Can meds make flares worse?

Hi everyone,

Right now, I think I'm in a flare. Asacol HD (800mg 1 pill 3x a day) was working great for controlling my UC, but then it randomly stopped. I have an appt with my GI on Wednesday, fortunately, so i'll get to ask him soon...but I was wondering if being on meds and then flaring somehow makes flares worse?

Like if you are trying to suppress the immune response somehow, and you flare, is your immune system working harder? I was having bloody stools for months but feeling absolutely fine. This is the first time I'm flaring and I feel awful all over, like slight pains in my joints...feeling sick and slightly feverish. Is this normal for a flare?

Meds can only make you worse if you have an allergy to them (e.g., a meslamine intolerance, or a sulfa intolerance).

Every uc flareup is different, just because you did not have nausea and pain before doesn't mean you cannot have it this time.

Uc has a tendency to both spread and get more severe over time, especially within the first 5 years of diagnosis. If you had simmering, untreated inflammation remaining in your large intestine then it may explain it. You might have been mostly symptom free with your Asacol HD, but had some inflammation lingering. Now, Asacol isn't enough for you, as your disease has gotten worse, thus the flareup. Prednisone may get you back into remission, or you might require a stronger dosage of Asacol (if not already at maximum of 4,800mgs a day), or you might need to add additional medications to your script (e.g., are you taking uc enemas like Rowasa or suppositories like Cansa?).

I would most certainly get a stool test done, to check for bacterial causes to your symptoms. CDIFF can mirror uc symptoms and is treated instead with antibiotics.

Good luck, flares can be misery, so I hope yours is short and you recover quickly.

Gary: Thanks for the informative answer! Asacol is my first UC med and it is the only thing I'm taking right now for UC. My GI doc probably wanted to take it slow. My question was basically why my flare seems to affect me more now that it is supposedly under more control with a medication than it was when I was not on medication and had bloody stool for months. But I suppose now that I think about it, around the time I decided to get help for it, I was experiencing more urgency and did come down with a random fever that lasted half a day for no particular reason.

iPoop: Ah, okay...good to know about the progression of the disease, thank you. No, no rectal meds for me at the moment. I'm also at half the max dose for Asacol. Doctor doesn't really want me on steroids due to my medical history. But yes, I will definitely ask about all of that, thank you!

kazbern: Ah, I didn't know oral medicine couldn't reach that far, but it makes sense. The bleeding stopped but I still had a pretty bad constipation problem. Thank you for the info!

General question: Can exhaustion trigger flare ups? Like I was fine before university started, but since it started, with all the running around I do and the constant studying, I've been come home feeling not just tired, but kind of run-down. Before school started, the medication worked fine and I don't think there was even any mucus. Since school started I noticed more mucus than small amounts of blood until eventually this flare up. Wonder if there's a connection.

Post Edited (Tunnelvisionary) : 9/9/2014 10:05:26 AM (GMT-6)

I ditto taking 4.8 grams per day. Both exhaustion and stress can weaken your immune system, allowing you to come down with things easier. Anytime you get sick or these things happen I would automatically increase your Asacol dosage up to the max to try warding off a flare.

Amandawastaken, what the med insert lists that you are referring to is an allergy/intolerance for a med which results in an exacerbation of the disease symptoms. Not funny if you get them...

So I just got out of his office and told him the asacol HD 2400mg a day was working really well until this last week. Told him about my flare. He told me sometimes things like stress and exhaustion can mess things up and I asked if going back to school could have contributed and he said it could have.

He prescribed me 5mg of prednisone for two weeks to help get me out of the flare. I'm kinda nervous about the side effects and he told me that such a small dose for only two weeks won't do anything side effect wise. I hope he is right.

I asked about rectal meds and VSL#3 and he said both are great, but said he wants the burden of Medicine on me to be as little as possible being that I'm young. I can see where he is coming from and I don't mind it so much. He is willing to put me on those if I can't get this flare under control though.

Hopefully things will go okay.

Due to my medical history, he is wary of giving me prednisone and I was actually surprised that he prescribed it to me at all. If this doesn't help, he mentioned that he would up the asacol and get me on some rectal meds. I see him again in six weeks.

I do have a feeling that being exhausted from school everyday might be a contributor to this flare. I started noticing weirder bowel movements around a week into school, while in the summer I wasn't up and out as much and my bowel movements were basically normal.

I think you need a new GI. That 5 mg/day is ridiculous and it is even more ridiculous that he thinks a higher dose of Asacol and/or rectal meds is risky because you're young.

I'm actually really interested to see how it goes but I wouldn't bet the farm on this approach. Several months ago I was doing really well (probably about 90% remission also), going about 5 times per day and actually talked my doc into a short term pred dose. I think we started out at 25mgs and was completely tapered off in 4 weeks. I was hoping it would give me that final jump into remission and the Asacol would keep me there. I was totally shocked that I didn't even achieve total remission while on the pred and after tapering off I was right back to my 90% and going 5 times per day. It was worth the try, I think, but I have been fighting to get my ten pound weight gain off ever since. Still not there.

It's 5 mg a day for two weeks. Is that too long a period of time? Serious question, I don't know very much about dosages with prednisone.

I'm with Kaz, you need another GI. 5mgs of Pred seems silly. Disease in young people tends to get more aggressive and tougher to treat. Starting and staying behind the curve is an outdated model of treatment. You have a good point about stress though,it isn't good for anyone, esp IBD patients. Try the enemas soon and don't let this get too far without another opinion. Glad you are on this forum.

Hi everyone,

The two weeks on Prednisone 5mg ended today.

It definitely took a few days to work, probably due to the small dose, but once it started working, life was definitely bearable. I had one minor accident (sneezed while in the car and some came out...I was like...really??) and it reduced my urgency maybe 90% compared to before I started taking it. Very liquid D and on and off blood and mucus. Toward the end of the course, I could feel the symptoms reducing more and more...now been off it for a day. I feel so uncharacteristically tired (been sleeping all day basically) and the blood is definitely back.

Called my GI doc's office yesterday...I have no idea what that is supposed to accomplish. I want him to up my mesalamine dose and give me rectal meds now. I feel like I'm done with prednisone but I'm still a month out from my appt.

Doc should have prescribed hydrocortisone enemas for at least 2 weeks and then mesalamine enemas for maintenance. The hydrocortisone enemas worked on me like a charm, but unfortunately they are not for long time use.

You have to get the inflammation down or it will spread, as I have experienced in my uc. I thought a little blood and not going to the bathroom that much was okay and just went day to day thinking whats the big deal I can live like this, then the urgency started and although 3 to 4 times in the morning was what I was going, it only seemed to affect me in the morning so I was able to get everything out of the way and then off to work. But what I didn't know is that that simmering inflammation caused the ulcerative colitis to move up and I had to take stronger med (ie. hydrocortisone enema) but I refused pred at the time because hydrocoritsone although it is absorbed somewhat is not as potent as pred.

You could ask him to try these first and see what happens. Good luck hope you feel better soon.

There is also the cortifoam enema but I think that will only help the rectum and maybe some sigmoid.

Read somewhere that the pred and the cortisone enemas will make you feel better before the inflammation actually goes down so the two week course probably made you feel better although it was not long enough to do any help.