Mesalamine: What It Is, How It Works, and Alternatives You Should Know

When you're dealing with mesalamine, a type of anti-inflammatory drug used to treat inflammatory bowel disease. Also known as 5-aminosalicylic acid or 5-ASA, it's one of the most commonly prescribed medications for people with ulcerative colitis and mild to moderate Crohn’s disease. Unlike steroids that shut down your whole immune system, mesalamine works right where it’s needed — in the lining of your colon. It doesn’t make you sleepy, doesn’t cause weight gain, and doesn’t increase your risk of infections the way stronger drugs do. That’s why so many people stay on it for years.

It’s not a cure, but it keeps flares under control. People who take mesalamine regularly often go months or even years without needing hospital care. It comes in pills, suppositories, and enemas so it can reach different parts of your gut. If your inflammation is mostly in your rectum, a suppository works better. If it’s higher up, an oral tablet or delayed-release capsule is the way to go. The key is consistency — missing doses can bring back symptoms fast.

But mesalamine isn’t the only option. For some, ulcerative colitis, a chronic condition causing inflammation and ulcers in the colon and rectum doesn’t respond well enough. That’s when doctors turn to other 5-ASA, a class of drugs that includes mesalamine and similar compounds used to treat bowel inflammation alternatives like sulfasalazine — though it often causes more side effects. Others try biologics, immune modulators, or even dietary changes. But mesalamine remains the first-line choice because it’s safe, affordable, and works for most people.

What you’ll find in the articles below are real comparisons: how mesalamine stacks up against other treatments, what side effects to watch for, how to take it right, and what to do when it stops working. You’ll see how people manage flare-ups, why some switch to enemas instead of pills, and when it’s time to consider something stronger. This isn’t theory — it’s what patients and doctors actually use every day.