Medicines

Mesalazine foam enema for inflammatory bowel disease

This leaflet is for parents and carers about how to use this medicine in children. Our information may differ from that provided by the manufacturers, because their information usually relates to adults. Read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Your child should not have mesalazine if they are allergic to aspirin or other salicylate drugs.

Name of medicine

Mesalazine foam enema

Brand names: Asacol®, Salofalk®

This leaflet is about the use of mesalazine foam enema for Crohn’s disease and ulcerative colitis, which are known as inflammatory bowel diseases. Mesalazine is also available as a liquid enema, suppositories and in oral forms – these are described in separate leaflets available on the Medicines for Children website.

Why is it important for my child to take mesalazine foam enema?

In inflammatory bowel diseases, parts of the large intestine (colon), small intestine, back passage (rectum) and anus become inflamed (red and swollen) and sores (ulcers) may form. This causes symptoms such as diarrhoea, pain, stomach cramps and bleeding from the back passage.

Mesalazine reduces the inflammation in the bowels and so reduces the symptoms. Rectal mesalazine is used to treat the lower parts of the colon and the rectum, which are difficult to treat with oral mesalazine. 

What is mesalazine foam enema available as?

Asacol or Salofalk: 1 g per metered application

When should I give mesalazine foam enema

Mesalazine foam enema is usually given once or twice a day depending on which brand your child has. The medicine label will tell you how often to give it to your child.

Once a day - this is usually at bedtime.

Twice a day - give one enema in the morning and one at bedtime. Ideally, these times are about 12 hours apart, for example some time between 7 and 8 am, and between 7 and 8 pm.

Give the enema at about the same time(s) each day so that this becomes part of your child’s daily routine, which will help you to remember. 

How much should I give?

Your doctor will work out the amount of mesalazine (the dose) that is right for your child. The dose will be shown on the medicine label. 

It is important that you follow your doctor’s instructions about how much to give.

How should I give mesalazine foam enema?

Foam enemas

Enemas have to be administered (given) through the anus into the rectum (back passage or bottom).

Ideally your child should open their bowels (do a poo) before you administer the mesalazine foam enema. If your child does a poo within 15 minutes of administering the enema, you will need to repeat it.

To administer the foam enema:

  • Wash your hands thoroughly with soap and hot water.
  • Remove the safety tag from under the dome. Push a plastic applicator firmly onto the spout of the can and twist the top to align the notch beneath the dome with the spout.
  • Shake the can vigorously for about 20 seconds.
  • Hold the can in the palm of one hand with the dome pointing downwards. The can must be upside down for the foam to come out properly.
  • Your child should stand with one foot up on a firm surface such as a chair.
  • Insert the applicator into the rectum as far as is comfortable. You can put some lubricating gel on the tip of the applicator to help.
  • Push the dome down fully once and then slowly release it – the foam comes out of the can when you release the dome. The dome must be pointing downwards. (To administer a second dose, press and release the dome again.) Keep the applicator in place for 15 seconds before withdrawing it.
  • Remove the applicator, put it in a plastic bag and throw it away with your household rubbish. Do not flush it down the toilet.
  • Wash your hands again with soap and hot water.

The foam must not be taken by mouth.

When should the medicine start working?

Mesalazine foam enema will start to work straight away but it may take a week or so for your child’s symptoms to improve.

What if my child is sick (vomits)?

If your child is sick, you do not need to worry, as the mesalazine will work as normal.

What if I forget to give it?

If you normally give one enema each day

You do not need to wake up a sleeping child to give a missed enema. Give it in the morning, as long as this is at least 12 hours before the evening enema is due. However, if this is not convenient, miss it out and do the next foam enema as usual.

If you normally give two enemas each day

You can give a missed enema if you remember within 4 hours of when you should have given it. For example, if you usually give the enema at about 7 am, you can give the missed enema at any time up to 11 am. If you remember after that time, do not give the missed enema. Wait until the next normal time. You do not need to wake up a sleeping child to give a missed enema. Just give the morning one as usual.

What if I give too much?

