Pentasa Q's

Hi everyone! First of all, I'm new here. I was diagnosed with CD recently in April 2014. Doctor said it was mild and isolated to my ileum. I was put in Pentasa 1 g 3x daily. I'm vegan and have been gluten free since January 2014. After 3 months of the Pentasa, my symptoms calmed and the doctor told me to stop because I was in remission. After a few months of not being on the Pentasa, I was seeing blood in my stool and having painful bm's. He did a sigmoidoscopy and found ulceration in my rectum. I started back on the oral Pentasa (same dose) and he gave me some Pentasa suppositories (1g) to try. I haven't had much relief or improvement from the Pentasa suppositories and it seems like I have more relief from the Hydrocortisone suppositories I have (had them hanging around from previous hemorrhoids). My questions are:

1.) Is my oral Pentasa dose too low? The bottle says 4 g per day for active Crohn's... 2-3 g seems like the dose for remission maintenance. I don't have abdominal pain, bm's are mostly normal (once in a while I have a looser bm but rarely diarrhea)... everything right now seems isolated to my rectum

2.) Should I be using the Pentasa suppositories more frequently, or just stick to the HC ones if they seem to be working better?

I've emailed my doctor but he's taking his time answering me, so your opinions are much appreciated!

Thanks!

You should never stop your meds when you achieve remission. In my opinion, this is enough reason for you to look for a new DR.

The rectal meds are your best shot at treating inflammation in the rectum. You can use both the steroid and the pentasa suppositories. Do one at night and the other in the morning. The steroid suppositories are not meant for long term use, so once you have gotten rid of the rectal inflammation you should discontinue them and use only the Pentasa ones. And yes, you should continue to use the Pentasa suppositories even when you are in remission.

You should be using the rectal meds every day (or twice a day like I suggest above). When you have gotten into remission you can slow down the frequency. I would not go to zero on either oral or rectal, although after a long enough time I have been known to stop rectal meds.

I don't want to sound negative, but there's many who now believe that Pentasa, and other 5ASA's are pretty much useless for IBD treatment.

You could certainly try the Pentasa route again, but If you are still showing disease progression or symptoms, then it's time to look at more aggressive medications.

Pentasa and other oral mesalamines have worked well for me. If they are working, no reason to look elsewhere IMO.

The Pentasa suppository should work fine. We don't have that here in the states - I have to use Canasa, which is a brand name mesalamine suppository. They are effective, but rectal inflammation is stubborn.

Maybe it's relevant that my IBD has never been clearly identified as CD or UC. In any case, if someone has fistulizing disease they should never be given mesalamines. That is clearly a losing proposition.

Sure. but if you have disease anywhere you are not "in remission."