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oral or suppository?

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Ulcerative Colitis
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Posted 6/18/2014 2:49 PM (GMT 0)
I have been seeing different doctors every month and have been getting different opinions.
I have been diagnosed with 6 cm UC since November 2013. I am 24 years old

the first doctor: 2 X 500 mg of ASACOL suppositories per day and 2 g of oral pentasa extend

Result: Bad quality stool (almost diareha) + mucus + blood

Second doctor: Imuran
Result: I did not take it because I heard of its side effects and that my condition does need Imuran yet

Third Doctor: 3.2 g of ASACOL oral per day + 500 mg ASACOL sup per day ( 1 supp per day )
Result: I feel a little bit better. been on it for 5 days. Not perfect. I still see some blood in the morning, but being on only 1 suppository per day instead of 2 is helping me a lot, as suppositories made me feel bloated and bothered.

Please let me know what is the best medication !!! thank you
Posted 6/18/2014 3:16 PM (GMT 0)
I am not sure what type of symptoms you're experiencing but the treatments you describe are almost in-line with maintenance, not for treating a flare up. I was able to get into remission with Asacol once on 3600mg + suppositories. My condition was considered mild/moderate at the time but the symptoms were awful. If you're having very mild inflammation, any of these options could work for you. Imuran, while it sounds scary, is taken in a low dose and is generally well tolerated. On the other hand, I think i would try to get things under control with the mesalamine medication before going to imuran. Can you take the max oral dose of Asacol for a bit and see if things improve? 500mg suppository isn't that much. Can you use the 1000mg or try enemas? Again, this is really dependent on where the inflammation is active. If it's right in the rectum, suppositories are probably the best thing for you. If it extends further, enemas will help more.
Posted 6/18/2014 3:23 PM (GMT 0)
Thank u for ur reply. I am feeling bloated in the mrng from the suppository of the night before i guess. Wen i try going its Diareha and some blood and mucus. Id have to go more than once to empty my bowel. My disease is only in the rectum bottom 6 cm. but i am hating the supp cz it gives me gas and bloating. Will oral 3.2 g asacol help me or i need to stick to supp? What is the flare up dosage? Nw i am taking 3.2 g asacol oral and 500 mg asacol supp. Thank you
Posted 6/18/2014 3:25 PM (GMT 0)
I take suppositories, one in the evening, and I can't say it ever makes me feel bloated, once that tablet is in you don't know its there, are you sure your not talking about enemas? Anyway, although your not keen on taking suppositories I think you would probably benefit from taking 2 a day to be honest with you...just a thought.
Posted 6/18/2014 3:35 PM (GMT 0)
The suppositories aren't going to treat 6 cm of inflammation. They are very small and probably only effective in the immediate area. I would go for the 4g enema. There is good advice on the forum on how best to use it; please read the resource thread at the top of the page.

I would also agree that you should continue with the higher dose of oral mesalamine, at least until you are free of all symptoms. At that point you can start tapering both the oral and the rectal, but you should plan on using both at some level for a very, very long time.
Posted 6/18/2014 3:48 PM (GMT 0)
Thank u all for ur advice. I will look into enema. But the doc told me if i am not tolerating suppositories than definitely i cant use enema.
Another question, whats the difference between asacol and pentasa oral?? Is it true that asacol reaches the lowest part of the colon while pentasa opens early? Thanks again
Posted 6/18/2014 4:45 PM (GMT 0)
Pentasa opens early. Asacol treats parts of the large colon but none of the oral meds are effective in the rectum.

You are "tolerating" the suppository just fine from what you posted. You should get the enema; if you are concerned about intolerance issues you should consider asking your DR to prescribe a sulfite-free version of the enema.
Posted 6/18/2014 4:45 PM (GMT 0)
Pentasa opens early. Asacol treats parts of the large colon but none of the oral meds are effective in the rectum.

You are "tolerating" the suppository just fine from what you posted. You should get the enema; if you are concerned about intolerance issues you should consider asking your DR to prescribe a sulfite-free version of the enema.
Posted 6/18/2014 5:00 PM (GMT 0)
If your UC is limited to the rectum and you don't have inflammation anywhere else, using Asacol is a good start. You don't need the Pentasa...it's an option, but's released in the small intestine way before the other 5ASA meds.

If you live where there's Salofalk oral, you could try that.

Regardless....you don't need to overmedicate an oral 5ASA. 2400mg daily should suffice. You can increase it if you need.


The suppositories could work for you, but 500 mg daily isn't anywhere near enough. I'd suggest the 1000mg once or twice a day while you're flaring.
You could ask for the enemas, they are a much higher dosage. They will also deal with the sigmoid where the oral meds might not fully cover.

The constipation and bloating are in connection to the limitation of inflammation in the rectum.
You need to get on more rectal medication dosage. If you live where there are Asacol foam enemas, that could be a good option in conjunction with the suppositories.

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