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Do you stay on canasa for maintenance?

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Ulcerative Colitis
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Posted 7/12/2008 4:46 PM (GMT 0)
Just wondering, I think I would like to stay on canasa as well as asacl for maintenance, I think my doc is just wanting asacol for maintenance, any opinions on this?  Thanks, Bellski
Posted 7/12/2008 7:22 PM (GMT 0)
Hello, I have ulcerative proctitis and am currently on Canasa once per day for maintenance. I tried oral 5ASAs but they give me a bad rash. With Canasa the rash is very mild, so I opted to stay on it instead of the oral (Lialda, Colazal). My GI says it will be fine since I can't take the normal oral stuff. I have been on it for a month & a half. The only side effects so far are the mild rash (on jawline) and some hair loss. I'm not sure it will maintain long term, but I'm keeping my fingers crossed! I'll be interested to hear what others have to say on this topic.
Thanks!
Posted 7/12/2008 8:56 PM (GMT 0)
I asked my doc about this once and he has had some patients that use either Canasa or Rowasa as part of their maintenance program for years. So I think that if you are doing good with it, why rock the boat yah?
Posted 7/12/2008 11:07 PM (GMT 0)
You can taper to a maintenance dosage,..It'll be an increase/decrease thing anyway.

Are you still on 2 daily?  What did the doc propose for you do do....just stop them completely or to taper them?  You should taper off the morning ones firstly .... that will take at least 6 weeks anyway.

Then see how you do and start tapering the nightly ones.

6 Asacol is a good dosage for maintenance. It's my constant dosage and I increase with the enemas.

NEVER, NEVER, NEVER stop rectal meds completely....remember that's where UC starts. Stay on the Asacol because you want everything from the sigmoid up to be nice and quiet.

quincy

Posted 7/13/2008 3:25 AM (GMT 0)

I use two a week (Rowasa) for maintenance.  Works beautifully.  I intend to keep this up for the long term as it works so well for me.  I've been doing it for over a year and have been flare-free the entire time.  I tapered down from nightly enemas after a flare in April of last year and found that things tended to not go so well as I tapered to fewer than 2 enemas a week so I just stuck with the 2 a week. 

Interestingly, there seems to be a lot of support for maintenance rectal 5ASA meds in the medical literature.  Here are some examples:

Effect of weekend 5-aminosalicylic acid (mesalazine) enemas as maintenance therapy for ulcerative colitis: results from a randomized controlled study.

http://www.ncbi.nlm.nih.gov/pubmed/17455207

Trouble maintaining remission in ulcerative colitis? give 'EM an enema!?

http://www3.interscience.wiley.com/journal/113522504/abstract

Long-term intermittent treatment with low-does 5-aminosalicylic enemas is efficacious for remission maintenance in ulcerative colitis

http://www.informaworld.com/smpp/content~content=a713799767~db=all~order=page

Medical Management of Ulcerative Colitis

http://www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi?uid=2360;article=hm_64_12_703_707.

here's the html version as I couldn't get the above link to load

http://209.85.141.104/search?q=cache:JZugpDRIU3QJ:www.bjhm.co.uk/cgi-bin/go.pl/library/article.cgi%3Fuid%3D2360%3Barticle%3Dhm_64_12_703_707+ulcerative+colitis+maintenance+enema&hl=en&ct=clnk&cd=14&gl=au&client=firefox-a

 

Posted 7/13/2008 8:33 AM (GMT 0)
Hi Knitty_Cat....do you use the enemas every 3rd or 4th night? or one on Saturday/one on Sunday as suggested in the first article?

I believe the foam enemas are 1g dosages, correct? You could progress to the retention enemas with more dosage during flares if you need them...at least you have a huge option base in which to increase.

quincy
Posted 7/13/2008 12:16 PM (GMT 0)
Hi Quincy

I do my 5asa foam enemas every Thursday and Sunday night to get my twice weekly enemas. I find that two set/regular days is easier than counting out every third or fouth day. My reading of the article that suggested doing the enemas just on the weekends was that this dosing was more likely to be adhered to by patients because it was probably easier to do, rather than that consecutive days with a five day break was the optimal dosing. All the other articles just say twice weekly. Makes sense to me to spread them out over the week if possible.

The foam enema is 1g per squirt of the applicator on the can. Two squirts to deliver 2g is the common or recommended dose, and that is what I do. And you're right, any sign of a flare coming and I will just increase the frequency of the enemas. I'll also probably add in some liquid enemas if I flare as I believe they reach a little higher up than the foam does. However, I haven't had to worry about that since starting my maintenance enemas. I actually just came back from a 2 week holiday of Asia where I took my foam and continued the Thursday/Sunday routine with no issues!
Posted 7/13/2008 7:18 PM (GMT 0)
Sounds great! If you're still taking the Salofalk tabs at 8 daily, you shouldn't have too many problems above the sigmoid. The foam should reach the sigmoid, and what you're doing is what I can't stress enough....rectal meds increased for flares and tapered to maintenance.

Thanks for the information sites...good for the rectal med "cause"..lol!
At least the weekend use for the 1gr dosage is a good option for patients who have tapered down. Patient adherance is a tough one...I know it's not for everyone to want to use them.

Be well,
quincy
Posted 7/13/2008 10:22 PM (GMT 0)
I am for sure staying on my asacol, I was just wondering about the canasa.  I got the impression from my doc that when symptoms subside, to stop the canasa.  I am mildly flaring off and on.  I am still doing 2 canasa a day (when I don't forget).  I do feel that personally I'd like to stay on at least one canasa a day even when I feel I'm in remission.  Thanks for the input, It's great as usual.  Have a good night!  Bellski

Posted 7/13/2008 11:34 PM (GMT 0)
Hi Bellski

Quincy and I are just talking about 5ASA rectal meds - Canasa, Rowasa, Salofalk - all mean the same thing for these purposes.  They are just different methods of delivering a topical dose of 5ASA.  So all the stuff we were talking about applies to Canasa too.

My personal recommendation would be to slowly taper the Canasa down as you get better until it is at 2 or 3 a week and then leave it there.  Or just leave it at a frequency that suits you.  You can certainly use them for maintenance.  When you are in remission, you (probably) shouldn't need one a day but play around as you taper down and find the right dose for you.  If your Dr doesn't think this is a good idea, refer him/her to the studies I posted and let him/her know that you'd feel better using Canasa for maintenance.  I don't think many Drs would really prevent their patients from having some extra 5ASA meds if the patient is keen.

I *love* rectal meds!  They have made the world of difference to me.

Quincy - yep, I always take the 8 Salofalk tabs a day.  My Dr and I used to try to taper that amount down, but for some reason, I don't do well on less than 4g of oral 5ASA a day.  4g doesn't cause me any troubles or side effects so we've given up and are just going to leave it at 4g daily.  He said in my recent appointment that there is now some evidence that younger people need higher (oral) 5ASA doses to maintain remission.

Posted 7/13/2008 11:56 PM (GMT 0)
Thanks for the resposes. Silly me, I was thinking canasa once a day was the lowest I could go even on remission. I never thought of a few times a week. I just really think it helps me and makes sense. In November I go to a new doctor (Dr. Hanauer) simply for a second opinion to make sure I know what I am doing is on the right page. He is suppose to be one of the best so he will probably be my new GI if I like him. Thanks for all of the help, Bellski
Posted 7/15/2008 4:45 PM (GMT 0)
I use the Canasa suppositories every other night. And I am on the Asacol for maintenance, I take two twice a day.
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