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Spacing of Colazal doses

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Ulcerative Colitis
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Posted 3/22/2013 4:44 AM (GMT 0)

So I've been in remission for about a year and a half! Yay! My question now is I'm on colazal as a maintenance med and Remidcade every 6 weeks (not sure of the dose right now, but I think it's above the standard starting dose. I was hard to get into remission). I take 9 750mg colazal a day. I've been on it for about 2 years, maybe a little longer. My first doc told me to take 3, 3x a day. After a while I called and asked his nurse if I could take 5 pills in the morning then 4 at night so I was only taking pills twice a day and it's easier to remember. She said that was fine.

Then I moved and started seeing a new GI, he said that I shouldn't do that. He thinks it's important for me to do the 3x a day dosing.

For one thing, obviously it's the remicade keeping me in remission and I've never had ill effects of missing a day of maintentance meds (I've been on several others in the past) so does anybody really think doing 3x instead of 2x a day really makes a difference? Also, I asked if I could start decreasing the amount of colazal I take and he said studies show that once you find a level of meds that help, it's better to stay on that. I can't help but think they don't really do anything and it's all the remicade, but who knows.

Wondering if anyone has had a similar experience. Ever since I started grad school it's been hard for me to remember to take it all the time. I didn't like telling my new classmates about it at first and I definitely don't want to be throwing back huge pills in front of everybody. I've been really bad about forgetting until dinner time so I just take all 9 in two doses.

Posted 3/22/2013 12:38 PM (GMT 0)
I am not on biologics but my 2 cents.

From my information, taking 3X a day is best solution, mainly because of the peak concentration needed to do the job. Balsalazide is a kind of pro-drug i.e. the drug as such doesn't do a job but the metabolite does and to have that metabolite present at the site of action all through out the day is important.

From my understanding, if you take 2 mega doses, you will have more concentration of the drug than necessary so anything above the peak level required to do the job will not be used and will be wasted (primarily because you are on a biologic). Instead, if you take 3X a day, you have best bang for the buck, in terms of its action at the site. You may want to pick pharmacist's brain for this.

Since you are on biologic, then may be you don't really need 9 a day.

Finally, why would you not take a pill in front of everyone? During my grad school, I had one bottle on my drawer all the time and I ALWAYS took my afternoon meds in front of everyone. Nobody really cared (they are stressed enough with their work as it is, why on the earth they would care about you taking pills in front of them?). But I did tell my condition to other folks in the lab, should anything weird happen, they need to know (Plus, we watched each other's back, was necessary for survival from a psychopath boss). If you have smartphone, then there are tons of apps to remind you to take a pill. Don't perform your daily or weekly religious stuff but make sure you take your meds lot more religiously.
Posted 3/22/2013 1:32 PM (GMT 0)
I have been on colazal for almost 3 years and have taken it twice a day. I read a article that claimed that 3 times a day dosing is a carryover from Sulfasalazine which has intolerance issues that are helped by spreading out the dose.I figure the first doctor knew this and your second doctor just wants to follow the label.

I did find that taking the pills during breakfast and dinner helped with indigestion that I got from colazal on a empty stomach.
Posted 3/22/2013 2:23 PM (GMT 0)
I've been on Colazal since 2006. I really didn't think it was doing much so I reduced the amount to 6 a day. Worst mistake of my life! It put me in the hospital. Since that time I have started on Remi and I've been on it for 1 1/2 years. I honestly don't know if I still need the Colazal or not either but my GI told me after I asked him about it that he still wants me on Colazal because he didn't want to rock the boat.

I've always done the 3 x 3 dosing because too much at once makes me go to the bathroom with yellow D. I think the higher concentration is too much for me.
Posted 3/23/2013 4:54 AM (GMT 0)
I've been on Colazal most of the time since 2003-- take it 3 x 3 daily, after a meal. RE your need to take midday dose in front of fellow grad students: DELTAFORCE IS ABSOLUTELY SPOT ON with his advice. Don't let their presence bother you a bit! On the other hand, if splitting Colazal dose into 5 +4 has not disagreed with your body over time, it is probably better for you to continue this routine than to reduce or eliminate the mesalamine. Many leading gastros/IBD researchers believe that taking oral mesalamine while on biologics helps guard against colon cancer. / Old Hat (32 yrs with left-sided UC; presently in remission taking brandname Colazal)
Posted 3/23/2013 10:00 AM (GMT 0)
Often the dosing regimen is simply the way it was done in the trials and there is no information about alternative regimens. I believe this was the case for Asacol for example. See Dr. William J. Sandborn from Mayo Clinic comments on clinical study.

http://www.youtube.com/watch?v=P5z2KQmAZOo&list=FLkqZSvCf2jUWgySYlDradRg
Posted 3/23/2013 11:50 AM (GMT 0)
I take 3 x 3 times a day . Morning , about 3 to 4 pm and before going to bed. Been on it for about 5 years. I also take Humira . Why rock the boat?
Posted 3/23/2013 4:19 PM (GMT 0)
I've been on colazal for 8 years. I do 3 x 3. 3 after breakfast, next one around lunchtime, then after dinner. My GI has said I could switch to Apriso to lessen the number of pills I take, but I've been doing this routine so long why switch?! He was also okay w/ me doing 4 in the am and 4 in the pm if it was easier to remember.
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