Medicines

Mesalazine suppositories 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 suppositories

Brand names: Asacol®, Pentasa® Salofalk®

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

Why is it important for my child to take mesalazine suppositories?

In inflammatory bowel diseases, parts of the colon (large intestine), small intestine, rectum (back passage) and anus become inflamed (red and swollen) and ulcers (sores) 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.

Depending on which parts of the bowel are inflamed, mesalazine can be given by mouth (orally) as tablets or granules, or into the rectum by enema or suppositories. Your doctor may recommend both oral and rectal mesalazine. 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 suppositories available as?

Suppositories (solid): 250 mg, 500 mg, 1 g

When should I give mesalazine suppositories

Mesalazine suppositories may be given once, twice or three times a day, depending on which brand your child has. The medicine label will tell you how often to give it to your child.

Once each day: this is usually at bedtime.

Twice a day: give one dose 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.

Three times a day: give one dose with breakfast, one early in the afternoon and one at bedtime. Ideally, these times are at least 4 hours apart.

Give the medicine 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 suppositories?

Suppositories

Suppositories are administered through the anus into the rectum.

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

If your child empties their bowels (does a poo) within 15 minutes of inserting a suppository, you will need to insert a new one.

  • Your child should be lying on their left side or front.
  • Unwrap the suppository and hold it with the rounded end close to the back passage.
  • Use one finger to push the suppository gently into the back passage. It needs to go in by about 2 cm. (You can use lubricating gel to make insertion more comfortable.)
  • Your child should stay lying down on their left side for at least 15 minutes, and ideally for an hour, to allow the suppository to spread further inside the bowel.

Suppositories must not be taken by mouth.

When should the medicine start working?

Mesalazine 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 your child normally has one suppository each day

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

If your child normally has two suppositories each day

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

If your child normally has three suppositories each day

Do not insert the missed suppository. Just do the next 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). 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

If your child is short of breath or is wheezing, or their face, lips or tongue start to swell, or they develop a rash, they may be allergic to mesalazine suppositories. Take your child to hospital or phone for an ambulance straight away.

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 inserting a suppository, 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 suppositories. 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 www.mhra.gov.uk/yellowcard

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

  • 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 a suppository, give them plenty of water to drink and contact your doctor straight way or take the person to hospital. Take the medicine pack with you so that the doctors know what has been swallowed.

Suppositories are administered through the anus into the rectum and must not be taken by mouth - see 'How To Give Rectal Medicines' leaflet on the Medicines for Children website for more information. 

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.
  • 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 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.

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.

Who to contact for more information?

Your doctor, pharmacist or nurse will be able to give you more information about mesalazine suppositories 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.