WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Pentasa 1g Enema contains mesalazine in a liquid enema form that delivers
the medicine directly into the lower part of the large bowel (the rectum and
sigmoid colon). This targeted delivery means high concentrations of mesalazine
reach the inflamed bowel lining without much of it being absorbed into the
bloodstream — making it particularly effective for left-sided ulcerative
colitis (UC) affecting the rectum and the lower sections of the colon, with
fewer whole-body side effects.
It is used both to treat active flares of left-sided ulcerative colitis
(the lower colon is inflamed and causing symptoms like bloody diarrhoea,
urgency, and cramping) and to maintain remission once symptoms have settled.
3. HOW TO TAKE THIS MEDICINE
The usual dose is one enema (1g/100mL) inserted into the rectum once
daily, ideally at bedtime. Using it at bedtime helps the medicine stay in
contact with the bowel lining for as long as possible overnight — the longer it
stays in, the better it works. The enema comes as a ready-to-use suspension in
a squeezable bottle.
Shake gently before use. Lie on your left side with knees bent, gently
insert the nozzle, and slowly squeeze the bottle to deliver the contents. Try
to retain the enema for at least 30 minutes — ideally all night. Treatment
duration depends on whether you are treating a flare (usually 4 to 6 weeks) or
maintaining remission (ongoing, long-term).
The enema reaches the rectum and lower sigmoid colon. For disease that
extends higher in the colon (up to the splenic flexure), your doctor may
combine the enema with oral mesalazine tablets for fuller coverage. Always
follow your gastroenterologist's prescription regarding duration and whether to
combine with oral treatment.
⚠ PATIENT TIP: Many people find it easier to
retain the enema if they empty their bowels before using it. If you find it
very difficult to retain, start by lying still for at least 15 to 30 minutes
after inserting the enema — the longer you hold it in, the better the medicine
works. It may feel uncomfortable at first but gets easier with practice.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Common |
Mild rectal
discomfort, urgency, or a feeling of wanting to open the bowels after
insertion — usually settles quickly. Occasional nausea if some medicine is
absorbed systemically. |
|
Less Common |
Headache, abdominal
discomfort, flatulence |
|
Rare — Tell Your
Doctor |
Worsening of colitis
symptoms (paradoxical reaction — rare but possible in the first few days).
Kidney problems with long-term use (same as with oral mesalazine — kidney
function tests recommended periodically). Severe allergic reaction.
Mesalazine-related blood disorders (very rare — blood tests if unexplained
bruising or fatigue). |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Pentasa enema should not be used in people who are allergic to
mesalazine, other aminosalicylates, or aspirin (due to structural similarity).
Use with caution in people with pre-existing kidney or liver disease. Kidney
function should be checked before starting and periodically during long-term
use. Generally considered safe during pregnancy and breastfeeding but discuss
with your gastroenterologist.
⚠ KIDNEY MONITORING: Although the systemic
absorption of mesalazine from rectal preparations is lower than from oral
forms, long-term use still warrants periodic kidney function monitoring (eGFR
and creatinine). Inform your doctor of long-term enema use.
⚠ WORSENING SYMPTOMS: If your bowel symptoms
worsen shortly after starting the enema, stop using it and contact your
gastroenterologist — a rare paradoxical reaction can occur.
⚠ ASPIRIN ALLERGY: If you have ever reacted to
aspirin, tell your doctor before using mesalazine products — there is a
structural relationship between the two.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Mesalazine can increase the risk of blood cell toxicity from azathioprine
and 6-mercaptopurine (commonly co-prescribed in IBD) — monitor FBC if both are
used. Warfarin effect may be altered — INR monitoring if anticoagulated. NSAIDs
can worsen ulcerative colitis and should generally be avoided.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Keep the enema bottles in their original foil pouch
until use. Do not refrigerate — cold enemas are more difficult to retain and
cause discomfort. Keep out of reach of children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — typically prescribed and monitored by a gastroenterologist |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Use your enema at bedtime, after emptying your bowels if possible. Lie on
your left side, insert the nozzle gently, and slowly squeeze the bottle. Try to
hold it in for as long as possible — ideally overnight. It may feel strange at
first, but most people get used to the routine within a few days. Even when
symptoms improve or disappear, continue using the enema for the full prescribed
course and do not stop without speaking to your gastroenterologist — stopping
too early is one of the most common reasons for a relapse. Store at room
temperature — not in the fridge.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Counsel on correct
administration technique (left lateral position, slow instillation, retain
overnight where possible). Pre-instillation bowel emptying improves retention
and efficacy. Room temperature use — do not refrigerate (cold enemas impair
retention). For left-sided UC: consider combined oral + rectal mesalazine if
disease extends beyond rectum — discuss with gastroenterologist. Aspirin
allergy cross-reactivity screening. Periodic renal function monitoring (eGFR,
creatinine) for long-term users. Azathioprine/6-MP co-therapy: FBC monitoring
(TPMT-related toxicity risk). Adherence counselling — stopping in remission
triggers relapse. Warfarin INR monitoring if anticoagulated. |
11. FREQUENTLY ASKED QUESTIONS
Q: How do I use the enema correctly?
Empty your bowels if possible before using it. Lie on your left side with
your knees bent. Insert the nozzle gently into the rectum and slowly squeeze
the bottle to release the liquid. Try to remain lying still for at least 30
minutes — ideally all night. Breathing through your mouth and focusing on
relaxing your bowel muscles can help with retention.
Q: What if I can't hold it in?
This is common at first, especially when the bowel is inflamed and
irritated. Even holding the enema for 15 to 30 minutes provides some benefit.
As the inflammation settles and the bowel calms down, retention usually becomes
easier.
Q: Do I use it every night or just when I have symptoms?
During a flare: usually once daily at bedtime for 4 to 6 weeks. For
maintaining remission: your gastroenterologist may recommend ongoing use at
intervals — sometimes nightly, sometimes less frequently. Follow your
prescribed schedule and do not stop without advice.
Q: Why can't I put it in the fridge to keep it fresh?
Storing it cold makes the enema liquid thicker and more uncomfortable to
use, and cold rectal preparations are harder to retain. Store at room
temperature — below 25°C — until use.