Mesalamine (Rectal)

Overview

Mesalamine is a medication used in the treatment of inflammatory bowel disease, such as ulcerative colitis. These suppositories are used in the treatment of moderate and mild active inflammation of the rectum (ulcerative proctitis.) They work inside the intestines to help reduce the level of inflammation and other symptoms associated with the condition.

You cannot obtain this medication on its own. It is only available via a prescription from a doctor.

This drug is available in the dosage forms of:

  • Enema

Conditions treated

  • Ulceration of the Rectum

Type of medication

  • Enema

Side effects

Alongside the effects that are intended from this drug, its consumption could cause unwanted side effects and whilst not all of these may be present, if they do occur, you may need to seek medical advice.

You should obtain advice from a healthcare professional if you suffer from any of the following side effects whilst taking this drug:

Less common or rare

  • Chest pain, possibly moving to the neck, left arm, or shoulder

Incidence not known

  • High fever

The severity of side effects range significantly and usually many don't require medical attention as once your body starts adjusting to the medication, they begin to disappear. If you are finding the side effects bothersome in your daily life, then your doctor may be able to suggest advice on ways to reduce the intensity of these effects. It's important to let your healthcare team know if any of the following side effects that are listed below begin to linger or become bothersome.

More common

  • Stomach or abdominal pain or cramps

Less common

  • Rectal irritation or pain

It is possible that you could suffer from other side effects that are not listed about. It's best to seek medical advice if you notice anything unusual after taking this medication.

Dosage

Your final dose of Mesalamine will depend upon different factors. Your healthcare team will consider your age, weight, and height, other medical conditions you may suffer from any other medications you are currently taking. They will also consider the duration of your treatment, the strength of your medication and your response to the first dose. It's important not to change your dose without speaking with your doctor beforehand.

The rectal dosage form for treatment of proctitis or ulcerative colitis in enema form.

Adults: Four grams should be given each night for three to six weeks.

Children: The final dose and use will be determined by a doctor.

For rectal dosage in suppository form:

Adults: A dose of 1000 milligrams should be inserted into your rectum once daily at bedtime for three to six weeks.

Children: The final dose and use must be determined by your doctor.

Missed Dose

If you miss a dose of Mesalamine, you need to take it as soon as you remember. This is unless it's almost time for your next dose. In this instance, you should skip the missed dose and return to the original dosing schedule that was set by your healthcare team.

Proper Use

You should use this medication exactly as has been directed for by your healthcare team. Don't use it more frequently, for a longer period of time or a higher dose than ordered.

This medication comes alongside a patient information insert. You should follow and read these instructions carefully. Speak with your doctor if you've got any questions.

Keep using this medication for the full time of treatment, even if you start to feel better after a couple of days. Don't skip any doses.

To obtain the best results from this medication, you should empty your bowel just before you use the suppository or rectal enema.

If you are using the enema:

This medication usually comes with specific directions. You should ensure you read these carefully before you use this medication.

First, remove the bottles from the protective foil pouch, and be cautious not to puncture or squeeze them. The enema is a tan to an off-white color. The contents held within the enemas may darken with time once removed from the foil pouch. However, if you have any enemas with dark brown contents, they need to be disposed of.

Shake your bottle well to ensure that the medication is mixed thoroughly. You need to remove the cover that is protecting the applicator tip. You should hold the bottle at the neck so that you ensure no medication will spill out.

You need to lie on your left side with your left leg straight and your right knee bent in front of you. You could also lie in the knee-chest position if you wish.

Next, gently insert the rectal tip of the applicator pointed slightly towards your naval to help lessen damage to the rectal wall. You need to then tilt the nozzle toward the back slightly and slowly squeeze to cause the enema to flow into your rectum.If you use steady pressure, this will discharge most of the medication. After administration, withdraw and dispose of the bottle.

Remain in this position for at least thirty minutes to allow the medication to distribute thoroughly. Retain the medication all night if you can.

If you are using the suppository:

You should always avoid taking rectal suppositories via the mouth.

Remove a suppository from the strip of suppositories supplied. Next, hold suppository upright and remove the foil wrapper carefully.

Before inserting a suppository, you need to go to the bathroom and pee and, if possible, exercise a bowel movement.

This medication can stain any surface it touches (eg, bedsheets, clothing, floors, countertops, etc.). To help protect these items and clothing, consider wearing an adult undergarment such as Depend® or sanitary napkin. Protect sheets by using a waterproof pad on the bed. These pads often called underpads or Chux® pads are easily available from a medical supply store.

Wash your hands with water and soap before and after you use this medication. You should remove the wrapper or foil from the suppository before you insert it.

Don't keep the suppository in your hand for a long period of time or it could melt.

To help make the insertion of the suppository easier, you can use a lubricating gel, but don't use petroleum jelly.

Insert suppository fully into rectum with gentle pressure.

