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Lialda vs Asacol

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Ulcerative Colitis
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Posted 1/6/2011 8:41 AM (GMT 0)
I know practically the same subject line was used recently... I guess that's what I get for putting off my intro post!

I've been lurking on the forum for a bit... I guess I'll start with my history, and then my question.

I was diagnosed with UC after a colonoscopy at the end of October. Symptoms started about a year before that. Basically constant diarrhea, nausea... lots of mucus at the end... fun stuff. I was sent home with some pamphlets and two prescriptions - prednisone started at 20mg and tapered to down to 10, and Lialda 2 x 1.2g a day.

At the first followup appointment the doctor told me that I had moderate level colitis, but it was "pretty much all over" and she was surprised I had held out for so long. She asked me if there had been any blood, and there was, one day. I almost wish I hadn't mentioned it because it seems like a freak incident, but I know it was enough blood (in the toilet) that afterward I was trying to look up online what warning signs were since of course it was over Thanksgiving weekend and there wouldn't be anyone in the office to answer the question.

She said she didn't want to raise my prednisone dosage so she switched the Lialda to Asacol, 1200mg 3x/day.

Before the appointment I had been doing better. With some Metamucil on the recommendation of a coworker, also with UC, I was having few solid stools a day (I cluster in the morning), still some urgency but I read that that's the last thing to go, and I seemed to be on the way to remission.

Three days after switching meds the diarrhea started again. The pharmacist had mentioned that as a side effect, and I called my doctor asking if I could switch back to the Lialda since I was doing better with it. She said it's the disease making me feel bad and not the drugs, and raised the prednisone to 25mg (now tapered back to 10mg).

I'm really frustrated right now. I feel like I've just stabilized but not where I want to be, and not where I was. I'm still having... I don't know if it would be considered full-blown diarrhea but soft/loose stool most days. I'm back to popping Immodium on a regular basis just to get on with my life.


What I'm wondering is, is it possible this is actually a side effect of the Asacol, or since they are both mesalamines, would I be reacting to both if I was going to react to one? I didn't notice symptoms getting worse lowering the prednsone, just not improving, so I don't think that one makes a difference. I have another followup appointment in a couple weeks and I'd like to give a good argument to switch back.
Posted 1/6/2011 12:27 PM (GMT 0)
Hi and welcome to the forum! I am sorry for your diagnosis.

I've only taken Asacol, but from what I've heard we can respond to these supposedly more or less "identical" meds differently. When my son was first diagnosed, his GI talked with us about how he'd be able to go on Lialda after he was flare-free for a while, and the ease of the dosing of that....... and a year later, when I asked her about it again, she told us that a significant number of her patients who had been in remission on Asacol were flaring when they switched to Lialda. My guess would be it's something about the binders in the pill... maybe the binders, fillers, whatever change the way it acts, very slightly.

So my kid is still on Asacol. Recently, while he was really stable, we changed his dosing so he splits the pills to take half in morning and half at night. He had no problems, and it's a lot easier to remember!

I am a big fan of Metamucil, so... glad you're trying it. We're all so individual is how we react to meds and supplements; this is not a "one size fits all" disease, which is frustrating.

Have you tried probiotics? Folks here take a bunch of different ones. I find they make a huge difference for me.

Also..... rectal meds might be helpful, even if your UC is located throughout the colon. You might ask for Rowasa retention enemas. I find that if the "bottom" is being treated by the enemas, I am more comfortable in general.

If you haven't already, a journal tracking meds, symptoms, and even foods is helpful. Some folks here have found that previously undiscovered food sensitivities affect their UC quite a bit. (For me, food isn't an issue, except when flaring..... we are all different!)

Again, welcome, and I hope this helps!
Posted 1/7/2011 8:16 AM (GMT 0)
Thank you for the response... I did just start probiotics this week so not enough time to tell yet there. Stopped taking the Metamucil when the symptoms came back because I didn't want to overdo it.

I've also been keeping a food journal since before I was diagnosed, thinking it was going to turn out to be a food allergy, and haven't found any connection. Hopefully I'm not just in denial there but I can eat "bad" food (dairy, etc) and feel fine, or eat nothing and be sick.

I can't help wondering though.... seems practically every post I read someone says rectal meds or enemas.... is there anyone who *doesn't* need those to get by??
Posted 1/7/2011 8:26 AM (GMT 0)
Hi..welcome to the forum!

Basically, i would request rectal meds such as Rowasa (I'm assuming you're in the US)..stay at the Lialda for now and get ithe improvement.

Regarding your not wanting to use them....maybe eventually you'll change your mind, and it seems some can get away without using them. It might not be that there isn't any inflammation, it could be that some don't have obvious symptoms and don't feel the need for them.

Consider, however...UC starts at the rectum and continues upward, it heals downward leaving the rectum pretty much untreated if rectal meds aren't used.
No medications taken orally will sit in the rectum long enough to be treated.

Definitely up to you as to using them...but I caution your apprehension because pred may eventually become your best friend and your worst enemy....

Did I mention that the rectum can be the most difficult area to treat? oh, well...for some it's never "end"ing.

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