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Max dose of Asacol HD? And why isn't one Asacol HD = 2 Asacol 400mg?

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Ulcerative Colitis
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Posted 3/16/2014 1:32 AM (GMT 0)
Hi all:

Battling this weird mini/sorta flare so I asked my GI for the max prescription for my Asacol HD...that way I have flexibility to take it up or down as needed...that's how he'd written my enemas so I wanted the Asacol that way too. Anywho...when I get to the pharmacy to pick it up it says "2 tablets twice a day." I wanted 6/day. I have enough to do 6/day for about another week...but it kinda surprised me.

And also...found this...can anyone translate this?

One Asacol HD 800 mg tablet has not been shown to be bioequivalent to two Asacol 400 mg tablets. In a single dose, cross-over pharmacokinetic study in 20 healthy volunteers, the mean mesalamine Cmax was 36 percent lower and the mean mesalamine AUC was 25 percent lower with administration of one Asacol HD 800 mg tablet relative to two Asacol 400 mg tablets. Because the mechanism of action of mesalamine appears to be topical, the impact of these differences in measures of systemic exposure on clinical efficacy is not known.
Posted 3/16/2014 1:44 AM (GMT 0)
it means systemic absorption (reflected in blood work) was 25% higher for regular. But IMO that is good. you want it in the colon - not in the blood.
Posted 3/16/2014 2:08 AM (GMT 0)
Max dose would be 6 pills per day. I always wondered how these 5ASA's work topically. I mean the total colon is huge overall and even 3 Asacol HD pills couldn't possibly coat the whole colon all at once. It seems like this would be all hit and miss with possibly different areas getting different amounts of meds and several areas not getting any meds at all each time the meds were taken. You'd have to depend on the randomness of it all coating all areas of the colon after days and days or months of taking he meds hoping for the best of coverage.
Posted 3/16/2014 7:04 PM (GMT 0)
Well, I haven't read a ton on this as I've always had success with the Asacol...but isn't it true that some of the different 5ASAs break down at different points in the colon? I thought Asacol was formulated to make it closer to the end before it broke down...in theory anyway...I know it could depend on transit time and pH and all that. I only have UC in the extreme lower part of my colon and rectum so hence the Asacol and enemas working so well...just thoughts...
Posted 3/16/2014 7:06 PM (GMT 0)
Max dose is 6 pills per day. Your doc is wrong.
Posted 3/16/2014 7:34 PM (GMT 0)
Asacol is one of the few 5asa orals that had FDA testing and labeling for both induction and maintenance. The tested dosages were 2.4 grams a day for 6 weeks for induction and 1.6 grams/day for 6 months for maintenance. GI started playing around with orals and rectals and higher dosages. Some generic small trials showed higher dosages were better for inducing remission. The owners of the patent (J&J?) saw an opportunity for a new patent and along came Asacol HD. It is labeled for induction only and has a tweaked plastic coating. Tested dosage is 4.8 grams.

Oh and Gary, they dye the entire Chicago river with just 25 lbs of green dye for St Pactrick's day.
Posted 3/16/2014 7:51 PM (GMT 0)
I am currently on asacol hd 800 mg. 6 pills a day, I take 2 am. 2 mid afternoon and 2 at night.

I was previously on asacol 400 mg. (before discontinuation) at 2 am. 2 mid afternoon and 2 night.

Doctor says I am at the max dosage, right now.
Posted 3/16/2014 7:57 PM (GMT 0)
I'm on 1.6g of asacol HD a day, but my doc wrote my script at 4.8g a day, in case I need to go up to the max of 6 pills a day. Sounds like that's what your dr was going to do, maybe he just forgot.
Posted 3/29/2014 12:57 PM (GMT 0)
I noticed a couple of times the pill imbeded in my stool in the toilet. It seems like it went through my body without breaking down. My doctor is telling me to take 3 in the morning but i was trying to space the 3 out during the day. Maybe the ones i'm taking late at night are just passing through.
Posted 3/29/2014 2:51 PM (GMT 0)
@bobsam55- What you are seeing is just the shell from the Asacol. It opens up to let the meds out, then exits your body looking much the same as it went in. Totally normal.

What's funny is that during my last colonoscopy when I was taking Asacol HD, my doc showed me a pic of some Asacol shells still sitting in my colon. We all had a good chuckle out of that one, lol...
Posted 3/29/2014 3:32 PM (GMT 0)
I think far too many just assume that it is the shell only, without the medicine inside. I'm going to take it for granted that most people who post this have checked and found that it is not just the shell only. I know for a fact that when I took Asacol I would occasionally find it imbedded in my formed stool and every single time I checked, the medicine was still inside. Sometimes it wasn't. You can usually tell if it is the shell only because it is in a weird shape. All the times I found medicine inside you could also tell by looking at it because it looked exactly like the pill you swallowed. I eventually switched to Lialda and this happens much less often but every once in a while I still see a pill imbedded in my stool that never broke down. I think this can happen with formed stool on occasion because the stool surrounding the pill kind of protects it from reaching the correct PH level to break it down.
Posted 3/29/2014 4:58 PM (GMT 0)
I never saw intact Asacol in my stool, and I took it for 13 years.
Posted 3/29/2014 7:29 PM (GMT 0)
My doc prescribed me max dose of asacol HD at 2 pills twice daily as well but, I knew otherwise and do 6 pills a day when I'm in a flare.
Posted 3/29/2014 7:34 PM (GMT 0)
I'm just saying that everyone is different. I don't doubt you at all but I absolutely guarantee that I found several unused Asacol's imbedded in my stools. I was curious and even put my hand in the toilet, fished them out of the stool bare handed, and broke them apart - several times. Every once in a while it was just the shell but the majority of the time it was full pills, never been opened. I eventually switched to Lialda where even though it still happens, it is very rare. There have been a few people who posted on here who also found unused Asacols in their stools. I'm just saying that you can't say it's nothing but shells 100% of the time. Like everything else with this disease, everyone is different and you can't just apply findings on your own particular case unilaterally across the board.
Posted 3/29/2014 9:03 PM (GMT 0)
Well then, I guess yours were definitely still intact, Gary! tongue

I just remember asking my doc because I kept seeing them, and he just said that means they are doing their job. I never fished mine out of the toilet, but I could tell that they were opened because they looked bloated.

Sorry, I didn't mean to say that everyone has the same experience as me. I can only post about what has happened to me.
Posted 3/30/2014 1:05 AM (GMT 0)
I can confirm that I've passed whole asacol too. I fished one out and it still had white mushy medicine in it! Such a waste of money! Sounds like most people only pass the empty shells though, lucky buggers.
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