mesalamine
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.
What is Mesalamine (Rowasa)?
What is Mesalamine (Rowasa) used for?
Certain types of ulcerative colitis (UC), including proctosigmoiditis and proctitis
How Mesalamine (Rowasa) works
Mesalamine (Rowasa) is an aminosalicylate. It's unclear how exactly this medication works. But it's known to block certain chemicals in your gut that cause swelling and inflammation. This might help lessen inflammation in the gut.
Drug Facts
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What are the side effects of Mesalamine (Rowasa)?
Common Side Effects
- Stomach pain, cramps, or discomfort (8%)
- Headache (7%)
- Gas (6%)
- Nausea (6%)
- Flu-like symptoms (5%)
Other Side Effects
- Diarrhea
- Constipation
- Stomach bloating
- Pain, soreness, or burning at rectum
- Leg or joint pain
- Back pain
- Hemorrhoids
- Kidney stones
- Hair loss
- Dizziness
- Tiredness or weakness
- Cold-like symptoms or sore throat
- Fever
- Itching
- Rash or spots on skin
Serious Side Effects
- Allergic reaction: itchy; red rash (hives); shortness of breath; chest tightness; swelling of lips, tongue, face, or eyes
- Serious skin reaction: severe rash, itchy skin, skin pain or redness, blisters, weakness, cough, fever
- Acute intolerance syndrome: stomach pain or cramps, bloody diarrhea, nausea, fever, headache, rash
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 (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
Pharmacist tips for Mesalamine (Rowasa)
Insert mesalamine (Rowasa) only into the rectum as instructed. Don't put the medication in any other areas of your body, such as your mouth.
Drink plenty of water or liquids while you're taking mesalamine (Rowasa). It's possible for this medication to cause kidney stones, and staying hydrated helps prevent stones from forming.
Be sure to wear clothing that protects you from the sun, such as a hat, and wear a broad-spectrum sunscreen when you're outside, even on cloudy or overcast days. This is because mesalamine (Rowasa) can make your skin more sensitive to sunlight and make it easier for you to get sunburns, especially if you have certain skin conditions like eczema.
While you're taking mesalamine (Rowasa), it's normal for your urine to look reddish-brown if it gets onto anything cleaned with certain types of bleach. But if your urine is reddish-brown before it hits the toilet water, call your prescriber that’s not normal.
Mesalamine (Rowasa) can stain items made of fabric, such as clothing or linens. It can also stain floors, painted surfaces, and any hard surfaces made of marble, granite, or vinyl. Use mesalamine (Rowasa) carefully, and be mindful when you're choosing an area of your home to use the medication.
Keep mesalamine (Rowasa) at room temperature in its original foil pouch. The liquid is typically off-white to tan in color, and the pouch protects the medication from darkening. Once you remove bottles from the foil pouch, they might become slightly darker over time, but this doesn't affect how well the medication works. Don't use the enema and throw it away if you see that the liquid is dark brown.
How to use mesalamine (Rowasa)
Before you use mesalamine (Rowasa), go to the bathroom if you need to.
When you're ready, open the foil pouch and take out the enema bottle. Be careful not to squeeze or poke a hole through the bottle.
Shake the bottle well to make sure the medication is completely mixed. Then, take off the cover from the applicator tip. Hold the bottle by its neck to avoid squeezing any medication out. You can apply some lubricant to the bottle tip so it's easier to insert the enema into the rectum.
It's important to get into the correct body position to get the most benefits from mesalamine (Rowasa). Lie down on your left side with your left leg extended out and your right leg bent forward to balance yourself. Another position you can try is the "knee-chest" position (lie forward with your knees on the ground with your buttocks in the air and your chest touching the ground). Refer to your medication guide to see images of both positions.
Slowly and gently insert the bottle tip into your rectum pointing slightly towards your belly button. This helps prevent any damage to the wall inside your rectum.
Once the tip is inside, grab the bottle, aim it towards the back, and slowly and steadily squeeze out the medication. Then, pull out the tip from your rectum.
Stay in the same position for at least 30 minutes to help the medication reach all areas of your colon. Leave the medication in your rectum all night while you're asleep (for about 8 hours) if you can so that the medication works as best as it can.
Frequently asked questions about Mesalamine (Rowasa)
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What are the risks and warnings for Mesalamine (Rowasa)?
Mesalamine (Rowasa) 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.
Serious allergic reactions and serious skin reactions
Risk factors: Allergy to mesalamine (Rowasa) | Allergy to sulfites | History of asthma
It's possible for you to have an allergic reaction to mesalamine (Rowasa). Allergic reactions can be life-threatening. Symptoms can include shortness of breath; chest tightness; and swelling of your face, lips, tongue, or eyes. Some allergic reactions affect the skin and cause hives, itchiness, skin pain, skin redness, blisters, or peeling skin. Stop taking the medication and get emergency medical help right away if you have an allergic reaction.
