Rowasa Side Effects
Generic Name: mesalamine
Note: This page contains side effects data for the generic drug mesalamine. It is possible that some of the dosage forms included below may not apply to the brand name Rowasa.
It is possible that some side effects of Rowasa may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to mesalamine: oral capsule delayed release, oral capsule extended release, oral tablet, oral tablet delayed release, oral tablet enteric coated
Other dosage forms:
As well as its needed effects, mesalamine (the active ingredient contained in Rowasa) may cause unwanted side effects that require medical attention.
If any of the following side effects occur while taking mesalamine, check with your doctor immediately:More common
- Abdominal or stomach pain (severe)
- bloody diarrhea
- rectal bleeding
- Abdominal or stomach cramps (severe)
- blurred vision
- full or bloated feeling
- headache (severe)
- pounding in the ears
- pressure in the stomach
- skin rash and itching
- slow or fast heartbeat
- swelling of the abdominal or stomach area
- unusual tiredness or weakness
- back pain (severe)
- blue or pale skin
- chest pain, possibly moving to the left arm, neck, or shoulder
- nausea or vomiting
- shortness of breath
- yellow eyes or skin
Some mesalamine side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:More common
- Abdominal or stomach cramps or pain (mild)
- diarrhea (mild)
- headache (mild)
- runny or stuffy nose
- Acid or sour stomach
- back or joint pain
- difficulty with moving
- excess air or gas in the stomach or intestines
- hair loss or thinning of the hair
- loss of appetite
- muscle pain or stiffness
- passing gas
- stomach discomfort or upset
For Healthcare Professionals
Applies to mesalamine: compounding powder, oral capsule extended release, oral delayed release capsule, oral delayed release tablet, rectal enema, rectal kit, rectal suppository
Colitis symptoms (including cramping, acute abdominal pain, and bloody diarrhea, and occasionally fever, headache, malaise, pruritus, rash, and conjunctivitis) have been exacerbated after starting mesalamine (the active ingredient contained in Rowasa) or sulfasalazine in 3% of patients in controlled clinical trials. This acute intolerance syndrome may be difficult to distinguish from a flare of inflammatory bowel disease.
Worsening of colitis or symptoms of inflammatory bowel disease, including melena and hematochezia, have also been reported after commencing mesalamine rectal suspension enema.
Very common (10% or more): Abdominal pain (up to 18%), eructation (up to 16%), nausea (up to 13%)
Common (1% to 10%): Diarrhea (up to 8%), dyspepsia (up to 6%), ulcerative colitis (up to 5.8%), vomiting (up to 5%), constipation (up to 5%), upper abdominal pain (up to 5%), gastrointestinal bleeding (up to 5% or greater), flatulence (up to 5% or greater), acute intolerance syndrome (3%), colitis exacerbation (up to 3%), lower abdominal pain (less than 3%), rectal hemorrhage (less than 3%), gastroenteritis (2% or greater), gastrointestinal hemorrhage (2% or greater), stool abnormalities (color or texture change; up to 2% or greater), tenesmus (up to 2% or greater), rectal disorder (2% or greater), abdominal enlargement (up to 2% or greater), abdominal distention (up to 1.3%)
Rare (less than 0.1%): Colitis, pancreatitis, rectal polyp, duodenal ulcer, esophageal ulcer, dysphagia, fecal incontinence, oral moniliasis, thirst, recurrence of ulcerative colitis, gastritis, stomatitis, perforated peptic ulcer
Frequency not reported: Worsening of colitis or symptoms of inflammatory bowel disease (including melena and hematochezia), elevated amylase, elevated lipase
Postmarketing reports: Pancreatitis, gastritis, dry mouth, oral ulcers, gastroenteritis, gastrointestinal bleeding, perforated peptic ulcer, bloody diarrhea, taste perversion
Very common (10% or more): Headache (up to 35%)
Common (1% to 10%): Dizziness (up to 8%), lightheadedness (8%), faintness (8%), tinnitus (less than 3%), vertigo (less than 3%), migraine (2% or greater), paresthesia (up to 2% or greater), insomnia (up to 2%)
Rare (less than 0.1%): Benign intracranial hypertension (at least 1 case)
Postmarketing reports: Systemic lupus erythematosus, peripheral neuropathy, Guillain-Barre syndrome, transverse myelitis, somnolence, tremor, hyperesthesia, tinnitus, vertigo
A 23-year-old female with ulcerative colitis who had been taking 400 mg mesalamine tablets three times a day developed benign intracranial hypertension. The examination disclosed benign intracranial hypertension that resolved when mesalamine was discontinued and recurred when the drug was restarted.
