Mesalazine liquid enema for inflammatory bowel disease

Name of medicine

Mesalazine liquid enema

Brand names: Asacol®, Salofalk®

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

Why is it important for my child to take mesalazine liquid 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 liquid enema available as?

Pentasa: 1 g in 100 mL

Salofalk: 2 g in 59 mL

When should I give mesalazine liquid enema

Mesalazine liquid enema is usually given once a day. This is usually at bedtime.

Give the enema at about the same time 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.

How should I give mesalazine liquid enema?

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

Ideally your child should open their bowels (do a poo) before you administer the liquid enema. Wash your hands thoroughly with soap and hot water before and after administering the enema.

If your child empties their bowels (does a poo) within 15 minutes of administering the enema, you will need to repeat it.

To prepare Pentasa – shake it well. Break the seal by twisting the nozzle anticlockwise. Use one of the plastic disposal bags like a glove (and use to wrap bag for disposal after use).

To prepare Salofalk – shake the bottle for 30 seconds. Remove the protective cap from the applicator and hold the bottle upright.

To administer the liquid enema:

• Your child should lie on their left side with the left leg straight and the right leg bent forward or kneel with their upper chest and arms resting on a bed.
• Carefully insert the applicator tip as far as is comfortable into the rectum.
• Gently squeeze out the enema liquid. Keep the bottle compressed while removing it from the rectum.
• Your child should remain relaxed in the same position for at least 10 minutes until the urge to open the bowels has passed.

When should the medicine start working?

Mesalazine rectal enema will start working 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 possible, give the enema in the morning, as long as this is at least 12 hours before the evening enema is due. However, if this not convenient, just do the enema as usual at bed time.

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). Have the medicine packet with you if you telephone for advice.

Take your child to hospital if they seem unwell. Take the medicine container or packet with you, even if it is empty. This will be useful to the doctor. 

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

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.

• Your child may get a mild rash or itching when they first start taking mesalazine liquid enema. You can give your child an antihistamine to help. 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 mhra.gov.uk/yellowcard

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

• Your child may find it difficult to keep the enema liquid in place at first, and they may feel that they want to open their bowels 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.
• Be careful not to spill the mesalazine solution, as it can permanently stain clothing and fabrics, flooring, painted surfaces, marble, granite, vinyl, and enamel.

General advice about medicines

• Try to give medicines at about the same times each day, to help you remember.

• 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.

• 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.

• 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.

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.

Who to contact for more information?

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

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.