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What Is Rowasa?

Rowasa is a prescription rectal medication containing mesalamine, also called 5-aminosalicylic acid. It is an aminosalicylate used to treat active mild to moderate distal ulcerative colitis, including proctosigmoiditis and proctitis, in adults. Rowasa is supplied as a rectal suspension in single-use enema bottles containing 4 grams of mesalamine in 60 mL. It acts locally on inflammation affecting the rectum and lower portions of the colon. Rowasa is not an oral medication and is not intended for treatment of every form of inflammatory bowel disease. Kidney function and medication tolerance require monitoring during treatment.

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What Is Rowasa?

Rowasa is a prescription rectal medication containing mesalamine, also called 5-aminosalicylic acid. It is an aminosalicylate used to treat active mild to moderate distal ulcerative colitis, including proctosigmoiditis and proctitis, in adults. Rowasa is supplied as a rectal suspension in single-use enema bottles containing 4 grams of mesalamine in 60 mL. It acts locally on inflammation affecting the rectum and lower portions of the colon. Rowasa is not an oral medication and is not intended for treatment of every form of inflammatory bowel disease. Kidney function and medication tolerance require monitoring during treatment.

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How Does Rowasa Work?

Rowasa delivers mesalamine directly to the inflamed lining of the rectum and distal colon. Mesalamine has local anti-inflammatory activity, although its complete mechanism in ulcerative colitis is not fully established. Its effects are believed to involve changes in inflammatory signaling and the production of substances such as prostaglandins and leukotrienes. Applying the medication rectally allows substantial contact with affected tissue and can reduce symptoms related to local inflammation. Rowasa does not permanently cure ulcerative colitis or treat all areas of the digestive tract. Its effectiveness depends on the location and severity of the inflammation and the ability to retain the medication.

What Conditions Does Rowasa Treat?

Rowasa is approved for active mild to moderate distal ulcerative colitis, proctosigmoiditis, and proctitis in adults. Ulcerative colitis causes inflammation and ulcers in the lining of the large intestine. Proctitis affects the rectum, while proctosigmoiditis involves the rectum and sigmoid colon. Symptoms may include rectal bleeding, urgency, diarrhea, and abdominal discomfort. Because Rowasa acts locally within the lower bowel, it is not intended as the sole treatment for extensive inflammation beyond its reach. A gastroenterologist evaluates disease extent, symptoms, kidney function, and previous reactions to salicylates or mesalamine before prescribing it.

How Should Rowasa Be Used?

The recommended Rowasa dose is one 4 g/60 mL rectal enema once daily, preferably at bedtime, for approximately three to six weeks according to symptoms and clinical findings. The medication should ideally be retained for approximately eight hours. Shake the bottle before use, remove the protective cover, and gently insert the applicator tip into the rectum while lying on the left side or using the knee-to-chest position. Squeeze the bottle steadily, then remain in position for at least 30 minutes to help retain the suspension. Patients should maintain adequate fluid intake and follow their clinician's treatment schedule. Kidney function should be assessed before and during therapy.

What Are the Side Effects and Warnings of Rowasa?

Possible adverse effects include rectal discomfort, abdominal pain, nausea, headache, and diarrhea. Serious risks include kidney injury, mesalamine-induced acute intolerance syndrome, pancreatitis, liver problems, severe skin reactions, and blood disorders. Rowasa contains sulfites, which can cause allergic reactions in susceptible patients, particularly those with asthma. Mesalamine has also been associated with intracranial hypertension, which can cause headache and visual symptoms. Patients with a history of salicylate or aminosalicylate hypersensitivity should not use Rowasa. Worsening bloody diarrhea, severe abdominal pain, reduced urination, persistent headache with vision changes, or allergic symptoms requires prompt medical assessment.

Common Questions About Rowasa

Is Rowasa the same as mesalamine?

Yes. Rowasa contains mesalamine in a rectal suspension used for certain forms of distal ulcerative colitis.

Can Rowasa treat ulcerative proctitis?

Yes. Rowasa is approved for active mild to moderate proctitis and proctosigmoiditis in adults.

How long should Rowasa be retained?

The enema should ideally be retained for approximately eight hours. Bedtime administration can make this easier.

Does Rowasa require kidney monitoring?

Yes. Mesalamine can cause kidney problems. Kidney function should be assessed before treatment and monitored periodically during therapy.

References

DailyMed - MESALAMINE rectal suspension. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=485ed763-976e-4410-a401-7ff762a931b3. Date Accessed November 4, 2026.

DailyMed - ROWASA (mesalamine) rectal suspension. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e505ab99-1943-4216-a178-4d5dbe64e3b2. Date Accessed November 4, 2026.

Mesalamine Rectal. MedlinePlus. https://medlineplus.gov/druginfo/meds/a614021.html. Date Accessed November 4, 2026.

Mesalamine (5-Aminosalicylic Acid). PubChem. https://pubchem.ncbi.nlm.nih.gov/compound/4075. Date Accessed November 4, 2026.

Treatment for Ulcerative Colitis. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/ulcerative-colitis/treatment. Date Accessed November 4, 2026.