Side Effects of Asacol (Oral Mesalamine, Pentasa, Mesasal, Salofalk)

Asacol tablets
Asacol is a drug that is used to treat ulcerative colitis, one form of inflammatory bowel disease (IBD). Image © Pillbox

Asacol (mesalamine) is a 5-aminosalicylic acid (5-ASA) drug that was approved in August 1997 for the treatment of ulcerative colitis. Asacol acts topically on the intestines, suppressing the inflammation that is caused by ulcerative colitis, which is one of the main forms of inflammatory bowel disease (IBD). Asacol was previously also sometimes used to treat another type of IBD, Crohn's disease. However, it has since been studied more closely, and IBD specialists now believe that mesalamine is not as effective for treating Crohn's disease. As a result, it is no longer recommended for routine use in treating this form of IBD. Mesalamine can be effective when Crohn's disease involves the colon or large intestine.

Asacol comes in various forms, including oral, suppositories, and liquid or foam enemas (rectal suspension). Because it acts topically, when the ulcerative colitis is affecting the last parts of the large intestine, the rectum, and the sigmoid colon, using a suppository or an enema may be helpful. Topical forms are not without the potential for side effects or adverse effects, so it's worth having an understanding of what those might entail.

Asacol Is a Maintenance Drug

Asacol is classified as a "maintenance" drug, which means that it is given on a long-term basis to treat ulcerative colitis. Asacol can also be used as a first line treatment for acute mild ulcerative colitis.

Ulcerative colitis causes inflammation in the colon, among other signs and symptoms throughout the body. Asacol is used to help stop the inflammation that is present in the colon and typically starts to take effect in about 2 to 3 weeks. After inflammation is under control, patients are prescribed this drug to help prevent more flare-ups of the disease from occurring.

For adults with moderate to severe ulcerative colitis, however, who have achieved remission on a biologic (eg. Humira), small molecule (eg. Xeljanz), or immunoodulator medication, 2020 guidelines recommend against the use of Asacol for maintenance treatment.

This maintenance drug is known to have a relatively low incidence (rate) of side effects, although some are still possible. The following is a list of the potential side effects and adverse effects of Asacol.

Common Side Effects

Check with your doctor if any of these side effects continue or are bothersome:

  • Abdominal or stomach cramps or pain (mild)
  • Diarrhea (mild)
  • Dizziness; headache (mild)
  • Runny or stuffy nose or sneezing

Less Frequent or Rare

Check with your doctor if any of these side effects continue or are bothersome:

  • Acne
  • Back or joint pain
  • Gas or flatulence
  • Indigestion
  • Loss of appetite
  • Loss of hair

Always Notify Doctor

These side effects are less common; call your doctor right away if you experience them.

  • Abdominal or stomach cramps or pain (severe)
  • Bloody diarrhea
  • Fever
  • Headache (severe)
  • Skin rash and itching

These side effects are rare; call your doctor or seek emergency medical care right away if you experience them.

  • Anxiety
  • Back or stomach pain (severe)
  • Blue or pale skin
  • Chest pain, possibly moving to the left arm, neck, or shoulder
  • Chills
  • Fast heartbeat
  • Nausea or vomiting
  • Shortness of breath
  • Swelling of the stomach
  • Unusual tiredness or weakness
  • Yellow eyes or skin

Symptoms of an Overdose

  • Confusion
  • Diarrhea (severe or continuing)
  • Dizziness or lightheadedness
  • Drowsiness (severe)
  • Fast or deep breathing
  • Headache (severe or continuing)
  • Hearing loss or ringing or buzzing in ears (continuing)
  • Nausea or vomiting (continuing)

Warnings With Asacol

Asacol is considered to be relatively safe, but people who take this drug should be aware that it has been associated with some adverse events. Some people have developed problems with their kidneys, and it's recommended that people taking this drug have their kidney function checked every so often.

Some people have also had adverse reactions that mimic the symptoms of a flare-up of ulcerative colitis, which include diarrhea, headache, and abdominal pain. Allergic reactions are also possible. Your prescribing physician should be told about any previous allergic reactions to mesalamine or to sulfasalazine.

A Word From Verywell

Asacol is generally tolerated very well by most people, and it is often used long-term by those who have ulcerative colitis. However, as with any drug, there is the potential for adverse effects and side effects. For most people, the side effects are mild, but people taking Asacol should be aware of the potential for an allergic reaction, an adverse effect on the kidneys, or a worsening of diarrhea and abdominal pain. For any concerns about the side effects of Asacol, contact your doctor.

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. This information is meant only as a guideline — always consult a physician or pharmacist for complete information about prescription medications.

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  1. Feuerstein JD, Isaacs KL, Schneider Y, et al. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis. Gastroenterology. 2020. 158(5):1450-1461. doi:10.1053/j.gastro.2020.01.006

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