Canasa (mesalamine) is a suppository used to treat a type of inflammatory bowel disease called ulcerative proctitis. Ulcerative proctitis causes inflammation, redness and ulcers to develop in the lining of the rectum, which is at the end of your large intestine. Ulcerative proctitis may also affect nearby parts of the colon.

Canasa contains the medication mesalamine, which is also known as mesalazine or 5-aminosalicylic acid (5-ASA). It is contained inside a base of hard fat. Canasa is used topically and is inserted into the rectum. As the warmth of your body melts the hard fat base, the drug is released into the area where it needs to work.

Canasa belongs to a class of drugs called aminosalicylates. Canasa is thought to work by reducing inflammation in the epithelial cells that line the colon. Its anti-inflammatory action may result from its ability to block the enzyme cyclooxygenase (COX) and inhibit prostaglandin production in the colon. COX and prostaglandins (a group of lipids) are both involved in generating an inflammatory response.

Medications containing mesalamine have been available for many years, however, Canasa was first approved by the US Food and Drug Administration (FDA) in 2001.

When Canasa was first approved it was available as a 500 mg strength suppository that needed to be used twice a day. This has been replaced by a 1000 mg strength suppository that only needs to be used at night. Generic versions of Canasa are also available.

What is Canasa used for?

Canasa is a prescription medicine used to treat adults with active ulcerative proctitis (ulcerative rectal colitis).

It is not known if Canasa is safe and effective in children.

Important information

Canasa is for rectal use only. Do not take Canasa by mouth.

Who should not use Canasa?

Do not use Canasa if your are:

• allergic to medicines that contain salicylates, including aspirin.
• allergic to mesalamine or any of the ingredients in Canasa. See below for a complete list of ingredients in Canasa.

Ask your doctor if you are not sure if your medicine is listed above.

What should I tell my doctor before using Canasa?

Before using Canasa, tell your doctor if you have any medical conditions, including if you:

• have a history of allergic reaction to the medicine sulfasalazine (Azulfidine).
• have kidney problems.
• have ever had inflammation of the sac around your heart (pericarditis).
• have liver problems.

How should I use Canasa?

• Use Canasa exactly as prescribed by your doctor. Your doctor will tell you how long to continue using Canasa.
• Canasa comes as a suppository that you insert into your rectum.
• Do not cut or break the suppository.
• Use Canasa 1 time each day at bedtime, for 3 to 6 weeks. It is not known if Canasa is safe and effective for use for longer than 6 weeks.
• After you insert Canasa in your rectum, try to keep (retain) the suppository in your rectum for 1 to 3 hours or longer if possible.
• It is important for you to stay well hydrated during treatment with Canasa. Be sure to drink plenty of fluids while taking Canasa.

What happens if I miss a dose?

If you miss a dose of Canasa, insert it as soon as you remember. If it is almost time for your next dose, skip the missed dose. Insert the next dose at your regular time. Do not insert 2 doses at the same time.

What should I avoid while using Canasa?

Canasa can stain surfaces including clothing and other fabrics, flooring, painted surfaces, marble, granite, vinyl and enamel. Keep Canasa away from these surfaces to prevent staining.

If you have atopic dermatitis or eczema you may become more sensitive to the sun while using Canasa. Avoid sun exposure, wear protective clothing, and use a broad-spectrum sunscreen when outdoors.

Dosing information

The recommended dose of Canasa for adults is 1000 mg administered rectally once daily at bedtime for 3 to 6 weeks. Safety and effectiveness beyond 6 weeks have not been established.

See full prescribing information for more information about Canasa dosing.

What are the side effects of Canasa?

Canasa may cause serious side effects, including:

• kidney problems. Your doctor will do certain tests before you start using Canasa and during your treatment with Canasa.
• acute intolerance syndrome and other allergic reactions. Some people who use Canasa can have allergic type reactions, including Acute Intolerance Syndrome. Other allergic reactions can cause heart problems including an inflammation of the sac around the heart (pericarditis), blood problems, and problems with other organs in the body including the kidneys, liver and lungs. These problems usually happen in people who have had an allergic reaction to medicines containing sulfasalazine. Stop using Canasa and tell your doctor right away if you get any of these symptoms:
  • cramps
  • fever
  • stomach (abdominal) pain
  • headache
  • bloody diarrhea
  • rash
  • chest pain
  • shortness of breath
  • decrease in the amount of urine
  • fatigue
  • eye inflammation
• liver problems. This can happen in people who have a history of liver problems and have taken other medicines that contain mesalamine. Tell your doctor right away if you get any of these symptoms while using Canasa:
  • yellowing of your eyes
  • flu-like symptoms
  • itchy skin
  • nausea or vomiting
  • feeling very tired
• serious skin reactions. Some people who use Canasa can have severe skin reactions. Stop using Canasa and tell your doctor right away if you develop any of the following signs or symptoms of a severe skin reaction, including:
  • blisters or peeling of your skin
  • mouth sores
  • blisters on your lips, or around your mouth or eyes
  • high fever or flu-like symptoms
  • enlarged lymph nodes
  • skin rash
• sun sensitivity. Canasa can make your skin sensitive to the sun if you have skin conditions such as atopic dermatitis and atopic eczema. Try to limit your time in the sun. You should use sunscreen and wear a hat and clothes that cover your skin if you have to be in the sunlight.
• kidney stones. Drink plenty of fluids when using Canasa to decrease your chance of getting kidney stones. Call your doctor right away if you get any of these symptoms:
  • severe pain in your side
  • severe pain in your back
  • blood in your urine

