Is there a downside to over-medicating?

I'm still only taking ASA medications (orally and rectally). I'm getting scoped later this week to determine if I'm in remission and if I am, my GI might taper medication. I'm somewhat reluctant to do that because I've been feeling mostly fine with basically no symptoms of UC since I'd started doing Rowasa every night.

So I guess I'm wondering there's any downside to being as cautious as possible and just continuing what's worked for me? Why taper if there's nothing wrong with continuing as is?

To be honest, from what you've said, it does not sound like you will have to taper meds. If what you are doing is working for you and keeping you in a solid remission then there is no reason to change.

It sounds like you're on some pretty safe medications to stay right where you're at with them. If you're feeling well on these type of meds, while in remission, stick with it. I am allergic to those type of medications, but if I wasn't, I wouldn't hesitate to do exactly what was keeping me in remission. It's when you start using the "heavier" classifications of drugs that the urge to reduce or stop weighs on you a little bit more.

Maintenance 5-ASAs and rectal meds as needed = NOT over-medicating

Permanent maintenance via prednisone = DEFINITELY over-medicating and need to get on less toxic meds.

An acceptable taper might be keeping your daily oral 5-asas but taper rectal meds from every night to less often. Quincy or Kaz might be the experts about that.

sfc....What dosage are you at oral/rectal?

Please call them 5ASA and not ASA (which is aspirin).

q

It's been years since I was on asacol/rowasa but my first GI doc always wanted to taper/stop my meds when my colonoscopy results were good and I would always end up flaring. I don't see any point for you to taper if your current meds are working well.

(I wonder if anyone would tell a heart patient to stop their seizure medication to see if they really needed it...?)

It can be tricky sometimes to balance the various risks involved.
You are right to be cautious, and to question whether it is wise to taper your meds at this point.
Good luck sfc.

It's important to note that most people have zero side effects from mesalamines, even at max dose for years.

To be fair, if it were me, I might be tempted to taper down to 3.6g per day Asacol and if that worked, taper down further to the official maintenance dose of 2.4g per day. I would also taper the enemas down to every other day and see what happened and if that worked, taper down to maybe just once or twice per week. This strategy does have risks though and you are perfectly right to worry about tapering and wanting to stay with the status quo because if you flare again sometimes just upping the dose back up doesn't work like it did the first time and then it's time to move up the med ladder to more dangerous meds. Staying at full dose now is preferable to that. If you do decide to taper at all I would increase back up automatically any time you or even your family members get sick, need antibiotics, or go through periods of stress. Hormonal fluctuations can also be considered. You don't want to wait to get worse first before deciding to up the meds back up. You always want to cut it off at the pass and be pre-emptive rather than reactive because by then it is often too late.

I have a unique philosophy about this chronic disease. Many people here are on an oral maintenance mesalamine and take rectal meds as needed. Actually that is not much different than my protocol. I am allergic to mesalamines but I use daily maintenance supplements and take extra supplements when needed.

One big problem with both meds and supplements is that they can work quite well for a while, but it is very common for them to all of a sudden stop being effective. We see this all the time. I know that subtle changes in my diet can cause at first minor symptoms. (A small diet change could be as subtle as a new multivite with iodine derived from kelp. Shellfish and seaweed instigate flares for me.)

But these symptoms could be masked if I took, my version of “big gun” meds, powdered psyllium seed / VSL#3DS every day. I wonder if my condition will gradually get worse if I continue to blithely eat something that disagrees with me while I mask the symptoms with Pseed. Under the surface will my UC gradually be getting worse until Pseed no longer works for me? I dunno.

The same thing for those who use rectal meds on an as needed basis. Most of the time you will be fine because you are still on a daily oral maintenance med. But you will be able to receive immediate feedback if there is something in your diet that causes inflammation. When that happens you can take your rectal meds to snuff out any symptoms before they get worse. Just as I use my big gun supplements to knock out my symptoms on an “as needed” basis.

In the meantime we will have valuable feedback on what dietary changes we need to make. I don't know if this makes any sense to you but this is what has been working for me.

Here's what I understand according to my last GI.....staying on max meds means something's not working. But...in all fairness, 5ASA meds take a while to work.

What extent is your UC...meaning up to where?

How long have you been on nightly enemas?

What exactly are your bms like...how many and consistency?

I'll continue with my next post.

q

Congrats on the good scope results.