MESALAMINE
5-ASA
Also known as 5-ASAs. Sulfasalazine is the cheapest but because of the sulfa component, it causes more side-effects.
How do I take 5-ASA?
5-ASAs can be taken orally by swallowing a tablet, capsule or granule, or topically through the anus as a suppository or an enema. A combination of oral and rectal treatment is often more effective than one approach alone.
• Tablets and capsules
Many brands of 5-ASAs have a special enteric coating around the tablets to enable the medicine to be released in the right part of the gut. It is therefore important to not chew, cut or crush the tablets, as this will destroy the coating and stop the medicine being released in the right area. A select few brands, such as Pentasa, can be cut but not crushed.
• Suppositories and enemas
Rectal 5-ASAs are used to treat the lower parts of the colon and the rectum, which are harder to treat with oral medication.
Suppositories are small, waxy bullet-shaped capsules of the drug that are inserted through the anus and dissolve at body temperature. Enemas can come in a liquid or foam form, and are put into the rectum through the anus using a specially designed applicator. Foam enemas are often easier to retain than liquid enemas, so they can be particularly useful at the beginning of a flare-up, when the gut is most sensitive. Liquid enemas can usually travel farther along the colon, reaching more of the inflammation.
Taking an enema or suppository can often be quite uncomfortable in the beginning, and take a while to get used to. Don’t be discouraged if it takes a few tries before you’re able to retain the medicine. Read the patient information leaflet that comes with your medicine for instructions on how to administer the treatment.
How long will it take to work?
It can take up to three weeks after starting 5-ASAs to feel the benefits.
How long will I be on 5-ASA?
You will probably be advised to take 5-ASAs long-term (lifelong) to keep your condition under control and reduce the risk of flare-ups. Some people with Crohn's or Colitis have a slightly increased risk of developing colon cancer, and there is some evidence that using 5-ASAs long-term can decrease this risk.
What are the most likely side effects on 5-ASA?
Like all drugs, 5-ASAs can have side effects which include:
• Nausea, vomiting, and watery diarrhea
• Headache and indigestion
• Mild allergic reactions with rash, itchiness and fever
Rarely, 5-ASAs can cause problems with the kidneys, liver, lungs and pancreas.
Can I have immunisations while on 5-ASA?
It is safe to have vaccinations whilst on 5-ASAs.
Can I take other medicines along with 5-ASA?
Most other drugs can be taken safely, however always check with your pharmacist first.
Can I drink alcohol while taking 5-ASA?
Alcohol is not known to have any interaction with 5-ASAs.
Do 5-ASAS affect fertility?
Sulfasalazine can cause male infertility by reducing the sperm count, but this usually resolves within two to three months once the drug is stopped. If you are trying for a baby, you may be switched to a different brand, as other 5-ASAs do not affect fertility.
Can I take 5-ASA while pregnant or breastfeeding?
5-ASA drugs are mostly considered safe to take while pregnant and breastfeeding. Studies have found no increased risks of birth defects, low birth weight or similar complications in the babies of people taking 5-ASAs.
While 5-ASAs can be taken if you are breastfeeding, small amounts do pass into breast milk. Infants of breastfeeding mothers using 5-ASA can in very rare cases develop diarrhea due to allergic reactions, so should be carefully monitored. This resolves itself once the drug is stopped or the baby starts bottle feeding.
If you are taking sulfasalazine while pregnant, you should also take a folic acid supplement daily, as the medicine causes folate deficiency.
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