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Mesalamine dose during flare

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Ulcerative Colitis
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Posted 9/28/2017 11:25 AM (GMT 0)
Hi,

I was diagnosed with UC 4 years ago and the initial flare was last about 8 months. Since then I was remission for 4 years till this March and started flaring again. My symptoms are 3-4 BMs daily with blood and mucus once/twice a day. I went to GI in May and had colonoscopy done. Report says islands of inflammation in Descending colon and Discrete inflammation in rectum and sigmoid . My GI has not advised to take any steroids or rectal meds and he thinks the regular dose of 2.4 mg of Mesalamine enough for the extent of the disease I have. It has been 3 months now I am still flaring with 3 BMs daily with occasional bleeding once in 2-3 days.Kindly advice if I have to insist on rectal meds or steroids to bring down the flare?

._.
Male 34 years
Dx With Left-sided UC in March 2013 was in flare for 8 months
Initial meds Budesonide 9 mg for 3 weeks tapering 3 mg each week along with 2.4 g Mesalamine
Currently flaring since March 2017 with 2.4 gm Mesalamine
Posted 9/28/2017 12:36 PM (GMT 0)
try increasing the mesalamine to 4.8g and add a rectal med -

your doc sounds less than helpful - can you find a new one ?
Posted 9/28/2017 1:03 PM (GMT 0)
A flare dosage of mesalamine is generally 4,800 milligrams per day and a maintenance dosage is 2,400 milligrasms per day. It sounds like you're still on a maintenance dosage despite your flare. Additionally, you should be on a rectal-route mesalamine like salofalk/pentasa/rowasa retention enema. I would call your doctor's office and ask for a dosage increase and the daily enemas.

Apriso has a max dose of 1,500mgs a day. Salofalk granules max at 3,000mgs. A few others max at 4,000mgs. So certainly check with your doctor or pharmacist before changing your dosage.
Posted 9/28/2017 5:27 PM (GMT 0)
Request mesalamine retention enemas and dont waste time with suppositories.
4g enemas....

What exactly is the oral mesalamine? Please put it in your signature...and is it 400, 500, 800, 1200 x whatever equal to 2400mg daily?

While the max of oral, except for Apriso, is 4800mg you should first introduce a high rectal dosage that covers the sigmoid as well. Suppositories can be added for day-time use to supplement the rectal regimen.

Increasing your oral dosage in increments is best rather than jumping to top dosage.....im suggesting that because some show increase in symptoms for a short time...which is normal....but you may not need that top dosage.

Call the doc and request...

Keep us posted......Welcome to the forum!
q
Posted 9/28/2017 6:39 PM (GMT 0)
Thanks iPoop and quincy for your advice to increase mesalamine to 4.8 gm. I remember my GI once was saying that, do not increase any dose without talking to him.So, I am very much scared to increse the dose myself. Currently i'm taking 1.2 gm delayed release tablets twice daily. So, is it wise to increase it to 3 times daily to see it is benefitting?
Posted 9/28/2017 6:49 PM (GMT 0)
Benefitting is subjective.....i would go to 3600mg, but it won't treat the rectum....keep that in mind. Fact is....UC starts at the rectum and continues upward. Heals downward....so you really need to treat it. Your symptoms will improve with increase dosage of oral mesalamine....but....improved by perception does not heal the rectum.

Make an appointment with your or have him call you.....your inflamed butt needs tending to. Say you want to try the retention enemas and can you increase the oral to 3600 because you are not improving.

q
Posted 9/28/2017 8:00 PM (GMT 0)
Nothing to be scared of.

Just a friendly reminder that we're not doctors here, so always consult with your doctor before changing your prescription dosing.

Generally there's no harm in overdosing with mesalamine with what we're talking about. As an example, I've taken 12 grams a day.
Posted 9/28/2017 9:24 PM (GMT 0)
I take 2g pentasa in flares and remission. I add rectal meds at first sign of anything. Then the dreaded pred!
Posted 9/28/2017 9:38 PM (GMT 0)
Do most UC patients use enemas as rectal mesalazine?

I have been using Salofalk suppositories since my diagnosis, my GI prescribes that because it is easier to retain.

However, since I am having every now and then bouts of loose stools multiple times a day followed by days of constipation (or viceversa), I am starting to think that suppositories are not quite effective anymore and maybe enemas would improve my symptoms.

Is there evidence that enemas are better at achieving and staying in remission than suppositories?
Posted 9/28/2017 10:34 PM (GMT 0)
If you have an UC limited to your rectum (also known as ulcerative proctitis) then a suppository would treat that well enough, but that's as far as they go. Suppositories are usually 500mg or 1 gram. If you are doing well symptomwise then stick with them.

