney and liver problems, while mesalamine can cause serious allergic reactions and intolerance syndrome. Both medications are available in generic forms, making them affordable options.

Balsalazide

(Colazal)

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Mesalamine

(Rowasa)

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Summary for Colazal

Prescription only

Balsalazide disodium, also known by the brand name Colazal, is an aminosalicylate. It's a first-choice treatment option for treating mild-to-moderate ulcerative colitis (UC) in people age 5 years and older. Balsalazide (Colazal) is available as 750 mg capsules. The typical dosage for adults is 3 capsules by mouth three times per day. Children can take either 1 or 3 capsules by mouth three times per day. Side effects include stomach pain and diarrhea.

Indications for Colazal

Mild-to-moderate ulcerative colitis (UC) in people age 5 years and older

Pros and Cons for Colazal

Pros

Can start to provide symptom relief after 2 weeks of treatment
Can sprinkle the pill contents onto applesauce if you have trouble swallowing it whole

Cons

Need to take three times per day
Can't take if you're allergic to salicylates, such as aspirin

Common Side Effects for Colazal

Stomach pain (6%)
Diarrhea (5%)
Joint pain (4%)

Warnings for Colazal

Kidney damage
Kidney stones
Acute intolerance syndrome
Allergic reactions
Severe skin reactions
Liver problems
Skin that's sensitive to the sun
Caution in people with gut blockage

Summary for Rowasa

Prescription only

Mesalamine (Rowasa) is an enema that's inserted into the rectum. It's used to treat adults with an inflammatory bowel condition known as ulcerative colitis (UC). This medication belongs to the drug class called aminosalicylates, and it works to lower swelling and inflammation in your colon (gut). The usual dosage is one enema inserted rectally every day at bedtime. Side effects include stomach cramps, gas, and headache. Mesalamine (Rowasa) is available as both a brand-name and generic medication.

Indications for Rowasa

Certain types of ulcerative colitis (UC), including proctosigmoiditis and proctitis

Pros and Cons for Rowasa

Pros

Works directly in your colon to lower swelling
Good alternative if you have trouble swallowing pills
Available as a lower-cost generic medication
Comes in a sulfite-free version (sfRowasa)

Cons

Can be uncomfortable or difficult to use for some people
Can cause unpleasant side effects, such as stomach pain, gas, nausea , and headache
Interacts with many medications, such as azathioprine (Imuran) and mercaptopurine (Purinethol)
Not approved for use in children