The most common side effects of Canasa include:

• dizziness
• rectal pain
• acne
• fever
• inflammation of the large intestine (colitis)
• rash

These are not all of the possible side effects of Canasa.

Interactions

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements.

Using Canasa with certain other medicines may affect each other. Using Canasa with other medicines can cause serious side effects.

Especially tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDS), or medicines that contain azathioprine or 6-mercaptopurine. Taking Canasa with NSAIDS may cause kidney problems. Taking Canasa with azathioprine or 6-mercaptopurine may cause blood problems. Ask your doctor if you are not sure if you are taking one of these medicines.

Your doctor may do certain tests during treatment with Canasa.

Know the medicines you take. Keep a list of them to show your doctor and pharmacist when you get a new medicine.

Pregnancy and breastfeeding

Tell your doctor if you are pregnant or plan to become pregnant. It is not known if Canasa can harm your unborn baby.

Tell your doctor if you are breastfeeding or plan to breastfeed. Canasa can pass into your breast milk. Talk to your doctor about the best way to feed your baby if you use Canasa.

Storage

• Store Canasa at room temperature between 68°F to 77°F (20°C to 25°C).
• Canasa may be refrigerated.
• Keep Canasa away from direct heat, light, or humidity.

Keep Canasa and all medicines out of the reach of children.

What are the ingredients in Canasa?

Active ingredients: mesalamine

Inactive ingredients: hard fat base

Canasa is distributed by Allergan USA, Inc. Madison, NJ 07940.

What is mesalamine?

Mesalamine is used to treat mild to moderate ulcerative colitis and prevent the symptoms of ulcerative colitis from recurring. Mesalamine is a long-term treatment that relieves inflammation and may be one of the first treatment options considered for ulcerative colitis. Mesalamine does not suppress the immune system and is not an immunosuppressant.

Mesalamine, also known as 5-ASA (5-aminosalicylic acid), is an aminosalicylic acid chemically related to aspirin. The exact mechanism of action for mesalamine in ulcerative colitis is not known, but it is thought to reduce inflammation by modulating the response of the cyclooxygenase and lipooxygenase pathways, reducing the production of prostaglandins and leukotrienes.

Some brands of mesalamine are for use only in adults, and some brands are for use in children who are at least 5 years old, for example, the delayed-release (Asacol HD) is for adults, but another brand, Lialda, may be used in adults and children who weigh at least 53 to 77 pounds (24 to 35 kg). Mesalamine capsules and tablets are taken by mouth (orally) and rectal mesalamine preparations (such as Canasa suppositories or Rowasa enemas) are inserted directly into the lowest part of the bowel to relieve inflammation associated with conditions such as distal ulcerative colitis, proctosigmoiditis, and proctitis.

Mesalamine first gained FDA approval in December 1987 as sfRowasa and Rowasa enemas. Asacol delayed-release tablets were the first oral preparation approved on January 31, 1992. Brand names for mesalamine include Lialda, Pentasa, Apriso, and Delzicol.

Mesalamine side effects

Common side effects of mesalamine may include:

• burping, constipation, nausea, vomiting, stomach pain, diarrhea, gas;
• dizziness;
• cold symptoms such as stuffy nose, sneezing, sore throat;
• back pain;
• headache;
• rash; or
• abnormal liver function tests.

Serious side effects and warnings

Mesalamine may cause hypersensitivity reactions, including anaphylaxis. Should not be taken by people with a known or suspected hypersensitivity to salicylates or aminosalicylates, mesalamine, or any of the inactive ingredients in the preparations. Some hypersensitivity reactions may present with heart inflammation, such as myocarditis and pericarditis. Stop taking mesalamine and call your healthcare provider right away if you have signs of an allergic reaction such as hives; difficulty breathing; or swelling of your face, lips, tongue, or throat.