Enemas cover the complete left side of the large intestine, a much greater area, and are typically 4.0 grams of medicine. So enemas are much more powerful anti-inflammatory medication when compared to a suppository. If you're struggling with UC symptoms then consider the enemas.
Posted 9/28/2017 11:59 PM (GMT 0)
iPoop- do suppositories reach the rectum/sigmoid juncture? Curious how far they reach.
Posted 9/29/2017 12:48 AM (GMT 0)
A good question, I'd say lower rectum reliably not sure on the rest of it. Couldn't quickly find an answer. Anybody know?
Posted 9/29/2017 7:39 AM (GMT 0)
Don't know if this helps but my GI said suppositories literally treat the very last bit of the colon (rectum). No mention of the sigmoid juncture.
Posted 9/29/2017 11:48 AM (GMT 0)
I'll have to ask my gi. I'm curious how far they actually go.

It's nice to know the enemas can cover up the left side. It's probably why rectals have been so effective for me...even tho it's a love hate relationship. ;)
Posted 9/29/2017 1:50 PM (GMT 0)
"even tho it's a love hate relationship. ;)"

Haha, I agree! Not the highlight of my day but I do what's necessary.

Let us know if your doctor knows how far they go.
Posted 9/29/2017 2:09 PM (GMT 0)
Its funny how some little things can actually irritate you over time. I don't like rectal meds at all but I guess its a necessary evil.
Posted 9/29/2017 6:35 PM (GMT 0)
I would say enemas go somewhat past the sigmoid. The point is to use both oral and rectal.

I wouldnt count on the supps dealing with the rectum/sigmoid juncture.

q
Posted 10/27/2017 1:29 PM (GMT 0)
Hi There,

I am posting this to update my progress since last month. Finally, I could be able to find another doctor since last one is not ready to up oral dose or to add rectal meds. This doctor recommended to use enemas for a month but he also insisting me to add short coarse of oral steroids, as he thinks enema wont treat descending colon. So, I'm in confused state whether to continue with enema or to add steroids as well. By the way as I mentioned in my last post, I've Active left sided UC with more ulcers in Descending colon. So, Kindly advice if I've to add steroids as suggested by doctor or should I continue with enema and see if it helps alone?
Posted 10/27/2017 1:40 PM (GMT 0)
I'm a throw everything at it and see what sticks, especially if you are struggling now with horrible UC symptoms. Nobody likes 100% systematic pred, you could instead ask for a prescription/script for delayed-release Budesonide version like Uceris/Entocort EC/Clipper to treat the right-side stuff with less side effects (all 90% topical and only 10% systematic). Enemas treat our biggest problem area that affects our quality of life the most.
Posted 10/27/2017 2:41 PM (GMT 0)
What do you mean use the enema alone? Use it in combination with oral mesalamine.

Use the enemas nightly till you need. One month isn't a cut off date. You may need them for 4 months nightly....your butt will tell you what you need

Did the doc not suggest to increase the oral?

The enemas arent meant to treat the descending, but some say it reaches there. Oral mesalamine treats the descending.

Personally, i would increase he mesalamines and give them a fair trial. Put the systemic steroid on hold.

q
Posted 10/27/2017 2:59 PM (GMT 0)
Thanks Quincy and ipoop for the reply. Quincy, I do mean enema in combination with oral. I just spoke to my doctor and he adviced me to increase oral by 400 mg in addition to 2.4 gm currently taking.But I forgot to mention with him that currently i'm taking 1.2 gm×2 daily. Did he mean to add another 400 mg tablet? Will it be fine with different comination dose tablets?
Posted 10/27/2017 3:03 PM (GMT 0)
Oral mesalamine is commonly dosed between 4,000 and 4,800 milligrams per day (depending on formulation) for UC flares. That'd be a grand total of 10-12 tablets a day that are 400 milligrams apiece. Any ambiguity then ask your doctor or pharmacist.

If you're taking only 2.4 grams (or 2,400 milligrams) then that's a maintenance dosage of UC, not a flare dose!
Posted 10/28/2017 12:45 AM (GMT 0)
Some of the latest research has called into question oral delayed release mesalamine dosing. They have found that for mild to moderate UC that 2.4 gm per day was actually more effective than 4.8 gm. For more severe cases the 4.8 was slightly more effective. I posted a video yesterday that reviewed the study briefly.
Posted 10/28/2017 5:38 AM (GMT 0)
When I asked my GI yesterday, whether i can increase oral dose to 4.8 gm he said high oral dose only desirable in case of proximal but not for th distal desease. Not sure how far he is true?
Posted 10/28/2017 6:06 PM (GMT 0)
The oral will not treat the rectum, but it will definitely help for the sigmoid. The enemas treat rectum and sigmoid and probably a bit beyond.

What part are you confused about?

Are you on the enemas nightly? And what dosage?

q
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