The medication needs to remain in your body for one to three hours or longer, depending on the advice given from your healthcare team. Avoid using the bathroom for at least that period of time after inserting the suppository.

Interactions

Drug interactions can occur with this medication which could produce serious effects. To help avoid these interactions, your doctor needs to know about all other medical conditions and medications you are taking. This will include all vitamin supplements, herbal products and prescription and nonprescription medications. Make you sure disclose everything you are taking to ensure it is safe for you to take this medication.

The use of this medication is not typically recommended with any of the following, but in some cases, it may be necessary. If you are given both medications together, your doctor may alter the dose or frequency in which you use either medication.

  • Rofecoxib

The use of this medication alongside any of the following could increase your risk of side effects. If you are given both medications your doctor may change the dose or frequency in which you use either drug.Despite the side effects, this may be the best treatment plan for you.

  • Warfarin

Let your doctor know if you are taking any of the following medications:

  • Metformin / repaglinide

Other Medical Problems

The presence of other medical conditions could affect the use of this drug. Ensure you tell your doctor if you have any other medical conditions especially:

  • Kidney disease, or history of

Warnings

Before you commit to taking this medication, there are a number of important factors to consider. Below are some things to take into consideration alongside the advice of your doctor to decide whether this is the best form of treatment for you.

Allergies

It's important to let your doctor know if you have ever suffered from an allergic reaction to this medication or similar medications. You should also make them aware of any other allergies you suffer from including to animals, dyes, preservatives, or foods. This drug can interact with allergies to salicylates, sulfasalazine or saturated vegetable fat.

Pediatric population

Appropriate studies have not been conducted on the relationship of age to the effects of this drug in the pediatric population. Therefore efficacy and safety have not yet been established.

Geriatric population

Appropriate studies conducted to date have not indicated a geriatric-specific problem that could limit the effectiveness of this drug in the elderly. However, older patients are more likely to have blood problems (eg, pancytopenia or neutropenia) and age-related kidney disease, which could require a degree of caution and an adjustment in the dose for those who are receiving mesalamine.

Use in pregnancy and breastfeeding

It is unknown whether this medication can harm an unborn child. You should let your doctor know if you are currently pregnant or intend on becoming pregnant.

This drug can pass into breast milk and could potentially harm a nursing child. You should let your doctor know if you are breastfeeding a child.

It's important that your doctor monitors your progress at regular appointments. This will allow them to see if this medication is working correctly and to decide whether you should continue using it. Blood or urine tests may be required to test for unwanted effects.

Check with your doctor immediately if you have a decreased amount of urine, bloody urine, side or lower back pain, swelling of the fingers, face, or lower legs, or unusual weakness or tiredness. These could be signs of problems with your kidneys.

Check with your doctor immediately if you suffer from stomach or abdominal pain, cramps, bloody diarrhea, fever, headache, or a rash while you are using this medication. These may be signs of a condition that is known as mesalamine-induced acute intolerance syndrome.

Let your doctor know immediately if you suffer from trouble breathing or chest pain.

Seek advice from a doctor immediately if you have tenderness or pain in the upper stomach, dark urine, loss of appetite, vomiting, pale stools, nausea, or yellow skin or eyes. These could be signs of a serious liver problem.

Check with your doctor right away if you notice blistering, rectal bleeding, pain, itching, burning or other signs of irritation that are not present before you started using this medication.

Mesalamine can stain fabrics, clothing, flooring, painted surfaces, granite, marble, vinyl, enamel, or other surfaces it touches. Take necessary precautions.

Before you take any medical tests, you need to let your doctor know that you are using this medication as it could affect the results of some medical tests.

Storage

Ensure you keep this medication out of the reach of children. Don't keep any medication you no longer require or has passed its expiry date. You can ask your doctor for advice on the best method of disposal for these medications.

You can store the suppositories in the refrigerator, but don't freeze them.

Make sure the enema is stored at room temperature, away from moisture, heat, and direct light. Do not let this medication freeze.

Summary

When used as directed, this medication is successful in the treatment of mild to moderate ulcerative colitis. Since there are a number of interactions possible, it's important that you disclose all medications you are currently taking to your healthcare team. If this isn't the appropriate medication for your treatment, your doctor can prescribe you another. The safety and efficacy of this drug have not been established for the use in children. It's unknown whether this drug can harm an unborn child. It's important to let your doctor know if you are currently pregnant. This drug can pass into breastmilk, so it's best to avoid breastfeeding whilst pregnant. Let your doctor know if you have been breastfeeding. In order to obtain the maximum benefit from this medication, you need to take it each day and not miss any doses. Try to take it at the same time every day to help remember. This medication can stain all surfaces it touches, so take the necessary precautions to prevent damage. You need to tell your doctor if your condition persists or worsens. Do not share this medication with anyone else. If you require any further information about the practical uses of this medication, or you have further questions, you can contact your doctor or healthcare team for more information.