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Does Lialda work better if you take all pills once daily or twice daily?

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Ulcerative Colitis
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Posted 5/9/2016 2:57 AM (GMT 0)
Hi all,
so I have been on Asacol HD for the last 3 years with pretty good results. I did have some minor flares throughout that I was able to get under control with mesalamine or hydrocortisone enemas, but have been pretty happy with the Asacol. So of course my insurance company decided that it would no longer cover Asacol HD, but will cover an equivalent such as Lialda. So I had to switch and had been taking Lialda for about 3 weeks when symptoms started back up - blood, mucus, urgency. I immediately started mesalamine enemas nightly and have slowly been getting things back under control. I feel like the Lialda is not working as effectively for me as the Asacol HD at maintaining remission and I'm wondering if it is not reaching the distal of my colon like it should be, possibly dissolving too soon.
My question is....does Lialda actually work more effectively if all 4 pills are taken once daily at the same time? Because, I have been splitting the dose - 2 in the morning, 2 at night, assuming that would be more effective. Why wouldn't you want the mesalamine released throughout the day instead of all at once? I assumed that was just a strategy by the drug companies to make Lialda more appealing to people. So now I'm wondering if it actually is more effective somehow if taken all at once??? Have I been taking it wrong this whole time?? Any input would be appreciated!!!

Also, has anybody ever had any luck with having your doctor send an appeal to get switched back to original medication that is not covered?? I'm sure they would rather pay for Asacol HD then Remicade infusions!!
Thanks guys!!

Amy
Lialda 4800 mg daily
Mesalamine/hydrocortisone enemas as needed
just started tumeric/circumin capsules 2 g daily
Posted 5/9/2016 2:06 PM (GMT 0)
It all depends on the ph or bacteria which starts to dissolve the outer coating and release the medication. All you can do is try and see how it works for you. They also release throughout the colon, so it should reach the sigmoid. The enemas will take care of the rest as well as the sigmoid for full coverage.

Some people cannot tolerate a higher dosage at the same time....looser stool being one of the side effects. Splitting the dosage can lessen that possibility.

No, you weren't taking it wrong. But you can try it with the Lialda to see if it works for you.

q
Posted 5/9/2016 2:20 PM (GMT 0)
I agree wtih Q. it probably requires some trial and error to find out what works for you. It really stinks when you're doing so well on something and you have to change for insurance purposes. I wonder what it would cost for you to go back to Asacol? I would try the appeal if I were you. I've seen people mention having luck and I agree, that would be the easiest solution (If it works).

At this point, I wonder if you're seeing reduced effectiveness of mesalamine to treating your condition, or if you're seeing less response to Lialda... I know over time, my UC stopped responding to mesalamine, but considering the order of events, it sounds like your situation is purely from the medication switch.
Posted 5/9/2016 3:06 PM (GMT 0)
Are you passing whole lialda pills? If not then it's likely working. Generally, lialda is all in the morning, but I've seen some split the dosing to am/pm. Honestly, I don't think the timing makes a whole lot of difference. As the biggest impact on when each pill reaches your large intestine is your digestive tract's speed and also what you've eaten that day. By the time the pills have travelled all the way to the large intestine, they might now be close together regardless of when they were taken. As Quincy said it's a PH-delay, not a time-delay. You can certainly try different timing and see if it matters for you.

Some do find one type of mesalamine/5ASA to work better for them. There's other choices, check and see if your insurance formulary list includes: apriso, pentasa, delzicol, colazal, etc.

Uc can spread and get more severe. Over time, mesalamine might no longer be sufficient to control your uc symptoms by itself, you might need a stronger medication.
Posted 5/9/2016 3:40 PM (GMT 0)
When I was taking 4 Lialda, I took 2 in the morning and 2 at night. I'm down to 2 now so I take them at night.
Posted 5/9/2016 5:09 PM (GMT 0)
I always took my Lialda 4 pills in the a.m. Worked great and maintained remission for almost one full year--when my insurance company made me switch to Asacol. Within a few days I had all the signs of impending flare. about 4 weeks on Asacol, things are settling. I also added a nightly enema. I think it's a blip on the screen with the med change--give it a little more time.

This event gives me new respect for the meds. No way will I ever go med free if this is what happens just with a change in the delivery system.

My G.I. told me if things don't settle completely she will appeal to the insurance company for an exception. Good luck!
Posted 5/11/2016 10:19 AM (GMT 0)
That's awful to have had the change in meds upset things for your.

I did better on Lialda than Asacol preps and was told that Lialda dissolves the furthest down in the bowel. Maybe it is even something in the coating that has made things worse?

From what I read the research was on once a day dosing and this is what is recommended. Whether that is for clinical reasons or because they were trying to find a regime that is more acceptable and reliable I don't know.

I've started splitting my Lialda dose because I think too many pills at once may contribute to my gastritis but I'm not sure. The GI was OK with me doing this.
Posted 5/11/2016 6:10 PM (GMT 0)
Did you have any issues when you tapered off. I was on 4 pills and my Dr lowered me to 2. I felt like crap so I added 1 pill back. I just want to know if this is something that will pass as my body gets used to the new dosage or should I call the GI and ask to go back to 4 pills. No major flare symptoms, just fatigue, a bit of nausea, loss of appetite and more tummy growling. Stool is still firm and NO blood.

Michelejc said...
When I was taking 4 Lialda, I took 2 in the morning and 2 at night. I'm down to 2 now so I take them at night.

Posted 5/11/2016 6:14 PM (GMT 0)
Theoretically 2 lialda is considered a maintenance dose. However, some people require 3 or even 4 pills to control their uc symptoms. Your individual uc disease severity and response dictates your true maintenance dose, not a textbook. I was never able to reduce lialda below 4.
Posted 5/16/2016 9:03 PM (GMT 0)
Thanks! I think I may be in the same boat.

iPoop said...
Theoretically 2 lialda is considered a maintenance dose. However, some people require 3 or even 4 pills to control their uc symptoms. Your individual uc disease severity and response dictates your true maintenance dose, not a textbook. I was never able to reduce lialda below 4.

Posted 5/17/2016 9:48 PM (GMT 0)
I am glad you posted on this dose splitting issue. It never made sense to me that it should be as effective in one dose as it is in two. I understand its passage is unpredictable, but dose splitting must increase chance it is passing areas more frequently.

I suspect they licenced as a single dose to give them a USP over asacol, rather than because it is optimum.
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