Kidney problems
Risk factors: History of kidney problems | Taking medications that cause kidney damage | Taking sulfasalazine (Azulfidine)
Let your prescriber know before you start mesalamine (Rowasa) if you have a history of a kidney condition. This medication is removed from your body through the kidneys. When the kidneys don't work as well as they should (in people with kidney damage), the medication can build up in the body and put you at risk for side effects. In addition, some people who took mesalamine (Rowasa) had serious kidney problems and sometimes even kidney failure. Your prescriber can discuss with you the risks and benefits of taking mesalamine (Rowasa).
Your prescriber might perform routine blood tests before you start mesalamine (Rowasa) and also during treatment. These lab results help check your kidney function as you take the medication. Avoid taking mesalamine (Rowasa) with medications that cause kidney damage, such as nonsteroidal anti‑inflammatory drugs (NSAIDs). Examples include ibuprofen (Advil) and naproxen (Aleve).
Liver problems
Risk factors: History of liver problems
People who have a history of liver problems might be at risk for worsening liver function while they're taking medications similar to mesalamine (Rowasa). Let your prescriber know before you start this medication if you have a liver condition. Your prescriber can help weigh the risks and benefits of treatment.
Acute intolerance syndrome
Some people can't tolerate the effects of mesalamine (Rowasa) too well and have a reaction to the medication called acute intolerance syndrome. Symptoms of this reaction can include stomach pain or cramps, bloody diarrhea, fever, headache, or a rash. Keep in mind that these symptoms can sometimes look quite similar to a flare-up of your UC. Stop taking mesalamine (Rowasa) and let your care team know right away if you have worsening stomach cramps and bloody diarrhea.
Mesalamine (Rowasa) dosage forms
Typical dosing for Mesalamine (Rowasa)
Each 60 mL enema contains 4 grams of mesalamine.
The typical dose is 1 enema inserted into your rectum once every day at bedtime.
Interactions between Mesalamine (Rowasa) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Amtolmetin Guacil
- Balsalazide
- Bismuth Subsalicylate
- Bromfenac
- Bufexamac
- Celecoxib
- Choline Magnesium Trisalicylate
- Choline Salicylate
- Clonixin
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Dipyrone
- Droxicam
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ibuprofen
- Indomethacin
- Ketoprofen
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Magnesium Salicylate
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Mercaptopurine
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Olsalazine
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Phenyl Salicylate
- Piketoprofen
- Piroxicam
- Proglumetacin
- Propyphenazone
- Proquazone
- Rofecoxib
- Salicylamide
- Salicylic Acid
- Salsalate
- Sodium Salicylate
- Sulfasalazine
- Sulindac
- Tenoxicam
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Trolamine Salicylate
- Valdecoxib
- Varicella Virus Vaccine, Live
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Tamarind
- Warfarin
How much does Mesalamine (Rowasa) cost?
Mesalamine (Rowasa) contraindications
Allergy to sulfites
Allergy to salicylates, such as aspirin or bismuth subsalicylate (Pepto-Bismol)
What are alternatives to Mesalamine (Rowasa)?
Certain types of ulcerative colitis (UC), including proctosigmoiditis and proctitis
Mild-to-moderate ulcerative proctitis (inflammation of the rectum caused by ulcerative colitis)
Mesalamine (Rowasa) images
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References
Best studies we foundAmerican Academy of Allergy, Asthma, & Immunology. (2024). Sulfite and sulfa drugs.
ANI Pharmaceuticals, Inc. (2024). Mesalamine enema [package insert]. DailyMed.
Crohn’s & Colitis Foundation. (n.d.). Types of ulcerative colitis.
Crohn’s & Colitis Foundation. (2019). Managing flares and IBD symptoms.
Crohn’s and Colitis Foundation of America. (2014). The facts about inflammatory bowel diseases.
Iacucci, M., et al. (2010). Mesalazine in inflammatory bowel disease: A trendy topic once again? Canadian Journal of Gastroenterology.
Meda Pharmaceuticals Inc. (2024). Rowasa- mesalamine suspension [package insert]. DailyMed.
Meda Pharmaceuticals Inc. (2024). SfRowasa sulfite-free formulation- mesalamine suspension [package insert]. DailyMed.
MedlinePlus. (2022). Abdominal bloating.
Mikami, Y., et al. (2023). Significance of 5-aminosalicylic acid intolerance in the clinical management of ulcerative colitis. Digestion.
Nakashima, J., et al. (2024). Mesalamine (USAN). StatPearls.
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Definition & facts for proctitis.
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