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Posted 1/12/2010 6:48 PM (GMT 0)

I am on Pentasa 2g (four pills) twice daily and almost every BM has what I am positive is undissolved meds.  I asked my GI about this last year and he said it is unlikey, or even impossible since Pentasa starts to dissolve immediately after entering your system.  I have researched it and it says that it can happen and to report it to your doctor.  Why if he doesn't believe me? LOL.  Just wondering if anyone else has this issue?  And should I be concerned about not getting enough medication if this is happening?  Also, I wonder if I should spread the meds out over the day, say 2 pills four times daily, instead of four pills twice daily.  Maybe this would help?  However, since I have a hard enough time remembering meds twice a day, four times a day would be almost impossible for me........

Any thoughts are appreciated.

Posted 1/12/2010 6:54 PM (GMT 0)
Is the Pentasa capsules or tablets?
Posted 1/12/2010 7:11 PM (GMT 0)
They are the HUGE (I call them horse pills) tablets.  I was under the assumption that they are slow release tablets that work all the way through your intestines.  The first time I noticed it, I had eaten some nuts the night before (Ya, I know, bad idea) so I just thought it was the nuts.  But I am seeing it constantly in my BMs. 

Posted 1/12/2010 7:12 PM (GMT 0)
So, you're seeing whole pills? not granules?
Posted 1/12/2010 7:15 PM (GMT 0)
Look down to the "how to use Pentasa".....it says you can dissolve the tablet in water and then drink the granules...that might help. It's possible you're not able to dissolve the stuff the tablet is made of.


http://www.medsafe.govt.nz/consumers/cmi/p/pentasa-tab.htm





Do you eat a meal when you take them? It might be a good idea to try that because they'll stay in your system longer.



I'd stick to the twice a day rather than 4 times a day unless you're specifically regimented. I'd be missing more pills that way....



q
Posted 1/12/2010 7:31 PM (GMT 0)
No, not seeing whole pills, more like granules like you said.  I have actually looked very closely at the pills before I take them and it looks like they are made up of small round pieces......does that make sense?  I take four pills in the morning right after I eat my breakfast (around 6am) at which time I also take my prednisone.  I take four pills when I get home from work, usually around 7pm, right before I eat dinner.  I wait until bedtime to take my cholestyramine to avoid any drug interactions.......I try to stick to this schedule or I forget to take meds......and even doing this I still forget at times. (I forget my Salofalk supps all the time and then remember when I wake up at 2am with "urgency".)
Posted 1/12/2010 7:39 PM (GMT 0)
Just to let you know that prednisone can increase acidity...could be part of the problem.

Yes, I'd assume some of the granules might not break open since they're time-released and dependent on ph balance in the colon.

I'll encourage you to ask for the Salofalk retention enemas rather than the salofalk suppositories....more dosage for the amount used....and they're efficient especially for the urgency.

How many bms are you having during the day and are they loose, diarrhea or more formed?

I like the lines of wisdom in your siggie...
quincy
Posted 1/12/2010 9:50 PM (GMT 0)
Enemas......hmmmm.  Are they easy to retain?  I like the supps as they are easy to use and I usually don't even notice after inserting.  The only thing with the supps is that I need to go to the bathroom as soon as I wake up as I have a lot of gas and pass all of the wax........

My BMs are very normal now, formed, and vary on the number throughout the day, anywhere from 1 - 5.  I notice urgency when I forget the supps at bedtime and during the day if I get upset or stressed out.  Is that something that others experience with emotions? 

I am going to try dissolving the Pentasa in water tonight to see if that makes a difference.  Thank you so much for your advice. 

PS.  my sig lines are two of my mottos tongue

Posted 1/12/2010 10:37 PM (GMT 0)
I have no problem retaining them....been 21 years.

Here's how I weould see it for you....anything you can do to stay off the pred is a good thing for the rest of your life....the retention enemas could become one of your best friends too..lol.

Normal to have gas when flaring, when stressed because many of us has IBS, from some foods...etc.

Regarding the enemas....you get a much larger amount of medication to the area that's the most difficult to heal. 1 - 5 bms a day is still flaring....but with no blood? That's a good thing too.

Let me know how long it takes for the pill to dissolve...just curious.

I hear you're having quite warm temps your way....tomorrow we're expecting +4..ugh. I like it cold and not mushy, slushy.

Please consider the Salofalk enemas.

quincy
Posted 1/12/2010 11:52 PM (GMT 0)

I am definitely trying to get away from the prednisone.......looking at Imuran.......I have an appointment with my GP next week so I will ask her about the enemas.  As for gas, well, I have a lot of gas all the time, even when not flaring, but in the morning, it's dangerous turn Very minimal blood in BMs although last week I had one that was a LOT of blood even though the stool seemed formed.  There is always mucous.  I will post later this evening or tomorrow to let you know how long it took for the Pentasa to dissolve.

