Any benefit to switching 5ASA meds?

Hi all -

GI suggested that we try switching from the Pentasa that my son has been on for about one year to Asacol - just a last ditch effort before going on the something stronger. The Pentasa worked initially but then he started flaring again - we've increased the dosage to the max and still no improvement. The doctor suggested trying the Asacol but isn't very hopeful. He has left-sided UC and is on rectal meds too (Rowasa and cortifoam).

Just wondering if anyone had any luck when switching from one 5ASA to another?? I'm trying to cover all our options (medicines / supplements) before having to go on to the stronger stuff - methotreaxte etc.

Thanks again for any input.

I think worth trying. Some people do work better with different asa meds!

I have left sided. From what I understand Pentasa isn't really the best choice for left sided, but it has worked better for me than Asacol did. It's not an exact science. Since all of the ASA's tend to release at different parts of the tract then it is worth a try. Sometimes I wonder why they don't give you more than one type at once, like half max dose of one mixed with half max dose of another. Might actually work better that way but no one ever seems to do it.

Definitely worth a try. As my signature indicates, Asacol worked for years, but its replacement did not. Tried Lialda, but it did not work either. Old Mike suggested I try Colazol (its generic in my case), and it did make the difference for me.

Also, you should be pleased that your GI is willing, and even encourages, this step. Mine only wanted to go to the next class of drugs, and if I hadn't almost demanded trying a different 5ASA, I would be on 6MP or something like it.

The meslamine-based medications are topical, anti-inflammatory and work pretty quickly. If you don't notice an improvement in 3-4 weeks I'd recommend seeing your gi and trying a different approach. You've not said the dosage, I am hoping it is 4,800mgs a day of oral asacol medication (the max). Is the rowasa 4,000 mgs once per day (the max)?

iPoop: he's taking 4 x 800mg pills of Asacol (one in the AM one in the afternoon and 2 before bed). I'm assuming the dosage is based on his weight... and he is on the lighter side. And yes, the Rowasa is a 4g bottle.

Old Hat: thanks for the info - will definitely keep it in mind! Good to know there are other options to try.

Just a quick update: today was day four on Asacol - and better than day three which was better than day two.... fingers crossed.

I was on asacol before they discontinued it in the usa and it worked great for me. They put me on asacol hd when asacol was no longer available and I flared for over a year.

I am now on balsalazide (colazol generic) and it seems to help.

Hope he is better soon.

Carol: a few people have mentioned to try Colazol - gonna keep that in the back of my mind in case (hoping not) we need to switch again.. we are in the US also - he just started the Asacol - i'm guessing its the Asacol HD.. haven't looked to closely

Notsosickly: you bring up a good point - so what is the best 5ASA for left-sided UC - i was told his inflammation is about 35cm up -so what does work that far down?? the Pentasa worked initially - and on the Asacol he seems ok - not a 100% by any means...

hate all this experimenting on him - just wish i had the answers to help him feel like himself again :(

I am surprised that no one here seems to mention nutritional support. After I began with the acidophilus supplement in 2005 things really began to improve for me.

In late 1999 I was a mess and very sick because of the UC and bleeding. Rowasa helped initially. But the doctors didn't mention the importance of the effects that foods have. I learned through experience by March of 2000 that eating snacks, sweets, pastries, and other foods that are irritating to the colon will worsen the condition. It really took many months of sickness and bleeding to realize that. (Perhaps initially I was in denial and didn't want to stop eating the junk food.) Things were better by April 2000, but I had relapses between then and 2005 even though I was strict with diet. Between then and now I have gradually learned a lot about nutritional medicines, including foods which are beneficial to the colon.

Between 1999 and 2010 I have had Rowasa, Asacol, Cortifoam, sulfasalazine, and Colazal. But since 2010 I have been relying solely on my nutritional support. Even with a bleeding relapse in November-December 2012 I refused to get any prescriptions. With the drugs, even if they say they are enteric coated and supposed to only be absorbed in the colon, prescription drugs still absorb into the system in general, and I don't like that.

So now I stay away from any foods that are irritants to the colon, such as pastries and sweets, caffeine (or any coffee which is acidic), fried foods and especially processed foods. I mainly depend on the acidophilus supplement, folic acid, vitamin D and other vitamins, quercetin, extra virgin olive oil and fish oil, butter and whey protein. Butter is milk fat and milk fat is high in anti-inflammatory properties (so drinking whole milk would be better than low-fat). I had read that whey protein contains natural amino acids which have been shown to aid in the repair of damaged tissue cells in the colon (such as damaged by inflammation).

So, unlike 10-15 years ago, now I am able to eat hard-boiled eggs, cooked chicken white meat, baked potato without skin, white bread toast with organic butter, and also organic concord grape juice (which had also been shown to be beneficial to UC because of its natural flavonoids), carrot juice, and apple juice. I do not even bother with other things, as my "trial and error" phase between 2000 and 2005 made me realize that it's just not worth it having the more "risky" foods, not even once.

Because everyone seems to only mention prescription drugs and nothing about nutritional support, is my experience with all that really as unique as it seems?

^You're preaching in the wrong thread, so make your soapbox in a separate one rothbardish.
This is a thread on 5ASA meds....please read the title.

Try not to take the integrity of the thread in your direction. The issue of prescription vs alternatives/food/probiotics is discussed VASTLY. Go beyond this thread and read the discussions to actually broaden YOUR perspective.

q

rb: this is from the resources thread. Might be useful to you but the truth is, it's a lot of trial and error to find what works.

Apriso® - Eudragit-L (pH6) coating of 5-ASA-polymer coated beads, small bowel and colonic release
Asacol® - Eudragit-S coating that releases at pH7, ileocolonic release - replaced with delzicol.
Asacol-HD® - Eudragit-S and Eudragit-L coating, ileocolonic release
Canasa® suppositories – topical rectal release
Colazal® - diazo bond to inert polymer, colonic release
Delzicol®
Lialda® - Eudragit-S coating of metallomatrix 5-ASA, ileocolonic release
Olsalazine (Dipentum®) - diazo bond of two 5-ASAs, colonic release
Pentasa® - ethylcellulose/5-ASA beads, small bowel and colonic release
Rowasa® or sfRowasa® enemas – topical rectosigmoid releases (sfRowasa is sulfate free for those with sulfa allergies)
Sulfasalazine – diazo bond with sulfapyradine, colonic release.


balsalazide (colazal) is supposed to release in the left side. I tried it and I had no luck at all. The pills are big and it's a lot of them too. No convenient pill for that particular medicine I don't think. Not that it should be a deciding factor.

notsosicklygirl said...



balsalazide (colazal) is supposed to release in the left side.

this is a false statement.

q