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These medications are generally well tolerated. Like all drugs, 5-ASA can have side effects, although not everyone will get them, and some are quite rare. They can include:
nausea, vomiting, and watery diarrhea
headache and indigestion
mild allergic reactions with rash, itchiness and fever, but these symptoms usually resolve with stopping of the medication
less commonly, problems with the kidneys, liver, lungs, pancreas, and outer sac of the heart (pericarditis)
kidney function may be affected in small percentage of patients
Sulphasalazine can cause a reversible male infertility, but this usually resolves once the drug is stopped. Sulphasalazine can also reduce the body’s ability to absorb folates (B vitamins) which are essential for blood cell formation. Most people taking sulphasalazine may need a folic acid supplement.
It is usual to have regular blood tests while on 5-ASA treatment, especially when you first start taking the drug, to check for any unwanted side effects. You may have, for example, regular blood tests. If you are taking sulphasalazine you may need slightly more frequent blood tests.
As for all drugs and medicines, if you are concerned about side effects or any new symptoms you experience while on 5-ASA, contact your family physician or IBD team.
There may be cross-reactivity if you have a sulfa allergy and therefore alternative medications to sulfasalazine should be considered instead.
There are some similarities between 5-ASA and aspirin and therefore there is a concern of possible cross-reactivity
There has been a report of successful use of 5-ASA in a patient with aspirin allergy by first using a test dose
You will have to discuss with your IBD specialist whether to pursue a supervised test dose to assess tolerability or consider desensitization (trying to overcome the allergy by slowly introducing small doses and gradually increasing to full dose)
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