Very warm temperatures here and a lot of rain.  Very depressing for a "Sled Head" like me especially since I was hoping to go for my first snowmobile ride since my flare started sad and the weather makes for very dangerous avalanche conditions. 

Posted 1/13/2010 12:18 AM (GMT 0)
I have been on azathioprine for two years. This is generic Imuran. Prednisone is awful, I had to take Lorazapam on top of pred to deal! Anyone else have this problem with Pred! My symptoms are coming back in a weird way: no 50 plus trips to the bathroom with diahhrea and tenesmus but every time I have a bm or urinate there is a mixture of mucous and blood in my stool. Always mucous.
I take Asacol and lately I have been seeing whole pills in my stool. I take 3 400mg 3X a day. I have been in remission for 2 years but having had these weird blood, mucous, anxiety, fatigue cropping up since before christmas, I am getting a scope done in a week. I'm nervous. Oh, also, I have about 15 small chankres in my mouth and just got over Iritis in my left eye. Sorry if I'm posting in a weird place, I just found this forum...[Asacol 1200mg 3x a day
azathioprine 200mg , Fish Oil tabs 1500mg,
Diagnosed with UC Jan, 2008, remission untill Nov. 2009, seeing signs of flares since then.]*
Posted 1/13/2010 12:18 AM (GMT 0)
What's the dif between Pentasa and Asacol? Are both sulfa drugs?
Posted 1/13/2010 8:05 AM (GMT 0)
I had the same problem... but guess what? one day I got real brave and decided to take a closer look, you know what it was? Its just the shell of the medication, the inside is all gone!
Posted 1/13/2010 6:55 PM (GMT 0)

Both Pentasa and Asacol are mesalamine. I tried Asacol in the past and it appeared to make my diarrhea worse, perhaps something in the coating?  I have been on Pentasa for over a year now and it seems to work fine other than the "granules" that I see in my BMs. I found the following information on the Pentasa web site......

  • Each PENTASA capsule has a gelatin-like coating. Once inside your stomach, the coating dissolves, releasing tiny semiporous spheres. These spheres help deliver the mesalamine to your small and large intestine.
  • Water found inside your intestine flushes mesalamine out from the spheres.
  • Once the mesalamine is released, the drug is free to help reduce the inflammation.

Other oral mesalamine drugs work differently. They may instead rely on your digestive system having the right levels of acid (pH) or bacteria to deliver the mesalamine into your colon.

Quincy, I dissolved the tablets in water last night.  Within seconds, the tablets looked like pulpy wood.  I stirred the water and let it sit for about ten minutes.  Everthing settled to the bottom of the glass, so I stirred again and then tried to drink it very fast as the settle rate is very fast.  I had to keep adding water in order to get all of the medication.  It looked like little granules which is what seems to be in my BMs.  So, I am not sure if it is undissolved meds or the coating.  Reading above, one would assume that the gelatin coating completely dissolves.

Anyway, I seem to be doing okay lately.  I'll just keep on keepin' on........Thanks everyone for your input.

Tuturoo, welcome to the Forum.  I am very new to it myself and have found it to be very helpful in so many ways.

Posted 1/13/2010 7:09 PM (GMT 0)
I've never been on Pentasa, but same thing happened to me on Asacol. I was taking 6 pills twice daily. I didn't notice until I was in the hospital with a bad flare and I could see a few completely undissolved pills in almost ever BM in the container thing they had me go in to keep tract of my stool output. Then when I had a colonoscopy they actually saw several of them just sitting throughout my colon. My GI said he's seen that happen a few times and switched me to Lialda which turned out to be a great drug for me so far. I haven't noticed any undissolved pills so far. Plus it's a lot fewer pills which is always a plus! Anyway, this is definitely something that happens with these type of pills. Maybe it's less common with Pentasa but I still don't see why your GI wouldn't believe you. Not sure if spreading it out during the day would help or not but definitely talk to your GI about it or maybe changing meds. If for some reason he/she refuses to believe you then get a new doctor. If they aren't dissolving then they aren't doing you any good.
Posted 1/13/2010 10:22 PM (GMT 0)
Tuturoo....Pentasa and Asacol are in the family of 5-ASA. They are mesalamine.
Neither are Sulfa.


The only one with sulfa is Azulfidine which is sulfasalazine (5-ASA with sulfa as a vehicle to get it to the colon).



q
Posted 1/13/2010 10:26 PM (GMT 0)
BCGirl...interesting experiment. I suppose one way to take it would be with applesause...swallowed (not chewed obviously).

It's good you're improving, however. I wouldn't worry about the spheres since they wouldn't completely dissolve anyway.

q
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