Rowasa and hydrocortisone enema

Is it OK to take Rowasa enema in the afternoon and hydrocortisone enema in the night? Any known issues? I have also emailed my doc. Will hear from him on Tuesday.

Thanks

hurtbyuc,
I think it's pretty common to combine the two meds. I'm also using both topical (rectal) mesalamine and hydrocortisone - in a slightly different form. I use a Canasa (mesalamine) suppository in the afternoon or evening and Cortifoam (hydrocortisone) at night.

Toilet trips are more frequent for me in the morning hours, so I don't try to use them in the morning. I picked the times of day when I feel like I'll be able to retain them the longest.

Thanks all for you responses. I will try that today. Seems like a safe option.

Quincy, (sorry for the long story here)

I was on 30mg Pred for 7 days with nightly hydrocortisone enema. I had talked to my doc and asked if I can try Rowasa instead of the colocort as it had helped me before back in Nov 2012 along with asacol. He said it is fine to try instead of the other and prescribed it to me and I received it from the pharmacy but didn't use it yet.

I am now on 40mg Prednisone for the last 5 days along with the nightly hydrocortisone enema.

After trying every combination with Prednisone (first dose taken at 6:00AM)

20+20 for 2 days - meds wear off around 6:00pm - afternoon there is blood and diahrrea and comes back again the night around 7:00pm. Some relief after I take the hydrocortisone if I can retain it for 3 hours.

10+10+10+10 combinations for 2 days - every 3 hours there is discomfort - discontinued

40mg (no split) yesterday. - The day is comfortable Meds wear off around 8:00PM. It seems like the best is 40mg it suppresses the immune system well enough to give me a comfortable day very few runs to the bathroom. Good solid stools in the afternoon little cramping as I pass the stools. Small amount of blood while wiping. So basically one the best days I have had in a while.

But the cramps and bleeding started around 8:00pm and I was lot of pain last night. I took the hydrocortisone enema at 11:30PM. Could retain it about 3:00AM. I had some blood and mucous, solid stools and could also see some clear waxy liquid. But not bad... very little pain while passing stools.

I then decided to take one more round of hydrocortsione enema since everything got fluhsed out. I have been thinking of doing this for the past several nights as I don't retain it for 8 hours and decided to take a second dose at 3:30 AM and that lasted till about 7:00AM. Again the 7:00AM BM was like the 3:00AM BM. Not much blood some solid stools.

Although fragmented, taking the corticosteroid twice gave me a relatively good sleep hours. There wasn't much pain and I didn't see the typical severe cramping, bloody diaherra with several drops dripping out in the end this morning.

So the logic I am trying to draw here is to increase the amount of topical treatment sometime this afternoon around 4:00pm is to take the rowasa and hopefully this will aid the prednisone as well (which today I took at 7:00AM) and take me well beyond 8:00PM tonight. And then continue with the hydrocortisone enema in the night. may take more than one dose on that if I can't retain it for sufficient number of hours.

That should get me through Sunday and Monday. But my guess is when I speak to my doc on Tuesday he might up my dosage to 50mg or suggest something else.

Thanks

In the link posted by 'badcolon' earlier .... http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886411/


The section below is related to the my question.

===============
What is the role of topical steroids in the treatment of UC?

SH The evidence shows that topical 5-ASAs are superior to cortisone, budesonide, and beclomethasone.

DP 5-ASAs are superior in chronic maintenance.

SH They are also superior in induction. However, there is also evidence—not much—that the combination of a 5-ASA and a steroid is better than either alone. In one study by Mulder and colleagues, the combination of beclomethasone and 5-ASA enemas was found to be more effective than either alone.

SH That brings up the important data from a study by Marteau and colleagues that looked at colitis patients, even those with extensive colitis, and found that the addition of topical therapy was superior in inducing remission, even if patients had the disease in the upper colon. So I think we all agree that if you heal the rectum, the patient feels better, independent of the extent of colitis. Patients with Crohn’s disease can have an ileorectal anastomosis and have a normal quality of life and near-normal stooling, as long as they have a healthy rectum. So a healthy rectum is the treatment goal.

old hat - working but the long weekend was good .... got some good rest. I have a supportive team and if I can't make conference calls they take over giving me as much rest I need. being able to work from home gives me a lot of comfort. I cut the pill today in half from 18mg to 9 mg to be on the safer side. I know what you mean as the tablet sticks even in the mouth before I swallow it. Makes sense what it can do in the colon too if it clumps. My GI did not want me to take the standard 65mg but said I should take between 12-16mg. Lowest I found in rite aide was 18mg. But thanks for your suggestions. Regards to you.

Update on rowasa:

Adding Rowasa in the afternoon to my regimen turned out to be a good choice. The bleeding cramping has subsided significantly. Last night's cramps were milder and came in at 11:30pm instead of 8:00pm. The colocort helped next and I slept soundly till 6:30am. that's the most sleep I got in a long time. Took 40mg pred at 7:30AM this morning and hoping for another good night.

I hope I am not getting elated too soon. Still tired as I have lost nearly 30 lbs to this disease. I am increasing my calorie intake. If I eat too much then the BMs become painful so eating small amounts several times a day.

Thanks

Hi Coni you should start a new post with this question.
Welcome to the forum.