Mesalazine - Brand names: Asacol, Mezavant, Octasa, Pentasa, Salofalk, Zintasa

Mesalazine is used to treat ulcerative colitis and Crohn's disease and other types of inflammatory bowel disease.

It belongs to a group of medicines called aminosalicylates. These help to reduce redness and swelling (inflammation) and can help with healing.

Some people take mesalazine together with steroids.

Mesalazine is only available on prescription. It comes as:

• tablets
• granules
• rectal foam
• suppositories
• enemas

• Different brands of mesalazine tablets and granules work on different parts of your gut. Rectal foam, suppositories or enemas are prescribed for the lower part of your gut.
• Once you and your doctor find a brand of mesalazine that works for you, it's usually best to stick to the same one.
• When your symptoms are under control you can usually go onto a lower dose.
• Common side effects of mesalazine include upset stomach, and muscle aches and pains.
• One very rare side effect can be problems with your blood. Tell your doctor immediately if you get unexplained bleeding, bruising or red or purple marks on your skin, or if you have a sore throat, high temperature or feel generally unwell.

Adults and children aged 5 years and older can take mesalazine.

Mesalazine may not be suitable for some people. To make sure it's safe for you, tell a pharmacist or doctor before taking or using it if you:

• have ever had an allergic reaction to mesalazine, aspirin, or any other salicylates such as methylsalicylate or choline salicylate
• have ever had an allergic reaction to any other medicine
• have any problems with your kidneys or liver
• have a rare blood condition called porphyria
• are trying to get pregnant, already pregnant, or breastfeeding

Always follow the instructions from a pharmacist or doctor, or the leaflet that comes with your medicine.

Dosage

Your dose will depend on why you need it and on the type and brand of mesalazine that your doctor has prescribed for you. It also depends on whether you are taking it for a short or long time.

For children, the dose may be lower, and it is calculated according to their weight.

How to take tablets and granules

You will either take the tablets or granules once a day, or as 2 or 3 smaller doses throughout the day.

Swallow the tablets whole with a drink of water or juice. Do not break, chew or crush them. This is because some tablets have a special coating to delay when they start to work, or to protect the medicine from the acids in your stomach.

For granules, open the sachet and tip the granules onto your tongue. Swallow them whole with a drink of water or juice. Do not chew them, as some granules have a special coating.

You can take some brands with food. Check the leaflet that comes with your medicine.

If you're also taking indigestion medicines or remedies, leave a 2 hour gap before and after taking mesalazine. Indigestion treatments can affect how well the medicine works.

How to use suppositories

Your doctor or pharmacist will tell you how many suppositories to use each day. Some types you use once a day before you go to bed, and others you use several times a day with the last dose before you go to bed. Use them after you do a poo.

1. Wash your hands before and after using the suppository. Also clean around your bottom (anus) with mild soap and water, rinse and pat dry.
2. Unwrap the suppository.
3. Gently push the suppository into your anus with the pointed end first. It needs to go in about 3 centimetres (1 inch).
4. Sit or lie still for about 15 minutes. The suppository will start to soften, as it melts with your body heat. This is normal.

Try not to do a poo for at least an hour after using a suppository. This gives the medicine time to work.

How to use enemas

You will usually use mesalazine enemas once a day before you go to bed.

Use the enema after doing a poo. This is because the medicine works best when your bowels are empty.

1. Wash your hands before and after using the enema.
2. Lie on your side, with your bottom slightly higher than the rest of your body. You can use a pillow to lift your bottom up. You may want to lie on a towel.
3. Put one of the disposable plastic bags provided over your hand (like a glove) and pick up the bottle.
4. Shake the bottle.
5. Break the seal on the nozzle, or remove the protective cap.
6. Gently push the nozzle into your bottom (anus) as far as is comfortable.
7. Squeeze the bottle steadily to allow the liquid to empty into your anus quite quickly. This takes about 30 to 40 seconds. It's normal for some liquid to be left in the bottle afterwards.
8. Remove the nozzle from your bottom.
9. Peel the disposable plastic bag off your hand and use it to cover the bottle, ready to throw away.
10. Roll onto your front and wait for 5 minutes. This will stop any liquid coming out of your bottom.
11. For sleeping, find a comfortable position that keeps the liquid in your bottom for as long as possible. The longer it stays there, the better it will work.

How to use rectal foam

You will usually use mesalazine rectal foam once a day before you go to bed. The dose is 2 full applicators.

Use the rectal foam after doing a poo. This is because the medicine works best when your bowels are empty.

After you apply the foam, try not to poo again until the next morning. For the medicine to work properly it needs to stay inside your bowel as long as possible.

First read the instruction leaflet. The pictures show you exactly how to use the foam.

Before using it for the first time, remove the plastic flap (or safety lock) from underneath the dome-shaped pump at the top of the can.

