Mesalazine suppositories or enema

Sounds like 'me-SAL-a-zeen'

Mesalazine suppositories or enemas are used to treat inflammatory bowel conditions such as ulcerative colitis in the rectum (called proctitis). Mesalazine is also called Asacol or Pentasa.

What is mesalazine suppositories or enema?

Mesalazine suppositories or enemas are used to treat inflammatory bowel conditions such as ulcerative colitis in the rectum (called proctitis). Mesalazine suppositories or enemas are given rectally (through the bottom) to treat inflammation in the rectum or lower bowel. It allows the damaged areas to heal and helps to prevent symptoms from flaring up. 

Note: Mesalazine is also available as tablets and granules. Read more about mesalazine tablets and granules.

Dose of suppositories and enema

In Aotearoa New Zealand there are different brands of mesalazine. The dose is different depending on the brand you are taking.  

  • Asacol suppositories (500 mg): The usual dose for adults is 1–2 suppositories up to 3 times daily.
  • Pentasa suppositories (1 gram)The usual dose for adults is 1–2 suppositories daily.
  • Pentasa enema: The usual dose for adults is 1 enema daily, at night.

How to use suppositories

Mesalazine suppositories are available as Asacol (500 mg) or Pentasa (1 gram). The dose will be different for different people depending on your condition. 

Your healthcare provider will explain how to use the suppositories. The following is a guide.

  • Use mesalazine suppositories at the same times each day. 
  • It is best to have a bowel motion (poo) before using mesalazine suppositories. The suppositories work better if the bowel is empty.
  • It is important to put them in correctly. Your doctor, pharmacist, or nurse can explain how to use the suppositories. As a guide:
    • Wash your hands and remove the wrapper or foil around the suppository. 
    • Lie on your side, with your knees up. Put the suppository as far as possible into the rectum with the pointed end first. 
  • Stay lying down for a few minutes after insertion to help retain the suppository. If the suppository comes out within 10 minutes, a new one should be inserted.

How to use Pentasa enema

  • Use the Pentasa enema at night.
  • It is best to have a bowel motion (poo) first. 
  • It is important to use it correctly. Your doctor, pharmacist, or nurse will explain how to use it. As a guide:
    • Wash your hands and remove the enema from the foil packet.  
    • Shake the enema bottle. To open, twist the top around (360°). You can put water soluble lubricating jelly on the tip. 
    • Lie on your left side with your left leg out straight and right leg bent forward for balance. Carefully put the tip of the enema into the rectum and squeeze the bottle to empty slowly over 30–40 seconds. When the bottle is empty take it out. Stay on your side for 5–10 minutes or you can stay in bed until the next morning.
  • A small amount of leakage may occur after use of the enema or suppository. It may be useful to wear protective clothing and/or use fluid absorbing pads in your underwear. This leakage is normal, but try to resist the urge to empty your bowels. Even if you retain just some of the enema the medicine will still work.

Possible side effects of mesalazine

Like all medicines, mesalazine can cause side effects, but not everyone gets them. Often side effects improve as your body gets used to the new medicine. 

Side effects What should I do?
  • Tummy pain
  • Feeling nauseous (sick) or being sick (vomiting)
  • Gas or wind in the tummy or feeling bloated
  • Diarrhoea (runny poo)
  • Discomfort, pain or itching in the anus or rectum
  • These are quite common when you first start mesalazine, and usually go away with time.
  • Tell your doctor if they bother you.
  • Signs of problems with your liver such as severe tummy pain, yellowing of the eyes and skin, dark urine.
  • Tell your doctor immediately or ring Healthline 0800 611 116.
  • Signs of problems with your blood cells such as bruising or bleeding easily, ongoing sore throat, mouth ulcers, dizziness, feeling tired and fever.
  • Tell your doctor immediately or ring Healthline 0800 611 116.
  • Signs of an allergic reaction such as skin rash, itching, blisters, peeling skin, swelling of the face, lips, mouth or breathing problems
  • Tell your doctor immediately or ring Healthline 0800 611 116.

For more information on side effects, see the Medsafe consumer information leaflets below. 

Did you know that you can report a medicine side effect to the Centre for Adverse Reactions Monitoring (CARM)? Report a side effect to a product.

Learn more

The following links have more information on mesalazine enemas and suppositories.

Mesalazine NZ Formulary 
Asacol suppositories Medsafe Consumer Information Sheet, NZ
Pentasa suppositories  Medsafe Consumer Information Sheet, NZ
Pentasa enema Medsafe Consumer Information Sheet, NZ

References

  1. Mesalazine NZ Formulary
  2. Asacol® Medsafe, NZ
  3. Pentasa®  Medsafe, NZ
Credits: Health Navigator Pharmacists. Reviewed By: Maya Patel, MPharm PGDipClinPharm, Auckland Last reviewed: 18 Jan 2022