Which 5-ASA medication has given you the best results?

Hi everyone, I'm looking for medication advice.

I was diagnosed with mild Ulcerative Colitis 4.5 years ago. When I was first diagnosed I was put on salofalk enemas and tablets (6 pills/day). This worked very well and I was in remission within a couple of weeks and eased off the enemas, just continued to take the pills. For a few years, whenever I noticed symptoms I would just go back to the enemas and it would clear up quite quickly, however for the past year or so I have not had such luck.

I've been taking the enemas and pills every day for months now (getting expensive!). They are keeping my symptoms under control but I can't seem to get back to complete remission (currently no pain, but 2-3 loose bowel movements/day and some urgency). My doctor has speculated that my body has gotten used to this medication, and perhaps switching to another drug within the same family could give me a boost back into remission. Has anyone tried this? Any luck? What would you recommend?

Any advice is appreciated. Thank you!

You should be able to take 4.8 grams per day. Switching to another brand probably won't help much because they all contain the exact same medicine inside, it's just the coatings that are different. In hindsight, you should have never completely stopped the enemas, even taking just one or two a week.

the different forms do release at somewhat different locations, so if your UC has extended into new part of colon, a change might help - but you could into worse flare finding out.

Ya, forgot to mention when I'm in a flare I do up the tablets to 9 a day. So I've been doing 9 pills/day and 4g mesalamine enemas every night. Been doing this for about 4 months. So I'm thinking this is as good as my condition will get on this type of medication. Never fully formed stool.
Only change I've made is I started taking a b complex vitamin a couple of months ago. But I haven't noticed that effecting me either positive or negative ..

MariaMaria said...

quincy said...
Hi Quincy. What exactly is stool sample testing? What would that show.
I had a colonoscopy 5 months ago. Same as always, doc says mild inflammation 13 inches up the colon. Not spreading or getting worst. Just staying the same.

Perhaps a switch to a 5-ASA that releases more towards the end of the colon would help then. Salofalk is good to treat pancolitis because it starts to release at the end of the ileum, but there are other formulations that release further into the colon so higher concentrations of the drug are released where its needed.

Also, the stool sample testing would be to look for infectious causes of your colitis. Its possible that your urrent "flare" could simply be something like a c. diff infection and not a UC flare

After you get better you should continue on 9 pills a day forever, plus an emema or two per week. Obviously 6 pills per day is not enough to keep you in remission. You don't want to come out of remission because often what worked before doesn't work again or work as well.

I've done well on Lialda and Asacol but unfortunately they don't seem to do too much for me anymore. I agree with the others, rectal meds in combination with oral work well.

Thanks for the help everyone!
I am definitely going to request stool testing at my upcoming appointment. And I'm going to ask about a steroid enema.
Would a steroid enema have negative side effects like oral steroids would? I am nervous to take my medication regime to the next level if it means harmful side effects.

For sure steroid enemas, either liquid or foam are available. Some are more sensitive to the side effects, but you probably wouldn't have to be on them for a long time.

As far as oral 5ASA, there's Mezavant (same as Lialda), generic and brand Asacol in 400mg and 800mg, Salofalk 500mg and Pentasa 500mg.
We don't have anything comparable to Colazal or Apriso yet.

If you're having problems with the Salofalk, then Asacol would probably be in the same category regarding coating. Maybe try for Pentasa (it's a capsule, not a pill) to start...lower dosage like you're on now, and increase if you need more.

I would suggest you use fibre supplements and probiotics once you get the stool testing done. I wouldn't wait till your appointment, I'd suggest you call and ask to pick up a kit so that the results are hopefully there when you go for your appt.

q

Thanks for the advice. Oral steroids really scare me, but from what I've read on this forum rectal steroids seem to be side-effect free and highly effective. Will definitely be trying them out and will update on how it goes.

I'm also intruiged by fecal transplants (here's a thread about them https://www.healingwell.com/community/default.aspx?f=38&m=1612467) but have decided to stick to a more medically-traditional route for now.