1. Wash your hands before and after using the foam.
2. Push a new applicator onto the nozzle. This nozzle sticks out beneath the dome at the top of the can.
3. Shake the can for about 20 seconds.
4. There is a rounded gap at the base of the dome. Twist the dome until the gap lines up with the nozzle.
5. Put your finger on top of the dome and turn the can upside down. The spray will only work properly if you hold the can with the dome pointing straight down.
6. Either stand with one leg raised on a chair, or lie down on your side with your lower leg stretched out and upper leg bent.
7. Gently put the tip of the applicator into your anus as far as possible. You may want to use a lubricating jelly on the tip of the applicator.
8. Push the dome down. This fills the applicator with a dose of foam.
9. Release the dome very slowly, to push the foam out.
10. Wait 10 to 15 seconds and then slowly remove the applicator from your bottom. Do this slowly to prevent the foam coming out.
11. Remove the applicator from the nozzle. Put it in the plastic bag provided and throw the bag away (with your normal household rubbish).

Repeat from step 1 using a new applicator, so that you use 2 full applicators of foam.

Will my dose go up or down?

Once your symptoms start to get better, it's likely that your dose will be reduced. This lower dose is sometimes called a maintenance dose.

Your doctor may want to increase your dose if your symptoms start to get worse again.

What if I forget to take it?

If you miss a dose of mesalazine, take it as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed one and take the next dose at the usual time.

Do not take 2 doses together to make up for a forgotten dose.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

Taking too much mesalazine as a one-off is unlikely to cause problems.

Like all medicines, mesalazine can cause side effects, but not everyone gets them.

The higher the dose of mesalazine that you take, the greater the chance of side effects.

Common side effects

Common side effects happen in more than 1 in 100 people. Your risk of getting a particular side effect varies, depending on whether you are prescribed tablets, granules, suppositories, foam or enemas.

Keep taking the medicine, but tell your doctor if these side effects bother you or do not go away:

• indigestion, stomach pain or wind
• feeling or being sick (nausea or vomiting)
• diarrhoea
• headaches, muscle aches and pains

Serious side effects

Serious side effects are rare and happen in less than 1 in 1,000 people.

Tell your doctor straight away if you get:

• any unexplained bleeding, an unexplained sore throat or high temperature, bruising, red or purple marks on your skin (these may be less obvious on black or brown skin), or if you feel generally unwell during the treatment – these can be signs of problems with your blood
• a high temperature, chills, a sore throat, ear or sinus pain, a cough, pain when peeing, mouth sores or a wound that will not heal – these can be signs of an infection
• a change in the colour of your pee or the amount you pee – these can be signs of kidney problems
• chest pain, a faster heartbeat or feeling more tired than usual – these can be signs of heart problems
• yellowing of your eyes or skin (this may be less obvious on black or brown skin), dark pee, stomach pain, high temperature, feeling tired or feeling sick – these can be signs of liver problems
• back or stomach pain, fever, feeling sick or being sick – these can be signs of an inflamed pancreas

Serious allergic reaction

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to mesalazine.

These are not all the side effects of mesalazine. For a full list, see the leaflet inside your medicines packet.

What to do about:

• indigestion, stomach pain or wind – try not to eat foods that cause wind (like lentils, peas, beans and onions). Eat smaller meals, and eat and drink slowly. Putting a heat pad or covered hot water bottle on your stomach may also help with stomach pain.
• feeling or being sick – stick to simple meals and do not eat rich or spicy food. Check the instructions that come with your medicine to see if you can take it after you've eaten. If you're being sick, try having small, frequent sips of water or squash to avoid dehydration. Do not take any other medicines to treat vomiting without speaking to a pharmacist or doctor.
• diarrhoea – drink plenty of fluids, such as water or squash, to avoid dehydration. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.
• headaches, muscle aches and pains – drink plenty of water and ask your pharmacist to recommend a suitable painkiller. Tell your doctor if the aches continue despite taking painkillers or if they last for more than a few days.

Mesalazine and pregnancy

You may be advised to continue using mesalazine during pregnancy to make sure that your inflammatory bowel disease remains well controlled. There's no evidence that taking mesalazine in pregnancy harms your baby.

If you become pregnant while taking mesalazine, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.

Your doctor can explain the risks and benefits of taking mesalazine and will help you choose the best treatment for you and your baby.

Mesalazine and breastfeeding

If your doctor or health visitor says your baby is healthy, then it's usually OK to take mesalazine while breastfeeding.

Small amounts of mesalazine pass into breast milk, and are unlikely to cause any side effects in your baby. Many people have taken mesalazine while breastfeeding without any problems, although there have been some rare cases of diarrhoea in babies.

Tell your midwife, health visitor, pharmacist or doctor as soon as possible if you notice your baby is not feeding as well as usual, or has diarrhoea, or if you have any other concerns about your baby.

There are some medicines that affect the way mesalazine works. Tell a pharmacist or doctor if you are taking:

• medicines that make your poo more acidic, like the laxative lactulose
• medicines that affect the way your kidneys work, such as azathioprine, mercaptopurine or thioquanine, and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen
• certain medicines that help to prevent blood clots, like warfarin

Mixing mesalazine with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements while taking or using mesalazine. Ask a pharmacist for advice.