Need Advice - Pentasa interfering with sleep and more

Pentasa is a pretty ineffective medication for Crohn's. Those with mild Crohn's have had success with it, but for the majority of Crohn's patients, it's almost less effective than a placebo. That's kind of a big jump from Pentasa to Entyvio/MTX. I'm surprised they're not suggesting Remicade or Humira, as those are standard biologics to start with. I never had hair loss while on mesalamines, but they did absolutely nothing for me. LDN is shown to have some success, but again, it's not going to be a big help to control. It works more as a symptoms-controller than to actually achieve remission (at least from what I understand).

Pentasa is woefully inadequate for Crohn's severe enough to need either biologics or surgery. I doubt your insomnia is due to the Pentasa; I suppose it's possible, I've just never heard of that as a side-effect of Pentasa before (unlike hair loss which is a rare, but known, side-effect).

Not sure why your doctor wants to try methotrexate next. It's an old chemotherapy drug and can have some pretty toxic side-effects, including nausea and hair loss. If you do try it, then injections have less side-effects than tablets, so I would go for injections. But can't say I would strongly recommend it myself. It really sounds like it's time for you to go on a biologic. Entyvio is an odd first choice of biologic, but there's nothing wrong with going on Entyvio first. The only thing I would say is that it takes longer to start working than either Remicade or Humira - typically up to 12 weeks, whereas Remicade takes about half that time. In theory Entyvio should have fewer side-effects too. Although most folks don't get any bad side-effects from Remicade: the most common is feeling tired for a day or two after the infusion.

Thank you for your replies. I appreciate them.

I have already tried Remicade - I was on it and Imuran for five years. I stopped it about five years ago due a weakened immune system and constant infections that need antibiotics. Since I was on antibiotics frequently, I couldn't get Remicade. I switched to Low Dose Natrexone, but my latest colonoscopy showed I had an ulceration around the Illoceal valve. Since I had such a hard time with Remicade (small veins and a week of extreme fatigue after each infusion), I am hesitant to try another infused medicine. Entyvio is sort of new and I have heard it has mixed results. When my doctor suggested going on Entyvio - I sort of panicked and just suggested something that didn't seem very strong, Pentasa. I do try the control Crohn's with a Gluten-Free, Dairy-Free Diet, but right now in quite a bit of pain - so the Pentasa is not working well. Just hoping for an easier solution than something like Entyvio. Methotrexate seems like a bad choice, too.