Very common (10% or more): Muscle aches (21%)
Common (1% to 10%): Back pain (up to 7%), arthralgia (up to 5% or greater), hypertonia (5%), myalgia (up to 3%), joint disorder (2% or greater), arthritis (2%)
Frequency not reported: Leg cramps, rheumatoid arthritis
Postmarketing reports: Gout, myalgia
A 72-year-old female with ulcerative colitis who had begun taking two 400 mg mesalamine (the active ingredient contained in Rowasa) tablets twice daily experienced pleural effusion and pulmonary infiltrates. Chest radiograph showed bilateral pleural effusions and an infiltrate in the lower lobe of the right lung. It was determined that the adverse events described appeared likely to be due to mesalamine therapy.
Pleural effusion and pulmonary infiltrates, generally accompanied by eosinophilia, have been reported rarely. More severe cases have included fibrosing alveolitis.
Very common (10% or more): Nasopharyngitis (up to 11%)
Common (1% to 10%): Rhinitis (up to 9%), influenza and influenza-like illness (up to 5% or greater), sinusitis (3%), dyspnea (less than 3%), bronchitis (2% or greater), increased cough (2%)
Rare (less than 0.1%): Pleural effusion, pulmonary infiltrates, fibrosing alveolitis
Postmarketing reports: Eosinophilic pneumonia, interstitial pneumonitis, asthma exacerbation, pleuritis, pneumonitis, hypersensitivity pneumonitis, allergic alveolitis
Common (1% to 10%): Chest pain of unknown etiology (3%), vasodilation (up to 2% or greater)
Uncommon (0.1% to 1%): Hypertension (up to 1%)
Rare (less than 0.1%): Tachycardia, hypotension, palpitations, pericarditis, pericardial effusion, myocarditis, T-wave abnormalities, severe symptomatic sinus bradycardia (at least 1 case), pleuropericarditis (at least 1 case)
Postmarketing reports: Angioedema, myocarditis, pericardial effusion, pericarditis
One 20-year-old patient died of cardiac arrhythmias attributed to myocarditis 13 days after starting mesalamine.
A 56-year-old male with hypertension and ulcerative proctitis experienced pleuropericarditis coincident with mesalamine therapy. Evaluation revealed acute pleuropericarditis manifested by ECG changes, pericardial effusion, and a small pleural effusion. All symptoms resolved when mesalamine was discontinued.
Very common (10% or more): Pain (in various parts of the body; up to 14%)
Common (1% to 10%): Asthenia (up to 7%), fever (up to 6%), chills (3%), peripheral edema (3%), fatigue (up to 3%), ear disorder (2% or greater), infection (2% or greater), malaise (2%)
Frequency not reported: Pyrexia, pharyngolaryngeal pain, ear pain, ear congestion
Postmarketing reports: Lupus-like syndrome, drug fever, neck pain, facial edema, edema
Common (1% to 10%): Rash (up to 7%), sweating (up to 3%), pruritus (up to 3%), alopecia (less than 3%), acne (up to 2%)
Rare (less than 0.1%): Lupus erythematosus-like reactions, prurigo, eczema, lichen planus, nail disorder, photosensitivity, folliculitis
Postmarketing reports: Psoriasis, alopecia, pyoderma gangrenosum, dry skin, erythema nodosum, urticaria, Stevens-Johnson syndrome
Common (1% to 10%): Decreased hematocrit and hemoglobin (less than 3%)
Rare (less than 0.1%): Agranulocytosis, aplastic anemia
Frequency not reported: Neutropenia, pancytopenia, ecchymosis, thrombocythemia, decreased platelet count
Postmarketing reports: Granulocytopenia, agranulocytosis, aplastic anemia, thrombocytopenia, eosinophilia, leukopenia, anemia, lymphadenopathy
Common (1% to 10%): Rash and pruritus (greater than 2%); arthralgias, myalgias, and fever (greater than 1%)
Uncommon (0.1% to 1%): Allergic reactions (which could involve eosinophilia), hepatitis, interstitial pneumonitis, pericarditis
Rare (less than 0.1%): Hypersensitivity reactions (such as hypersensitivity pneumonitis, angioedema, erythroderma, toxic epidermal necrolysis, palmar-plantar erythrodysesthesia, hypereosinophilia), pruriginous rash (at least 2 cases)
Frequency not reported: Mesalamine-induced cardiac hypersensitivity reactions (myocarditis and pericarditis)
Postmarketing reports: Anaphylactic reaction, drug reaction with eosinophilia and systemic symptoms (DRESS)
A male patient with ulcerative colitis experienced pruriginous rash coincident with mesalamine therapy. He experienced the cutaneous hypersensitivity reaction 48 hours after initiating therapy with mesalamine 500 mg orally every 8 hours. After mesalamine was suspended and antihistamines were given, the patient recovered. Upon reintroduction of mesalamine, the symptoms appeared again 24 hours later.
