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mesalamine differences?

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Posted 2/22/2011 3:48 PM (GMT 0)
Asacol, Lialda, Apriso, Colazal

Does anyone know the real differences between these medications outside of dosage amounts?

I have been taking lialda for about 18 months, but have still had some residual symptoms. My GI thinks changing to either Asacol or Apriso may be the answer... but I can't seem to figure out why that would be.

 

Posted 2/22/2011 3:54 PM (GMT 0)
I only took Apriso (6 pills while flaring, 4 while in remission) and it seems to work fine for me. I know that it has a delayed release, so the pills do not open until later and further in your digestive tract. This is supposed to help your intestines get the benefits of the mesalamine for a longer time.

Hope this helps,
R
Posted 2/22/2011 4:04 PM (GMT 0)
Asacol, Lialda, Apriso, Pentasa are all mesalamines and are called 5-ASA's. Each is designed to break down at different PH levels and at certain areas of the intestine. Colazal is a basalazide which breaks down to a mesalamine. Because of the gel coating capsule of Colazal, the contents are released further down which benefits mostly left sider's and people with Sigmoiditis/Proctitis.
Posted 2/22/2011 4:15 PM (GMT 0)

OK... so colazal is thought to be more for left sided colitis, what would be the main distinctions between lialda, apriso, and asacol? Do each of them have a specific target as well?

I know lialda and asacol both are tablets with a coated exterior where as apriso is a capsule with granules.  But what does that distinction mean? That is, do they perform any different and if so how?

Does anyone have experience taking 2 or more of these and if so, what was the main distinctions (if any) that you noticed?

Posted 2/22/2011 4:32 PM (GMT 0)
I'm currently on Apriso and used to take Asacol. I gained remission while on Asacol, but chose to switch to Apriso as it is a once-daily dosing. I also chose Apriso because it is designed to start dissolving at a lower gut pH than Asacol; I was finding undissolved Asacol pills in my poop and there is evidence that people with UC have lower gut pH than those who do not. Both are supposed to start dissolving in the terminal ileum, I think. Apriso is also a much lower dose of mesalamine than Asacol (at the maximum dose of 4 Apriso and 12 Asacol). My doc said that Apriso is supposedly more effective at delivering the mesalamine, and therefore is why the dose is so much lower...he said he wasn't sure if he'd buy that, though, as it's such a new medication and there's just not much evidence to show that.

Apriso, Asacol, and Lialda are all three supposed to treat the entire colon. Except that none of them (ie, no oral meds) really do a good job of treating the rectum and the most distal parts of the colon, which is why it's wise to also use rectal meds.

I honestly didn't notice any real difference when I switched. I was in remission and nothing changed. I suppose that my symptoms gradually got less and less (ie, I became more and more "normal") but I think one could very easily attribute that to being further from the flare, and so my colon was just healing more and more.
Posted 2/22/2011 5:25 PM (GMT 0)
Here's a discussion of various 5-ASAs, from our "links to articles" sticky thread at the top of the forum:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773399/

I would try various 5-ASAs before moving to another class of meds; I've discussed this with my GI.
Posted 2/22/2011 6:16 PM (GMT 0)
I don't think there is a specific answer that applies to an individual. They all involve Ph in the digestive track to some degree. You have to basic types from there. Ones that use polymer(?) coatings and ones that use compounds that are biologically broken down in the intestine. The coated products differ in the Ph level required so will start releasing at different points in the same person. All resist breakdown in the high acid stomach.

I think your GI is right if he considers Colazal or Sulfasalazine also.

You will notice the differing market share for the various countries in Songlady's link. This is an indication of preference from marketing or medical bias not based on science from what I understand.

I am happy I switched from Asacol to Colazal. Not a huge difference but a noticeable one.
Posted 2/22/2011 6:33 PM (GMT 0)
I use colazal for UP. Like mentioned above it's released further down.
Posted 2/22/2011 6:34 PM (GMT 0)
Thanks AZ... where is your colitis, is it predominantly left side?

 

I think sulfazine is out for me as I am alergic to sulfa drugs, but he did mention the colazal as a possibility after I run through the others.

 

I have read how it uses the bacteria in the intestinal track to break down the bonds and release the mesalamine, although to your point, I would imagine this too would have a different release point in different individuals and may/may not just target the left side of the colon.

 

 

Posted 2/22/2011 6:48 PM (GMT 0)
Colazal is initially released at the beginning of the colon by intestinal bacteria.
It's not released only in the left-side...that's a misunderstood belief. It's prescribed more for left-sided UC because it's shown in studies to be successful for that. Nothing more.

It's only available in the US, by the way.

Regarding using only oral meds...it won't treat/maintain rectal inflammation.  Rectal meds should be added.


q

Posted 2/22/2011 6:53 PM (GMT 0)
Thanks Quincy,
I am also taking a canasa every other day.
Posted 2/22/2011 7:11 PM (GMT 0)
Go back to daily, maybe even twice a day. I'd still suggest a retention enema.

q
Posted 2/22/2011 7:40 PM (GMT 0)
seems to me from what i've read that colazal had much more side efects than the other 5-ASA.
Posted 2/22/2011 8:19 PM (GMT 0)

Alinus said...
seems to me from what i've read that colazal had much more side efects than the other 5-ASA.

Actually the claims were that it had less. I don't see how it is any different than all but sulfasalazine which has a very high rate of adverse reactions. Something like 30% over time.