It is unlikely that you will do harm if you give your child an extra dose of mesalazine by mistake. If you are worried that you may have given your child too much mesalazine, contact your doctor or NHS Direct (111 in England and Scotland; 111 or 0845 4647 in parts of Wales). 

Are there any possible side effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side effects).

Side effects you must do something about

Contact your doctor straight away if your child has diarrhoea that gets suddenly worse or contains blood, or sudden or severe stomach pain.

Other side-effects you need to know about

  • After using the enema your child may get pain or cramps in their stomach. They may also get itching and discomfort around the anus and rectal area and they may feel that they want to open their bowels frequently. If the problem continues for more than a week or gets worse, contact your doctor.

There may sometimes be other side effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side effects to a UK safety scheme at www.mhra.gov.uk/yellowcard

Can other medicines be given at the same time as mesalazine foam enema?

  • Do not give your child ibuprofen or other medicines called non-steroidal anti-inflammatory drugs.
  • You can give your child medicines that contain paracetamol, unless your doctor has told you not to.
  • Check with your doctor or pharmacist before giving any other medicines to your child. This includes herbal or complementary medicines. 

Is there anything else I need to know about this medicine?

If someone accidentally swallows enema foam, give them plenty of water to drink and contact your doctor straight away or take the person to hospital. Take the medicine or packaging with you so that the doctors know what has been swallowed.

Some enemas may contain sulphites, which are used as preservatives. If your child has asthma or is sensitive to sulphites, they may get an allergic reaction such as rash or shortness of breath. Contact your doctor if you are worried.

  • Your child may find it difficult to keep the enema foam in place at first, and they may feel that they want to open their bowels (do a poo) frequently afterwards. The time that they can keep the enema in place will increase as they get used to it. 
  • Different brands of enema have different formulations. If your child reacts to an ingredient in one, they may get on better with another brand. Discuss this with your doctor or pharmacist.
  • If your doctor changes the brand of mesalazine and you notice that your child’s symptoms are worse or different, discuss this with your doctor. Remember to tell any new doctor or pharmacist the brand name and dose of the medicine your child usually has.

General advice about medicines

  • Try to give medicines at about the same times each day, to help you remember.
  • If you are not sure a medicine is working, contact your doctor but continue to give the medicine as usual in the meantime. Do not give extra doses, as you may do harm.
  • Only give this medicine to your child. Never give it to anyone else, even if their condition appears to be the same, as this could do harm.
  • Make sure that you always have enough medicine. Order a new prescription at least 2 weeks before you will run out.
  • Make sure that the medicines you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

If you think someone else may have taken the medicine by accident, contact your doctor straight away.

Where should I keep this medicine?

  • Keep the medicine in a cupboard, away from heat and direct sunlight.
  • Make sure that children cannot see or reach the medicine.
  • Keep the medicine in the container and packaging it came in.
  • Foam enemas are in a pressurised canister, containing a flammable propellant. They should be kept away from any flames or sparks, including cigarettes, and should be kept out of direct sunlight. They should not be pierced or burned, even when empty.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about mesalazine foam enema and about other medicines used to treat inflammatory bowel disease.

England: NHS 111

Tel 111

www.nhs.uk

Scotland: NHS 24

Northern Ireland: NI Direct

Wales: NHS Direct

Tel 111 (free) or 0845 46 47 (2p per minute)

111.wales.nhs.uk/

Crohn's and Colitis UK

Crohn's in Childhood Research Association (CICRA)

020 8949 6209

www.cicra.org/

Copyright disclaimer

Version [1]. © NPPG, RCPCH and WellChild, all rights reserved. Review by January 2014.

The primary source for the information in this leaflet is the British National Formulary for Children. For details on any other sources used for this leaflet, please contact us through our website, www.medicinesforchildren.org.uk.

We take great care to make sure that the information in this leaflet is correct and up-to-date. However, medicines can be used in different ways for different patients. It is important that you ask the advice of your doctor or pharmacist if you are not sure about something. This leaflet is about the use of these medicines in the UK, and may not apply to other countries. The Royal College of Paediatrics and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG), WellChild and the contributors and editors cannot be held responsible for the accuracy of information, omissions of information, or any actions that may be taken as a consequence of reading this leaflet.