Should I decrease my Asacol?

I've been pretty well for the past few years on 12 Asacol/day and Rowasa tapered to about once a week for maintenance. When I don't use the Rowasa for a few weeks in a row, i see symptoms come back.

Do you think it would be ok to decrease my Asacol a little? If i decreased, would I go down to 10 or 8? I ask because when i was first put on it I was put on 6, then increased to 8, then to 12 (never went to 10). I don't want to mess with a good thing, but I do get a lot of "brain fog" and I think it may be from the Asacol, but I'm not sure.

Thanks for your input.

I would do two things. 1)Decrease by one pill a week or two....never do a larger incriment.

2) up the enema usage to twice a week.

Good to hear all is good....

One positive is that if you taper the asacol oral, you can up it if you need it.

Do you have pancolitis?  if yes..I wouldn't lower any more than to 8 daily.

When was your last scope...what were the results?

q

nssg...you might consider to use the enemas instead of the supps to see if that can get you down to 6. The 2g Rowasa is available.

q

quincy, I have had a hard time with the enemas when I am having symptoms. It's as if I will have to use the toilet desperately within 30 minutes of inserting the enema. When I use them when I am feeling okay, no problems, but if I am even very mildly inflamed, I have to use the bathroom. It's not just the need to expel the enema either, it's a full movement. I was doing badly a few weeks ago and I kept trying to use enemas with the same result. Now I went back up to 8 Asacol and I am better. I am sure I could use the enemas now. Maybe I will try using the enemas while I am well and go down to 7 and see how I do. It seems like it's impossible for me to get below 8/day without having symptoms. Now my GI wants my script to be for 6/day which doesn't seem to cut it. I wonder if I hadn't gone back to 8/day, if I would have improved regardless. Maybe I was too quick to assume it was the decrease in oral meds but I don't think so because I've tried before with the same result each time.

Thanks for the input. Does it have to be taken in even dosages for any reason? I always see people taking 6, 8, or 12.

Thanks. That's a good point about the Lialda vs. Asacol.

I'm taking six Asacol twice a day.

This is from a 2011 Mett-analysis on remission stats with Asacol:

Effi cacy of 5-Aminosalicylates in Ulcerative Colitis:
Systematic Review and Meta-Analysis
Alexander C. Ford , MBChB, MD, MRCP 1 , 2 , Jean-Paul Achkar , MD3 , Khurram J. Khan , MD, FRCPC4 , Sunanda V. Kane , MD, MSPH5 ,
Nicholas J. Talley , MD, PhD6 , John K. Marshall , MD, MSc, FRCPC4 and Paul Moayyedi , BSc, MBChB, PhD, MPH, FRCP, FRCPC4
OBJECTIVES: The effi cacy of 5-aminosalicylic acids (5-ASAs) in ulcerative colitis (UC) has been studied previously
in meta-analyses. However, several randomized controlled trials (RCTs) have been published recently,
and no previous meta-analysis has studied the effect of 5-ASA dosage used.
METHODS: MEDLINE, EMBASE, and the Cochrane central register of controlled trials were searched (through
December 2010). Eligible trials recruited adults with active or quiescent UC, comparing different
doses of 5-ASAs with themselves or placebo. Dichotomous data were pooled to obtain relative risk
(RR) of failure to achieve remission in active UC, and RR of relapse of disease activity in quiescent
UC, with a 95 % confi dence interval (CI). The number needed to treat (NNT) was calculated from the
reciprocal of the risk difference.
RESULTS: The search identifi ed 3,061 citations, and 37 RCTs were eligible. Of these, 11 compared 5-ASA with
placebo in active UC remission, with the RR of no remission with 5-ASAs of 0.79 (95 % CI 0.73 –
0.85; NNT = 6). Doses of ≥ 2.0 g / day were more effective than < 2.0 g / day for remission (RR = 0.91;
95 % CI 0.85 – 0.98). There were 11 RCTs comparing 5-ASAs with placebo in preventing relapse of
quiescent UC, with the RR of relapse of 0.65 (95 % CI 0.55 – 0.76; NNT = 4). Doses of ≥ 2.0 g / day
appeared more effective than < 2.0 g / day for preventing relapse (RR = 0.79; 95 % CI 0.64 – 0.97).
CONCLUSIONS: 5-ASAs are highly effective for inducing remission and preventing relapse in UC. Evidence suggests
that doses of ≥ 2.0 g / day have greater effi cacy, although doses > 2.5 g / day do not appear to lead to
higher remission rates.
Am J Gastroenterol 2011; 106:601–616; doi: 10.1038/ajg.2011.67; published online 15 March 2011

Thanks all.

Oh okay, makes sense. Thank you! :)

Interesting, Quincy, your comment that you would go no lower than 8 if you have pancolitis.

I have pancolitis and I've been on 8 for one year and have just dropped to 7 and plan to stay on that for a year.

I'm wondering where you've pulled 8 from as a maintenance dose for pancolitis.

Sara, what symptoms return when you cut back on the enemas.

If they are just rectal related symptoms then the Asacol is probably doing its pan-colon job.

I dropped from 12 asacol to 6 on my previous doc's say so in January 2010. Flared major within a couple of weeks and had to go back up. I only attribute it partly to the decrease in Asacol. (I wasn't using enemas then)

When I dropped over several months back to 8 I told my doc I wanted to stay there even though he wants me to get to six.

It might be a year on 7 before I go to 6 if I do at all. Keeping up nightly enemas or taking a night off every third or four night.

Ellen

My doctor called me back and said I could decrease to 4 tablets twice a day. They said I don't have to decrease gradually but I think I will. I'm really scared to decrease at all.

Yes, they always call me back the very next day. Really like this place. My doctor said it is extremely rare to have kidney problems with the 5-ASAs. He did test it last summer because I asked him to. But it's not something they test for routinely at his practice because of the rarity.

Sara14,

Glad he tested you last summer. But it's not "such a rarity" as he claims, and it's best to be pro-active and get tested.

Did you get your liver functions done too?