Gastroenterology: Medications

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All About Rowasa

Many patients are not as well informed about prescription medications as they ought to be. We believe the more you know about your medications, the better. This leaflet has been written to help you understand more about what ROWASA is and the importance of taking it properly. If any of the information in this leaflet causes you special concern or if you want additional information about ROWASA and its use, check with your doctor or pharmacist.

Remember to keep all prescription drugs out of reach and sight of children when not in use. Store ROWASA in a cool dry place in its original labeled container. Always read the label before using.

What is ROWASA?

Introduced in 1990, ROWASA is a synthetic compound that is administered rectally to treat inflammatory conditions of the rectum and lower colon including ulcerative colitis and ulcerative proctitis. It is sometimes given with other medications for this purpose - such as the steroid, prednisone.

Mesalamine (mess-AL-am-een) is the chemical name for this drug. It is still under protected patent and not yet available in a generic form. It comes in two forms - a 4 gm. enema solution and a 500 mg. rectal suppository.

What ROWASA is not.

ROWASA is not habit forming. It does not cause drowsiness. Men should know that ROWASA does not decrease their sperm count as does Azulfidine. It does not affect the desire or ability to perform sexually.

Taking ROWASA properly

    1. Empty your bowels before taking ROWASA. Do not use ROWASA before a bowel movement since this would push out the medication. It is best to empty your bowels before inserting the medication.

    2. Take your ROWASA enema as prescribed at bedtime. The enema is usually best taken once daily at bedtime. Shake it well before using. Then lie on your left side in bed. Remove the protective cap and gently insert the pre-lubricated tip into the rectum. Gently squeeze the bottle until all the solution has been infused. Remove and discard the bottle. Remain on your left side for at least 30 minutes to allow to medication to disperse within your lower colon. Have a pleasant night's sleep.

    3. If using ROWASA suppositories, take them twice daily. The suppository form is usually taken twice daily. Take one dose in the morning after your bowel movement and the other at bedtime. Simply remove the protective foil and insert the suppository deeply into your rectum.

    4. Do not expel the medication. Unlike cleansing enemas and suppositories used to treat constipation, ROWASA is meant to be retained after insertion. If possible do not expel the solution. For maximum benefit, it is best to retain the enema all night. Retain each suppository until it is time for the next dose. At first this may be difficult, but as the inflammation within the rectum improves, the sensation of rectal urgency should diminish.

    4. Do not miss doses. If you do miss a dose, take your normal dose of ROWASA as soon as you remember and resume your normal schedule with the following dose. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

    5. Do not stop taking this medication on your own. ROWASA is prescribed for treatment of inflammatory bowel disease. There is no danger in stopping this medication suddenly, but stopping the medication too soon may flare up the intestinal inflammation and make you ill. Only do this under your doctor's supervision.

What are the side effects?

All medicines - even those purchased without a prescription - may sometimes produce unwanted side effects. In general, the frequency of serious side effects from ROWASA has been quite low. This is mainly because of the rectal route of administration. Medications taken by mouth have to travel through the entire blood stream to reach the rectum and lower colon. But since ROWASA is applied directly to the diseased area of the colon, much lower doses are required. Still, it is important that you keep all your appointments with your doctor so that he can be sure the medication is working and check for possible side effects.

These side effects should be reported to your doctor:

  • Skin rash, severe itching
  • Unexplained fever
  • Unusual bleeding or bruising
  • Unexplained skin blistering and peeling
  • Chest pain, shortness of breath
The following side effects usually do not require medical attention. They often will go away as your body becomes used to the medication. However, if they continue or are bothersome, check with your doctor:
  • Headache
  • Nausea
  • Mild abdominal cramping
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor, nurse, or pharmacist.

You can help limit side effects by taking the medication exactly as prescribed and promptly reporting any problems to your doctor. Drink plenty of fluids when diarrhea is active to prevent dehydration.


Tell your doctor if you are breast-feeding, pregnant or plan to become pregnant in the near future. Low dose ROWASA can be used in pregnancy, if necessary. However, we feel it is best to avoid all potent prescription drugs during pregnancy whenever possible.

Be sure your doctor knows if you have kidney disease, or if you have had a severe allergic reaction to aspirin, such as severe rash or wheezing.


ROWASA is a powerful drug with many helpful properties, but as with all medications, side effects may occur. You can best limit problems with this medication by taking it exactly as prescribed. If you have any questions or concerns, jot them down and discuss them with your doctor.


Text & Images Courtesy of Three Rivers Endoscopy Center
© Dr. Robert Fusco, Three Rivers Endoscopy Center, All Rights Reserved

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