Common (1% to 10%): Cholestatic hepatitis (less than 3%), elevated transaminases (less than 3%), abnormal liver function test (up to 2.3%)
Rare (less than 0.1%): Granulomatous hepatitis (at least 1 case)
Frequency not reported: Hepatitis (presenting with rash, fever, abdominal pain, nausea, vomiting, chills, dizziness, hepatomegaly, lymphadenopathy, and laboratory abnormalities [including elevated liver function tests, eosinophilia, and leukocytosis]), hepatic impairment, jaundice, cholestatic jaundice, cirrhosis, liver necrosis, liver failure, Kawasaki-like syndrome (including changes in liver enzymes), transient elevations in liver function tests, hypersensitivity hepatitis, hepatic failure
Postmarketing reports: Elevated AST (SGOT) or ALT (SGPT), elevated gamma-glutamyltransferase, elevated bilirubin, hepatitis, jaundice, cholecystitis, cholestatic jaundice, liver necrosis, liver failure, Kawasaki-like syndrome (including changes in liver enzymes)
A 42-year-old male with ulcerative colitis was admitted for investigation of prolonged fever associated with cholestatic liver tests. Endoscopic retrograde cholangiopancreatography demonstrated a normal biliary tree, and liver biopsy showed granulomata. The symptoms disappeared after cessation of mesalamine therapy and recurred on rechallenge.
Hypersensitivity hepatitis associated with mesalamine appears to occur less commonly than with sulfasalazine.
Hepatic failure has been reported in patients with preexisting liver disease.
Renal impairment (including minimal change nephropathy, acute and chronic interstitial nephritis, and, rarely, renal failure) has been reported with products that contain mesalamine (the active ingredient contained in Rowasa) or are converted to mesalamine.
Renal tubular dysfunction has been reported, although a definitive causality has not been established.
Common (1% to 10%): Decreased creatinine clearance (less than 3%)
Frequency not reported: Nephrogenic diabetes insipidus, nephrotic syndrome, renal impairment, renal tubular dysfunction
Postmarketing reports: Renal failure, interstitial nephritis, minimal change nephropathy, elevated blood urea nitrogen, elevated serum creatinine
Common (1% to 10%): Dysmenorrhea (3%), hematuria (less than 3%), urinary frequency (2% or greater)
Rare (less than 0.1%): Oligospermia, infertility in men
Frequency not reported: Albuminuria, amenorrhea, breast pain, hypomenorrhea, metrorrhagia, urinary burning
Postmarketing reports: Dysuria, urinary urgency, hematuria, epididymitis, menorrhagia, reversible oligospermia
Rarely, oligospermia and infertility in men have been reported and have been attributed to sulfasalazine.
Common (1% to 10%): Anxiety (2% or greater), nervousness (2% or greater)
Frequency not reported: Lethargy, mild disorientation, decreased libido
Postmarketing reports: Depression, emotional lability, confusion
Common (1% to 10%): Elevated triglycerides (less than 3%)
Postmarketing reports: Anorexia, increased appetite, elevated alkaline phosphatase, elevated lactate dehydrogenase
Common (1% to 10%): Vision abnormalities (2% or greater), conjunctivitis (up to 2%)
Postmarketing reports: Eye pain, blurred vision
Rectal suspension enemas:
Common (1% to 10%): Pain on insertion of enema tip (1.35%), hemorrhoids (1.35%), rectal pain (1.23%)
Uncommon (0.1% to 1%): Rectal pain/soreness/burning (0.61%)
Frequency not reported: Perianal irritation
More about Rowasa (mesalamine)
Related treatment guides
Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. This information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.com does not assume any responsibility for any aspect of healthcare administered with the aid of materials provided. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the substances you are taking, check with your doctor, nurse, or pharmacist.