Colazal is called colazide in Europe and Australia if you want to get more info on it. It is used more there and labeled for maintenance.
Posted 2/22/2011 8:35 PM (GMT 0)

jc1973 said...
Thanks AZ... where is your colitis, is it predominantly left side?


I think sulfazine is out for me as I am alergic to sulfa drugs, but he did mention the colazal as a possibility after I run through the others.



I have read how it uses the bacteria in the intestinal track to break down the bonds and release the mesalamine, although to your point, I would imagine this too would have a different release point in different individuals and may/may not just target the left side of the colon.



Yes I do have distal colitus. I don't think that colazal was supposed to only release farther down but that it was supposed to work better farther down. If you get what I mean. Most of the recent articles I have read say that it did not work better for most people with left side as hoped. Personally i think dosing is a problem . It is labeled in Europe for maintenance. The starting dosage is 1500mg twice a day. The bio equivalent of 750 mgs of colazal is only 263 mg of mesalamine. I take 3000mg(4 capsules) twice a day which allows me to eat anything I want. At the lower dosage, colazal does almost nothing for me.

I took sulfasalazine and after a month I had to stop because of adverse reactions. If you are actually allergic to sulfa, don't try it. There is tons of sulfapiridine released when it breaks down. For people that can take it, it may be the best maintenance drug for UC. And it is very cheap

Basically all the drugs are going to work differently in different people. Asacol HD would show up partially dissolved occasionally when I was symptom free. When I had mild symptoms that would happen more frequently. I don't think having your dosage drop when you have symptoms is so great. Other people never even get shells of the pills.
Posted 2/23/2011 2:52 AM (GMT 0)
They were all the same to me - none of them worked, on sulfasalazine for last 6 months.
Posted 2/23/2011 3:28 AM (GMT 0)
Sometimes I wished I could go back on Sulfasalazine. When I could take it, it worked really great..........well until I had HUGE hives all over my legs from it. Sometimes the older meds work the best it seems.
Posted 2/23/2011 6:45 AM (GMT 0)

AZYooper said...

Alinus said...
seems to me from what i've read that colazal had much more side efects than the other 5-ASA.

Actually the claims were that it had less. I don't see how it is any different than all but sulfasalazine which has a very high rate of adverse reactions. Something like 30% over time.

Colazal is called colazide in Europe and Australia if you want to get more info on it. It is used more there and labeled for maintenance.

i've simply read colazal prospects over the internet and compared to my salofalk prospects wich i am using. this is how i've got my conclusion, wich of course is subjective.

anyway, colazal is a balsalazide, a precursor for mesamamine, wich release it inside the colon after being decomposed by bacterias.
http://en.wikipedia.org/wiki/Balsalazide
Posted 2/23/2011 4:40 PM (GMT 0)
My GI had said that Lialda converts into a paste like substance once the encasing is dissolved. I was taking 6 lialda a day, and he thought it was possible that the paste itself (not the mesalamine) could be giving me some of my symptoms, so for starters I am trying the asacol and after a week or two and if the symptoms get better than I may switch to it, if not, I will give the asipro a shot and see what that yields.

Posted 2/23/2011 6:14 PM (GMT 0)
Yes, that's what I think JC that people do better or worse on different preparations mostly because of the "other" ingredients. Sometimes (for people like me) the amount of Mesalamine is key too. Some Mesalamine helps me. A LOT of mesalamine makes my colon grumpy. So, I'm taking Apriso. Supposedly the little granules spread a smaller amount of Mesalamine more evenly. The less is more approach I guess?
Posted 2/23/2011 7:59 PM (GMT 0)
jc...do you split your lialda dosages or take it once a day?

q
Posted 2/23/2011 9:56 PM (GMT 0)

I was taking the Liadlda twice a day (3 pills each time). Pprior to going to 6/day, I was taking 4 and when I took them all at once I had issues, but splitting them was much more tolerable. Problem was that I still was having bleeding and flaring at 4 which subsided when bumped up to 6.

So I definitely think there is something to the Lialda thing that I don't tolerate well at larger quantities, but I have probably been blaming on the UC and not necessarily the medication.

Posted 2/24/2011 7:13 AM (GMT 0)
Have you considered to use the mesalamine rectal meds in conjunction with the Lialda? Lower oral meds and higher rectal (tapered to maintenance after a flare is controled) can be a good combo...at least it's been for me.

q
Posted 2/24/2011 2:32 PM (GMT 0)
Yes, thanks for the suggestion.

I have tried reducing the oral and using more of the canasa. The problem is that I really did have a lot of inflamation on the right side (actually, GI said that I appeared somewhat atypical in that when scoping the inflamation actually increased the further up the colon he went, whereas ususually it remains constant or decreases).

Anyway, when I reduce the oral, I see the issues start to arise again. Then again, there could be a huge mental component here as well as I know I am very psychosomatic!

Posted 2/24/2011 6:49 PM (GMT 0)
You're not causing your symptoms....it could be that they're not the right meds for you.

You might want to suggest Pentasa...take a peek at it and possibly it can be one for you. But the Apriso might also be good for you...good dispersal with less mesalamine.

I also would suggest the retention enemas rather than the Canasa....

I think you'll find the balance eventually.

Are you also on probiotics and fibre supplements?

What other supplements are you taking?

q
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