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Rowasa vs. Sulfasalazine

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Rowasa (mesalamine) and Azulfidine (sulfasalazine) are both used to treat ulcerative colitis (UC), but they have some key differences. Rowasa is an enema that you insert rectally, while Azulfidine is an oral tablet. Rowasa works directly in your colon to reduce inflammation, but it can cause discomfort during use and has a risk of allergic reactions, especially if you're sensitive to sulfites. Azulfidine, on the other hand, is also used to treat rheumatoid arthritis (RA) and can be taken by children 6 years and older. It breaks down in your body into chemicals that help reduce inflammation, but it can cause stomach issues like nausea and vomiting. Both medications are available as lower-cost generics, but Azulfidine might require regular blood tests to monitor your liver, kidneys, and blood counts. Additionally, Azulfidine can lower sperm count, which is reversible after stopping the medication.

Mesalamine

(Rowasa)

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Sulfasalazine

(Azulfidine)

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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

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

Common Side Effects for Rowasa

  • Stomach pain, cramps, or discomfort (8%)
  • Headache (7%)
  • Gas (6%)
  • Nausea (6%)
  • Flu-like symptoms (5%)

Warnings for Rowasa

  • Serious allergic reactions and serious skin reactions
  • Kidney problems
  • Liver problems
  • Acute intolerance syndrome

Summary for Sulfasalazine

Prescription only

Sulfasalazine (Azulfidine) is an anti-inflammatory medication that comes in immediate-release and delayed-release tablets. Both formulations are used to treat ulcerative colitis (UC). The delayed-release tablets can also be used for rheumatoid arthritis (RA). Adults and children 6 years and older can take sulfasalazine (Azulfidine). It's best to split your total daily dose into a few smaller doses throughout the day. This medication can commonly cause stomach problems, such as nausea and indigestion, as side effects.

Indications for Sulfasalazine

  • Ulcerative colitis (UC) - immediate-release and delayed release tablets
  • Rheumatoid arthritis (RA) - delayed-release tablets only
  • Polyarticular juvenile rheumatoid arthritis - delayed-release tablets only

Pros and Cons for Sulfasalazine

Pros

  • Available as a lower-cost generic medication
  • Safe to take for children 6 years and older
  • Available as immediate-release and delayed-release tablets
  • Delayed-release tablets helpful for people with bothersome stomach upset from the medication

Cons

  • Can cause side effects like nausea, vomiting, and stomach upset
  • Might cause low sperm count
  • Might require regular blood work and lab tests to make sure your liver, kidneys, and blood counts are healthy and normal
  • Might not be safe for people with allergies to sulfa drugs, aspirin, or other salicylates

Common Side Effects for Sulfasalazine

For UC:

  • Nausea (33%)
  • Vomiting (33%)
  • Stomach upset (belly pain and cramping; 33%)
  • Low appetite (33%)
  • Headache (33%)

For RA (delayed-release tablets only):

  • Nausea (19%)
  • Indigestion (13%)
  • Headache (9%)
  • Belly pain (8%)
  • Vomiting (8%)
  • Fever (5%)

Warnings for Sulfasalazine

  • Risk of liver, kidney, and blood problems
  • Low sperm count
  • Serious infections
  • Severe skin and allergic reactions

Prices with our coupons for Rowasa vs. Sulfasalazine

Price Card Drug Icon
Mesalamine4 kits / 7 bottles and wipes of 4g/60ml
$171.14$707.89
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Price Card Drug Icon
Sulfasalazine120 tablets / 500mg
$18.95$61.00
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