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Asacol failed..what next

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Ulcerative Colitis
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Posted 7/24/2009 7:01 AM (GMT 0)
I don't even know if I should say that Asacol failed.  I think it was significantly helping the UC.  I was actually having formed stool which I haven't seen in a couple of years.  No blood or mucous, still some cramping pain.  I stayed on it for six weeks hoping that the side effects would go away, but they did not.  I had a constant headache, a minor itchy rash and upper stomach pain the entire time I was taking it.  So, my question is, what next?  I will do anything to avoid steroids.  Thanks for any input.
Posted 7/24/2009 9:05 AM (GMT 0)
What about the Colazal? Are you still taking it, and is it helping at all?

Usually the next step after the 5-ASA's is either an immunosuppressant (6-MP or Azathioprine) or Remicade.

If you have significant proctosigmoid disease, you should ask your doctor about rectal meds. Both Mesalamine and steroids are available for rectal use, and much less is absorbed systemically that way. Some people who don't tolerate the drugs orally do fine on them when taken rectally.
Posted 7/24/2009 7:43 PM (GMT 0)
hi i could not take asacol it made my diarrhea worse alot worse . I'm on lialda and doing good on it . Maybe you could try it ??? Sorry you are having this trouble .
Posted 7/24/2009 7:54 PM (GMT 0)
It depends if it's the formulation or the mesalamine that is bothering you. If it's the formulation, you may want to try other mesalamine drugs. If you have problems with mesalamine, you probably want to try biologics or immunosupprents. If you can't tolerate 5-ASA's I would NOT recommend sulfsalazine, as 5-ASAs are a metabolic derivative of the sulfur compounds.

Some other, less strictly medical ideas to try are: helminth therapy, omega-3 supplements, probiotics, and any of the number of diets that are out there.
Posted 7/25/2009 7:52 AM (GMT 0)
Malkavian....actually, 5-ASA is a salicylate, not derived from or related to sulfur at all. In sulfasalazine, the 5ASA is coupled with or connected to a sulfur molecule which in turn becomes its vehicle so that the 5ASA can go through the digestive tract till it's dispursed freely into the colon.

So, if one is sensitive to aspirin or any salicylates, any of the 5ASA meds including sulfasalazine could cause a reaction.

Some people are sulfa sensitive and can use the 5ASA meds, but may find reactions to the enemas or suppositories because of the metabisulfates.

Just clearing that part up.

quincy
Posted 7/25/2009 8:12 PM (GMT 0)
I think for some it works, others it doesn't. I also think the factors involved with med failure could be not high enough dosage, patient compliance or incomplete med coverage which should include rectal meds.

Some patients' ph levels of the ileum might not be as per the medication needs to dispurse....hence the other 5ASA meds available where bacteria is needed to dissolve the coating or for time released meds to be used.
There are many options....just because Asacol isn't sufficient, it's not the end of the line regarding 5ASA meds.

I need to stress the use of rectal meds....because it just wouldn't be me if i didn't.


q
Posted 7/25/2009 10:44 PM (GMT 0)

Yes, try the rectal meds.  Unfortunately don't think they are going to do it for me.  I may have to go back on prednisone.  I am using Cortifoam twice a day and Anusol suppositories three times a day.  Gradually getting worse since stopping prednisone.  Probably addicted or whatever!

I tried all mesalamines, including rectal and could not tolerate them - side effects like the flu. 
Blood tests showed that I could not take high enough doses of 6 MP to heal me and get me into remission.  All these are worth trying and wishing they worked for me like some people.  Doctor told me I am too old to do Remicade so I think I hoping for going back on prednisone for a while and maybe getting into remission or nearly (something I can live with).

ElaineNY

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