Aminosalicylates (5-ASAs)

Reviewed by: HU Medical Review Board | Last reviewed: August 2023

Inflammatory bowel disease (IBD), which includes both Crohn's disease and ulcerative colitis, is a condition of long-term (chronic) inflammation of the digestive tract. While there is currently no cure for IBD, there are medications that can:1

  • Help to treat and manage the symptoms of active IBD during flare-ups
  • Help to keep IBD in remission, and increase the time between flare-ups
  • Improve the individual's quality of life

What are aminosalicylates?

People living with IBD frequently experience symptoms caused by inflammation in the digestive tract, such as diarrhea and abdominal pain. One type of treatment for IBD is a class of drugs called “anti-inflammatories,” which reduce inflammation in the body. Aminosalicylates are special type of anti-inflammatory drug.2,3

Aminosalicylates are often prescribed to people with IBD, although they are especially effective in treating ulcerative colitis. They contain 5-aminosalicylic acid, which is called “5-ASA” for short. 5-ASA can help to reduce inflammation in the digestive tract by working directly on the lining of the bowel of the digestive tract.3

What kinds of aminosalicylates are used to treat inflammatory bowel disease?

The type of aminosalicylate medicine used to treat IBD symptoms depends upon the location and severity of the person’s disease.1,2,4 Some patients may need to take other types of medications, such as antibiotics, alongside aminosalicylates.

Types of aminosalicylates used to treat people with IBD include:

  • Sulfasalazine (brand name: Azulfidine, Azulfidine-EN)
  • Mesalamine (brand names: Asacol, Pentasa, Apriso, Lialda, Delzicol, Asacol HD, Rowasa, Canasa)
  • Balsalazide (brand names: Colazal)
  • Olsalazine (brand name: Dipentium)

Sulfasalazine, balsalazide and olsalazine are all oral medications that work in different ways to reduce inflammation in the large intestine (colon). Mesalamine is available in various oral and rectal forms, each of which targets different parts of the digestive tract.

How do people with inflammatory bowel disease usually take aminosalicylate medicines?

People can take aminosalicylate medicines by mouth (orally) or into the rectum (rectally).3 Healthcare providers will advise patients about which type of delivery may be the most effective for treating their specific symptoms.

Oral aminosalicylate medicines, taken by mouth in a pill or tablet, are available with various types of coatings. The different types of coating affect where the medication is released along the digestive tract, in order to more effectively treat specific kinds of symptoms.

Taking the medicine rectally can be effective for some patients with IBD, because it allows the person to receive a high dose of 5-ASA directly where the medication is needed. This also avoids delivering the medicine to other parts of the body that do not need it. This is an especially useful for treating patients with IBD who have more inflammation in the rectum and/or lower intestines.3

Patients who take aminosalicylate medicines rectally can do so in two different ways: using a suppository, or using an enema. Suppositories are inserted directly into the rectum once or twice daily, depending on the dosage the patient has been prescribed. 5-ASA suppositories can decrease inflammation in the lower intestine and rectum.

An enema is a liquid substance that passes through a small tube inserted into a patient’s rectum. The liquid then travels into the left colon. Medication that is taken using an enema can reach higher up into the intestinal tract than a suppository can.

What are common side effects of aminosalicylate medicines?

Some patients experience unpleasant side effects from taking aminosalicylate medicines.3 Patients should let their healthcare providers know if they experience side effects that are severe or that do not go away, such as:

  • Headache
  • Rash
  • Nausea
  • Abdominal pain
  • Vomiting
  • Fever
  • Diarrhea

In a very small number of patients, some types of 5-ASA medicines have been linked to pancreas and kidney problems. For this reason, patients with known conditions that affect those organs are usually advised to choose other forms of treatment for their IBD. Patients taking 5-ASA medicines should be monitored regularly by their healthcare providers to check for side effects.3

These are not all the possible side effects of aminosalicylates. Patients should talk to their doctor about what to expect with treatment with aminosalicylates.

It is important for patients to talk with healthcare providers about all potential treatment options and their side effects before choosing an IBD treatment. Patients should be sure to let their healthcare providers know about any and all medications or supplements that they are currently taking, because some drug interactions can have dangerous side effects.

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