Flaring again

Welcome back but sorry to hear you're flaring again. Flares suck.

I understand your intent of starting azathioprine, but it's more than a bit dangerous to start taking it on your own, without the required blood monitoring. Azathioprine will take a minimum of 3 months to work, so unfortunately, it is not going to give you quick relief from a flareup. I'd contact your doctor and ask for reintroduction of a blood monitoring (Comprehensive Metabolic Panel/Complete Bloodcell Count and a Hepatic Function Panel).

1.) For quick relief there is steroids (a week or two or less for relief). That's budesonide/uceris/clipper/prednisone or rectal foams, enemas or suppositories.

2.) Increasing your oral Asacol dosage from a maintenance dosage (2,400mgs a day) to a flare dosage (4,800 mgs a day) can take 3-4 weeks for relief.

3.) Reintroducing/Increasing your Pentasa enemas to nightly can take 3-4 weeks for relief.

Depending on how bad the flare is, #2 and #3 might be appropriate, and you might need #1 in there as well.

Most certainly, get a stool test for possible infectious causes to your worsened symptoms. As nasty bugs like c diff mirror UC flare symptoms, we're more prone to c diff, and c diff only responds to antibiotics (steroids make c diff worse).

Hi guys,


I’m already on 4grams asacol and that is a high dose. As for pred I’ve not responded to that either last time or this time.

All the steroid enemas and mesalasime enemas don’t work either.
I’m now in hospital due to blood loss. Waiting on a gastroenterologist to see me and hopefully overhaul my medicine.

You're undermedicated. My rheumatologist told me she straight up won't prescribe Azathioprine anymore due to the poor side effect and safety profile. It was a valuable drug before we had a variety of biologics but new guidelines in the U.S. are shifting to recommend biologics first (especially in severe pancolitis). I understand not all biologics available here in the U.S. are available in Australia so you'll have to see what your options are.

So everyone it’s day 4 and nil response to IV hydrocortisone.

I’m still in hospital and am having a flex sig today. Yesterday I was so unwell, I have never been this way before, it’s a first for me. I’m being spoken to about biologic therapy and surgery failing that. I actually want surgery but they simply can’t do surgery unless I’ve failed the next line drugs.

Let’s see what happens. I’ve got nil interest in food & have needles in both arms. I’m so drained from it all and just want my life back. So much for recovery..

They are still trying enemas daily and I’m that inflamed I can’t even hold in for a few minutes.

Cyclosporine is next in line. I failed steroids last year also so I knew this would come again.