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Ulcerative Colitis
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Posted 1/7/2009 12:23 AM (GMT 0)
I need an opinion here. Based on my colonoscopy yesterday (severe proctitis), my GI wants to start me on Remicade ASAP. I've become dependant on high doses of prednisone (40mg) and can't taper below 30mg without all of my symptoms coming back. So once I begin the Remicade infusions, I will be on 6 Asacol per day, 40mg prednisone, 50mg Imuran and Remicade. This seems completely silly! How will my GI know which medication is helping? There is no way I want to (or can afford) to be taking all of these meds at once for a long period of time. Maybe should I discuss this with my GI, once I start the Remi? Does this seem like too many meds at once? Oh yeah, I'm supposed to be using Rowasa too, but have had a hard time using that.
Posted 1/7/2009 12:28 AM (GMT 0)
while it sounds like a lot of meds, it really isn't- the Asacol is a maintenance med, designed to keep you in remission once you reach it. The Imuran suppresses the immune system, in theory lowering your bodies inflammatory response against itself. It also should help you from making antibodies to the Remicade. The Remicade is the tnf-blocker, another anti-inflammatory med. And you know the pred is to keep things from getting worse while the other meds kick in. You should be able to lower your pred dose & come off it completely while on Remicade. If not, then there's problems! But staying on Asacol, Imuran & Remicade are fairly standard for a lot of UC'ers.

Posted 1/7/2009 12:29 AM (GMT 0)
I am admittedly new to all of this but I was just curious how/why you had been prescribed all of this without having a colonoscopy yet? My PCP and GI didn't want me to start on anything that I am currently on until their theories were proven correct with the Endoscopy and Colonoscopy with biopsies.
Posted 1/7/2009 12:53 AM (GMT 0)
I had a colonoscopy yesterday and had a sigmoidoscopy back in 2006.
Posted 1/7/2009 1:32 AM (GMT 0)
It really is ridiculous, but in all reality its a failed treatment plan over and over again.
Posted 1/7/2009 1:06 PM (GMT 0)
speak for yourself.....

Posted 1/7/2009 2:12 PM (GMT 0)
You really need to get off prednisone, you seem to be steroid dependent which is not a good place to be. That should be your next conversation with your GI. Ask him/her what his plans are for you if Remicade doesn't work.

Sue
Posted 1/7/2009 3:03 PM (GMT 0)
SueBear, you are right.  I am steriod dependent, so this is why my GI is quickly getting me onto Remicade and has gotten me on Imuran. I am just concerned (I guess I should be happy if this happens) that if I find that all these medications begin to help with my flare, how will I know if it's the Remicade or Imuran that is helping.  I've been told it takes several weeks for any effect of Imuran to be felt.  By that time, I will have started Remicade infusions too.  I guess all I should be concerned with is getting my flare under control.  But this comes from someone who doesn't even like to take medication for a headache!

We haven't discussed into much detail what we would do if the Remicade fails.  My GI doesn't think my UC is that severe that I would need to resort to other measures (j-pouch).  But getting this flare squared away has been next to impossible!  I miss the days when Asacol made everything better smurf

Posted 1/7/2009 3:04 PM (GMT 0)
I don't know that I've heard of anyone being on all of those meds simultaneously. How long have you been on Imuran? If it works, it should allow you to taper off the pred. And if the diagnosis is proctitis, have you tried rectal meds?
Posted 1/7/2009 3:15 PM (GMT 0)
My belief is that your GI is in error if he thinks your case is not severe enough for surgery if the current regime doesn't get you off prednisone. He's not the one who is going to have to live with the long term side effects of prednisone. I know that you are concerned and that's good. You have a right to be concerned about all the meds, how long have you been on Imuran? If that hasn't been given a good 6 months to take effect it does seem odd that Remicade would be tossed at you so soon. If you have been on Imuran for 6 months then it's likely that it is not working and you should see about eliminating some of the medication.

In the meantime make sure you are taking calcium and engaged in plenty of weight bearing exercise to ward off potential bone damage from steroids.

Sue
Posted 1/7/2009 11:47 PM (GMT 0)
I used to use Canasa, but they began having no effect on my flare. I have more recently tried the Rowasa, but due to my symptoms, I have a hard time keeping the medication in, if you get what I mean....it's like 20 minutes max. I may try it on nights where my flare isn't quite as bad....but I'm not sure if using Rowasa on occasion is even worth the struggle?

I've only been on Imuran for 3 weeks now, and can predict I will have my first Remicade infusion within the month. So I am no where near the time needed for Imuran to take full effect. Maybe should I suggest to my GI that I get off Imuran and just concentrate on Remicade? I'd rather try just one, and not both at the same time. I am already having enough side effects from the predisone and Imuran together!! prednisone is horrible!

I currently take Viactive chews, but I may try something new....kinda sick of the chews flavor. Do you recommend anything?

Does anyone else find they are being "over-medicated"? I know many don't beleive so, or case, so long as they get into remission.
Posted 1/8/2009 12:15 AM (GMT 0)
All of my docs have told me that Imuran takes three months to reach the therapeutic effect. My current doc made me wait the three months and now, with no improvement whatsoever, I have my appointment Monday where we'll be discussing Remicade. However, he plans on stopping Imuran at that time as well. In the medication guide for Remicade, it specifically states that some cases of cancer/lymphoma were documented and all of these patients were on Remicade and Imuran/6-MP simultaneously, so I'm not sure why any doctor would keep a patient on both drugs at the same time with that potential effect?? What is the benefit of being on two immune suppressants?? It just seems like overkill to me.

http://www.drugs.com/drug_interactions.php?action=allinteractions&drugid=d00024&drugname=azathioprine

There's a list of drugs that interact with azathioprine/Imuran (there's a lot!!) and Remicade is on the list of drugs causing a major interaction...

I, too, am steroid dependent and when prednisone wasn't even helping this time, my doc just took me off it altogether. Everything seemed to be making me worse instead of better. Right now I'm just on Imuran. I agree that it doesn't make much sense to be on so much at once, especially if you're not finding any relief. Although three weeks is not enough time to know if the Imuran is working. But I certainly understand that three months is a long time to wait for results when you're flaring in agony!!! I'm sooo glad my three months are up.

Post Edited (ediekristen) : 1/7/2009 5:34:29 PM (GMT-7)

Posted 1/8/2009 12:18 AM (GMT 0)
Interesting... I was looking up info on Imuran and found "Under FDA rules, this drug, like many others, excludes eligibility for blood donation"

I haven't tried donating in years but I wasn't aware I'd be unable to on Imuran. That's good to know!
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