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Ulcerative Colitis
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Posted 7/10/2013 9:26 PM (GMT 0)
My doctor has suggested I start to taper my nightly Canasa. For about a week or so I have been using it every other night. I don't really notice any difference which is i am guessing is good. How far tapering do all of you recommend I go? I think my doctor would like me to get off of it if possible. I thought I would always need a recital med, is that not always the case?

I do have some unpredictability in symptoms such as ocassional frequency urgency and a little mucus so I am guessing I'm not in a remission yet. Most days I only have 1-2 BM's per day :)! Maybe every week to two weeks I will have a bad day where I have up to 5.

I should also mention Canasa alone did not work great for me. It was only after adding Apriso that I saw a big difference.

Thank you for any thoughts and suggestions.
Posted 7/10/2013 9:32 PM (GMT 0)
if it was me, i'd keep doing what you are doing -
Posted 7/10/2013 11:06 PM (GMT 0)
If your still having some urgency and mucous I wouldn't cut down further then you have. I will never go off of rectal meds completely. Its just asking for trouble for me but if I am in remission I only have to use them every third day.
Posted 7/10/2013 11:41 PM (GMT 0)
I only use mesalamine enemas now as needed, no schedule. But that was my choice when symptoms made that possible. Canasa was never used much. Trust your own instincts and needs, your doctor isn't living your life.
Posted 7/11/2013 4:12 AM (GMT 0)
You should get your GI to get you on the enemas and save the supps for support to use in conjunction with or for tapering or maintenance.

The goal (nowadays) isn't/shouldn't be to get off...but to find a maintenance dosage to keep you in a butt-happy state.

You're still flaring from my perspective.

q
Posted 7/11/2013 5:32 AM (GMT 0)
doh ! dummy me, I did not realize that canasa was a supp  - I assumed it was an enema - dope !

so ok rectal guru, splain the different - why use one instead of the other ?

 

Posted 7/11/2013 6:20 AM (GMT 0)
Supps are limited to the rectum, the enemas go farther up..including the rectum, sigmoid and possibly a tad beyond.

Enemas (mesalamine), depending on the brand come in 1g, 2g and 4g.

Supps are 500mg, 1000mg.

q
Posted 7/11/2013 12:12 PM (GMT 0)
I also think you're still flaring and should stay on rectal meds daily until the symptoms have been completely gone for a few weeks, then taper to a maintenance dose. I've been in remission for four years and I'm still using enemas twice a week.
Posted 7/11/2013 1:10 PM (GMT 0)
are supps cheaper ? are supps the normal treatment for proctitis ?
Posted 7/11/2013 1:26 PM (GMT 0)
Supps are generally more expensive for those with insurance in the US, because there are no generics, only name-brand Canasa. My generic enemas cost me $15 for a three-month supply whereas the Canasa cost $50 for a three-month supply (this is with a mail-order pharmacy).

I think that supps are often Rx'ed for proctitis instead of enemas because they actually do the best job of treating just the rectum, since all the medication is concentrated right there.

I had a Canasa Rx filled just before my daughter was born, because I figured I'd be up so much at night that I wouldn't be able to retain an enema. It turns out she's a great nighttime sleeper, so I've been using enemas since she was about 2 weeks old. I think I'm actually going to start using one enema a week and one supp a week, just to use up the supps. No reason in letting them go to waste, and I think I'm stable enough that it's not going to hurt anything.
Posted 7/11/2013 1:34 PM (GMT 0)
are supps cheaper ? are supps the normal treatment for proctitis ?

Canasa suppositories (spelling it out for newbies reading) are way more expensive in the US. I almost had a freaking heart attack when I asked--$700+ for one months supply. Enemas (generic mesalamine) are 1/3 the price, still expensive).

I ordered my Canasa from Canada (called Salofalk there). You need a US RX which I got written on paper from my GI and copied/faxed it to the CAD pharmacy. The mesalamine enemas are not cheaper from Canada so I get them from US local pharmacy.
Posted 7/11/2013 2:18 PM (GMT 0)
I would think that treating as much area as possible would be more beneficial - especially if it's cheaper !

what percentage of proctitis moves on up the colon - or, how often do things progress into something more involved ?
Posted 7/11/2013 2:42 PM (GMT 0)
My GI suggested I taper off of my rectal meds (in my case Rowasa Enema) and stick with only oral Meslamine, when I was still in a semi-remission/flare state back in August. I was fairly new to uc, and naive then, so and followed what he said. I guess his rational was that "rectal meds are the least pleasant to administer" and that "most people would rather just pop an oral pill instead". Needless to say it didn't work out well for me, as I reduced the rectal meds, my uc symptoms just got worse, so I jumped back to daily enemas and have never looked back since. So, the rectal meds certainly work and often fast (within 3-4 days). Today, I am still in a semi-remission/flare state so I haven't considered reducing them at all. I bet you would probably run into the same scenario if you tried to reduce your rectal meds.

To my GI's credit he did give me both oral and rectal meslamine when I was initially diagnosed, and not all GI's do, even though it is best practice according to a lot of studies.
Posted 7/11/2013 7:34 PM (GMT 0)
I'm not sure if I can get my doctor to prescribe me an enema. He will probably say its unnecessary in my case. I thought I heard him mention that its not good to be on rectal long term that it damages the rectum wall? I thought that was only with steriod enemas not mesalamine ones.

Do you think I could possibly be on rectal mesalamine only for maintenance of proctitis?
Posted 7/11/2013 7:41 PM (GMT 0)
Yes, the steroid enemas can damage the rectal wall, because steroids can cause thinning of the tissue. There's no reason to not use mesalamine-based rectal meds long-term.
Posted 7/11/2013 7:43 PM (GMT 0)

soystud said...
what percentage of proctitis moves on up the colon - or, how often do things progress into something more involved ?


If ulcerative colitis is initially limited to the rectum at the time of diagnosis (proctitis), fewer than 30% of individuals will go on to develop more extensive disease (Rowe). Approximately 10% of patients presenting with proctitis will develop a pancolitis (Rowe). The disease remains confined to the rectum in approximately 25% of all uc cases (Rowe).

Rowe, William A. "Inflammatory Bowel Disease." eMedicine. Eds. Rajeev Vasudeva, et al. 28 Apr. 2008. Medscape. 29 Sep. 2009 <http://emedicine.medscape.com/article/179037-overview>.
Posted 7/12/2013 12:48 PM (GMT 0)
Does that mean I may only need mesalamine enemas only?
Posted 7/12/2013 7:40 PM (GMT 0)
I'd strongly suggest to not depend on rectal medication alone, but you might consider to request a lower dosage of the Apriso to keep everything above the sigmoid happy. The enemas...for sure you should be on them rather than the Canasa. Unless you're in remission, you could use them for maintenance and then increase to the enemas if you're flaring.

q
Posted 7/12/2013 11:42 PM (GMT 0)
Thank you that makes a lot of sense. I will ask at my next appointment for enemas and once out of a flare reduce Apriso.
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