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Canasa and Other UC Meds Long-Term Use: Does it Lose its Effectiveness?

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Ulcerative Colitis
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Posted 3/14/2018 11:20 AM (GMT 0)
Hi Everyone,

I am new to the forum, as I need to reach out to a group who can relate to what I am going through. I was diagnosed with proctitis and diverticulitis in May 2017 and was put on Apriso and Canasa. After 30 days of Canasa, my GI told me to stop using it since the blood and mucous went away. I went into remission for 8 months, and it came back with a vengeance a month ago after I was super sick for two weeks with the flu. I think, but have no idea, the antibiotics caused the flare, but who the hell knows? My GI put me back on Canasa, but now it's not working as well as it did the first time. I am still having blood in the stool, cramps, and bloating.

My question is -- does anyone on here see their bodies sort of developing a resistance to certain UC meds over time? Like, do they become less effective? I would love to hear from someone, for example, who has been on meds for over three years or so and had to switch.

Thank you so much!
Posted 3/14/2018 12:33 PM (GMT 0)
Ulcerative colitis has a tendency to get more severe and spread in extent within the first 5 years after diagnosis. Each medication has a maximum strength and maximum effectiveness and if our UC goes beyond the capabilities of a medication then we flare and see uc symptoms. Thus Canasa and apriso haven't stopped working, they're still doing something but just not enough to completely eliminate your UC symptoms.

You might need higher doses and stronger meds this time. Some do several canasas a day. Rowasa retention enema has 4.0 grams medication versus canasa's 1.0g, and might be worth considering. There's always steroid suppositories as well!
Posted 3/14/2018 5:15 PM (GMT 0)
What is the extent location of your UC?
Explain your symptoms of flare.

No...they don't lose effectiveness per se. Your doc kind of set you up for a failure.....you were undertreated rectally. If you want to learn how to use them for most effectiveness...it is a commitment.
Definitely get on the 4g mesalamine.
You may need to add steroid rectals in conjunction.

q
Posted 3/14/2018 6:27 PM (GMT 0)
Hi Quincy,

Thank you for the response!

To answer your questions:
After giving birth to my second daughter in April, I had non-stop diarrhea (8x or more per day) with blood and mucous for two months before I found a GI doctor. The results of my colonoscopy from June 2017 showed proctitis and diverticulitis (inflammation of the rectum only). My doc put me on Apriso 4x / day and gave me Canasa to use at night only for 30 days only. After 30 days, the blood and mucous went away, and I was using Apriso only (still 4x/day) and achieved 8 months of remission.

A recent flare began in February of this year after I finished a round of antibiotics (Augmentin) for a sinus / ear infection. The symptoms of this recent flare have been blood and mucous in my regular stool. After two weeks of it, I called my GI and he put me back on Canasa for the next 30 days. He said that if the blood and mucous did not go away, he would put me on Humira, which scares me a bit based on the reviews and its side effects.

Your post suggests, based on your experience, I am being under-treated. So, if my symptoms do not go away in 30 days and I don't want to go on Humira, the other options would be increasing the mesalamine (this is what's in the Canasa, correct?) dosage and adding a steroid?

Thank you.....
Posted 3/14/2018 7:21 PM (GMT 0)
You need retention enemas in 4g dosage. Since you have diarrhea, it's probably into the sigmoid....but regardless, you should be given the best coverage before the threat to Humira.

You have choices in the treatment discussion....there are msny options regarding rectal meds, including steroid enemas and suppositories.

Im talking from a 29 year commitment, but it took me 3 years to figure it out with my doctor's encouragement.
My thoughts are your doctor is setting you up for failure if he is limiting the refills. There is a process of treating, then tapering then maintenance.

You could always request a one year trial process with follow up every 3 months with him to at least try the process.

Yes, mesalamine comes in topical oral, topical rectal suppositories, topical rectal retention enemas. Steroid comes systemic, topical oral, topical suppositories and topical enemas for treatment, but not maintenance use consistently.

Topical steroid can be used in conjunction with mesalamines, usually rectally.


I suggest you start a good probiotic.
q
Posted 3/14/2018 10:31 PM (GMT 0)
Thank you so much for your response; very informative and helpful as I approach the next doc visit. If I don’t heal I’ll ask for the stronger suppository.

One thing I did want to clarify—this flare is not diarrhea; it is soft stools with blood and mucous, three times in the morning. I am bloated with discomfort, and the gurgling stomach is back at night.

What do you recommend for a good probiotic? I’m currently taking Phillips Colon Probiotics. One/day.
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