Kidney problems have been reported in people taking mesalamine or products that are converted to mesalamine. Your healthcare provider will monitor your kidney function before starting treatment and then regularly thereafter. Mesalamine may not be suitable for people with pre-existing kidney disease or who are also taking other medications that can affect kidney function.

Mesalamine has been associated with an acute intolerance syndrome (AIS) that may be difficult to distinguish from an exacerbation of ulcerative colitis. Tell your healthcare provider if your symptoms worsen while on treatment, stop treatment, or if you suspect AIS.

May not be suitable for people with liver disease.

May cause blood disorders, and seniors or those taking other medicines, such as azathioprine or 6-mercaptopurine, are more at risk. Your healthcare provider will monitor you for these.

Do not give this medicine to a child without medical advice. Some brands of mesalamine are not approved for use in anyone younger than 18 years old. Delzicol should not be given to a child younger than 5 years old.

Stop using mesalamine and call your doctor at once if you have:

• severe stomach pain, stomach cramping, bloody diarrhea;
• fever, headache, general ill feeling;
• rash, itching, eye redness;
• bloody or tarry stools, coughing up blood or vomit that looks like coffee grounds;
• low white blood cell counts–fever, chills, mouth sores, skin sores, sore throat, cough, feeling light-headed, trouble breathing;
• signs of a kidney stone–severe pain in your side and back, frequent need to urinate, foul-smelling urine, dark or cloudy urine;
• kidney problems–increased or decreased urination, swelling, weight gain; or
• liver problems–loss of appetite, upper stomach pain, tiredness, easy bruising or bleeding, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Low white blood cell counts may be more likely in older adults.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA .

Mesalamine cost

The cost of prescription drugs varies depending on your insurance plan and which pharmacy you use. Refer to our price guide page for more information about the cost of mesalamine.

You may also be eligible for a mesalamine coupon, or mesalamine copay card. Ask your doctor or pharmacist if you qualify. Brand names for mesalamine include Lialda, Pentasa, Apriso, and Delzicol.

Before taking this medicine

You should not use mesalamine if you are allergic to mesalamine, aspirin, sulfasalazine, or salicylates (such as Disalcid, Doans Pills, Dolobid, Kaopectate, Nuprin Backache, Pepto-Bismol, Tricosal, Trilisate, and others).

Tell your doctor if you have ever had:

• a kidney stone or kidney disease
• liver disease
• a blockage in your stomach or intestines (such as pyloric stenosis) or
• a skin condition such as eczema
• are pregnant or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Some forms of mesalamine contain phenylalanine. Tell your doctor if you have phenylketonuria (PKU).

Pregnancy

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether mesalamine will harm an unborn baby. However, having untreated or uncontrolled ulcerative colitis during pregnancy may cause complications such as low birth weight or premature birth. The benefit of treating ulcerative colitis may outweigh any risks to the baby.

Breastfeeding

It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk. If you are breastfeeding, tell your doctor if you notice diarrhea in the nursing baby.

How should I take mesalamine?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

• Call your doctor if your ulcerative colitis symptoms do not improve, or if they get worse.
• This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using mesalamine.
• You may need frequent blood tests to check your blood cells or kidney function.

Oral mesalamine

Read the label on the container. Some mesalamine preparations are taken with food and others are taken on an empty stomach. For example:

• Asacol HD is taken on an empty stomach, at least 1 hour before or 2 hours after a meal
• Lialda should be taken with a meal
• You may take Apriso with or without food

Drink plenty of liquids to help prevent kidney stones.

Swallow the capsule or tablet whole and do not crush, chew, or break it. Tell your doctor if you have trouble swallowing the pill.

• If you cannot swallow a Pentasa capsule whole, open it and sprinkle the medicine into a spoonful of yogurt or applesauce. Swallow the mixture right away without chewing. Do not save it for later use.

Tell your doctor if you find undissolved mesalamine tablets in your stool.

Rectal mesalamine

The usual dosage of mesalamine rectal suppositories in adults is 1000 mg administered rectally once daily at bedtime for 3 to 6 weeks depending on symptoms and sigmoidoscopic findings.

• Using mesalamine rectal suppositories beyond 6 weeks have not been established.
• Do not cut or break mesalamine suppositories. Retain the suppository for one to three hours or longer, if possible.
• Drink an adequate amount of fluids.
• Mesalamine rectal suppositories will cause staining of direct contact surfaces, including but not limited to fabrics, flooring, painted surfaces, marble, granite, vinyl, and enamel, and should be kept away from these surfces to prevent staining.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking mesalamine?

If you have a skin condition such as eczema, mesalamine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

Ask your doctor before using an antacid, and use only the type your doctor recommends. Some antacids can make it harder for your body to absorb mesalamine.