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Sulfasalazine vs. Lialda - Make the switch???

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Ulcerative Colitis
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Posted 6/1/2009 6:57 PM (GMT 0)
Took son 17 to the GI today due to loose/blood in stool. It is looking like this is hopefully just going to be a mini-flare. Son did not see blood yesterday and thinks seem to be firming back up a bit, and hasn't even had to go to the bathroom yet today!

Doctor knew son has been battling horrible headaches frequently and asked about the headaches again and again mentioned stopping Sulfasalazine (this was mentioned at appt. in May). At least this time he recommended Lialda in it's place instead of no 5ASA at all. He really thinks we need to do this to see is the Sulfasalazine is the cause of all the headaches.

Son did have a couple weeks almost headache free, but they returned last week. We tried Ultram/tramadol and it didn't do much at all. GI says we need to stop chasing the headache with another med. and see if Sulfa is the cause since it has such a strong reputation for causing them.

Son has been on Sulfasalazine for 7 years now - hard to make a change, but I feel a bit better replacing it with something verses just dropping it altogether. He wrote an Rx and left it up to us.

Son is game - he is tired of the headaches and also liked the sound of a once per day med.

What do you all think?

If we go this route, do we wean off Sulfa and then on to the Lialda or just go cold turkey on Sulfa and start the Lialda?

Do we wait a few more days and make sure this is indeed just a "blip" and not a full blown flare, or start now regardless?

I hate decisions!!

If we do make the change, what and when would be the best way?

What do you all know of Lialda?

Thanks so much!!!!
Posted 6/1/2009 9:41 PM (GMT 0)
Just spoke to the pharmacist and he said they are similar enough to finish sulfasalazine today and start Lialda tomorrow.

Anyone else make this change and how did it go?

Headaches are the main reason for the switch, although once per day meds is a very nice change for my son.

What do you think - make the switch?

Thanks!
Posted 6/1/2009 10:32 PM (GMT 0)
I would...headaches all of the time aren't any fun!
Posted 6/1/2009 11:36 PM (GMT 0)
try it see what happens

i tried lialda first and it didnt work for me but the sulfasalazine works

however i dont get headaches with it, but everyone reacts differently to the same meds so mayby he will do well with it

hopefully he will do well

Posted 6/2/2009 2:16 AM (GMT 0)
I have headaches almost every single day and I believe that it is a combination of my medications and neck issues. If I could resolve these headaches, if it was from meds alone, then I would do it in a heartbeat! Having a headache every single day is enough to make anyone miserable. So I say, have him do the switch but have him keep an eye out for any changes. Just a FYI, he MAY notice an increase of symptoms for the first few days - to a week after switching medications. Or he may get lucky and have no issues at all...if he does have an increase of symptoms that don't go away in a few days to a week, notify his GI or have him start back on the Sulfasalazine.
Posted 6/2/2009 2:39 AM (GMT 0)
Thanks everyone. We just really don't know what is causing the headaches, but they don't seem to fit migraines, tension, sinus, etc. and since Sulfa is such a strong possibility (at least that is what the doctor believes) he thinks we should start there.

Son's headaches will last for days, round the clock, day after day. Advil will put a dent in them and sometimes take them away entirely until it wears off, but more than occasional Advil here and there, it is not a great choice for IBDers. Advil may even be what has caused this latest little blip. He has suffered headache on and off over the years, but the last few months are way worse than anything before.

Son really wants to make the switch and since he is almost 18 and it is his health, I guess we should try. It is just hard to change something after 7 years.

I guess we will give it a try and see how it goes... Thankfully he does seem to be the type that tolerates most meds very well, so hope this will hold true for Lialda, too!!

Thanks for the feedback!!
Posted 6/2/2009 3:49 PM (GMT 0)
I tried sulfasalazine for a week and after all the headaches and everything... I went to Lialda.... I realized the sulfasalazine actually made my UC worse...so for me it was worth the switch.
Posted 6/2/2009 4:32 PM (GMT 0)
I would go ahead and make the switch it is definitely worth a try but I would be surprised if it helps the headaches. I had headaches with sulfasalazine when I first started it and went off the drug. After a few months tried it again and had no problems, that was 25 years ago and I still use it If you have insurance that covers the cost of the meds there is no down side to other ASA's if not you will find a huge cost differential between the drugs as sulfasalazine is very cheap. Good luck
Posted 6/2/2009 4:46 PM (GMT 0)
I just noticed that your son is on 6 grams a day of sulfasalazine. That dose, according to my GI is too high, he told me the max dose was 4 grams a day, you can go a little higher for a while but not on a sustained basis, this could also be contributing to the problem. 6 grams would constitute 12 of the 500mg tabs a day so I can see why he would want to go to the once a day med.
Posted 6/2/2009 5:07 PM (GMT 0)

Sulfasalazine has helped me the most, whereas I got no relief from Asacol, of which Lialda is a reformulation, if I'm not mistaken.

As a previous poster has mentioned, six grams a day is a lot of sulfasalazine.  I take four grams, and my GI thinks that probably too high for a long time (and indeed it seems to be effecting my hearing).  As was also mentioned, stopping and "rechallenging" with sulfasalzine oftens eliminates the headaches.  It is said, that starting with a low dose and increasing it over time will help with side effects.

(The sulfasalzine has also almost completely eliminated the joint pain I've had for probably close to twenty years.)

Posted 6/2/2009 5:55 PM (GMT 0)
Thanks everyone. He takes 6 grams when flaring and half that when in remission. Both his Pediatric GI and his current adult GI said 6 grams when flaring - ped GI split into 4 doses per day, adult GI does it over 3 doses. The headaches started while he was still on 3 grams. My signature was from when he was last flaring.

He seems to be on the mend IBD wise with just a few days of loose stool blood. Says things are pretty much back to normal.

He started the Lialda today. It sure is scary to make a change after 7 years! He is so tired of the headaches and I totally understand that.

We'll see how it goes...

Thanks again,
Posted 6/2/2009 9:34 PM (GMT 0)
i hope lialda works for your son. Even i m new to lialda..just started 4 days back.
take care
Posted 6/2/2009 9:49 PM (GMT 0)
saposs, I see in your signature that you flared after your Rubella vaccine - does your doctor think it is related or just a coincidence? I ask because my 10 year old is overdue for various boosters including MMR (measles, mumps, rubella) and it makes me nervous - actually I'm not sure she can even have them - is there a live component to them? She is on 6mp.

Here's hoping Lialda is great for you and my son!!
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