convinced my pharmacy to compound 4gm mesalazine enemas and i used it!

And i am alive!! Woho

since my smuggler got caught i have been hugging my two boxes of gold eggs (asacol 4gm 100ml enemas) trying everything i could to get more enemas which is impossible in Egypt we only have the measly pentasa 1gm suspension, and importing such thing takes months and months "bureaucracy".

I asked them to crush the Pentasa 1gmX4 sachets and to add Xanthan gum as a dispersing agent, but they didn't have it and used tragacanth gum instead and purified water.

They actually asked me for one of the enemas to analyse it in their lab, they have found a ton of elements in it !! talc, iron, zinc, lactulose!!, coloring and smell agents and others i am thinking may be they are to maintain long shelf life and consistency, the pharmacist told me they couldn't know the exact ratios of such elements but they will test the results.

After compounding the pharmacist confirmed to me the results their enemas will have the same efficacy, i was very worried that was my last straw and i have used one yesterday i think it works the same! and at a fraction of the cost.

I am thinking i might also ask them to add a water soluble vitamin e to it, since i saw that it helped some when injected via a rectal syringe i am not sure how much though.



If you live anywhere were 4gm mesalazine enemas is a forbidden luxury ask your pharmacy to compound them (if possible) and to add a suitable dispersing agent.

Awesome you found a better way to get your medication.

Judy, the OP is not in the US.

Congrats Dreadsteel on figuring out how to move forward!

That's really great!

Thanks guys and gals, sorry for the excessive puns i am so excited ! :D , it was a pain in the butt smuggling them which included paying for 3x their price and bribes.

Judy2 said...
I suspect after the meningitis scare from contaminated medication made by a compounding pharmacy that the FDA is watching the pharmacies in the US closely. They may be very careful with what they do now. I suspect to be legal they'd have to have an order from your doctor, and good luck getting that from most GI's.

The sunny side is, i live in Egypt i can get anything without a prescription (except narcotic drugs, or things like calmepam that is addictive if overused), same goes with compounding, the compounding lab only needs a recipe or a sample of the required med and they analyze it and make it.

the lab that compounded it is one of the largest in here and they have a very good reputation and track record, i have actually recorded the recipe with them, if anyone calls http://www.khalilpharmacies.com/ and asks for the med with code 33287 they will get the same med :) for L.E 39 / $5.3 per enema [ 4gm pentasa in 100ml]

quincy said...
Cool you can get them compounded where you are...maybe you could ask for the 60ml liquid instead of the 100ml if retention is an issue at all.

Did your doc write a prescription for the sachets for the compounding?

What is the oral Pentasa you're on...the sachets as well?

q

Sure i can ask them to do anything, i never had an issue with retention i like to think of myself as Mr.Miyagi in terms of butt meds :D , i opted for the 100ml like the asacol ones for bigger area coverage since i have pancolitis, i also think i'll write a huge "how to" for techniques on retaining enemas and getting the best results with them.

My doctor didn't want anything to do with compounding, i took full responsibility also my brother is a pharmacist, and i didn't need prescriptions.

I am taking 8 Pentasa 500mg pills a day, divided in two dosages 4 by morning and 4 by night, i asked them to use the 1gm pentasa sachets instead of the pills to avoid as much fillers as possible.


The recipe is simply :

- 100ml of Distilled water ( or 60ml like the perrigo/rowasa enema )

- 4 sachets of 1gm pentasa pills crushed/pulverized completely ( pentasa sachets have lesser fillers i think than the pills)

- Xanthan gum or Tragacanth gum powder, just enough to disperse and suspend the solution completely (something like 1/2gm)


Important notes: needs to be compounded and mixed Quickly to avoid as much exposure to light as possible and also in a controlled temp below 25/77 ºC / ºF and afterwards kept in an opaque container.

Cheers

quincy said...
Really....the most coverage needed is in the rectum and sigmoid. Beyond that, your oral meds will for sure cover.
Make sure you draw the syringe tip to just the sphincter to get the very first edge of the rectum.

Nice your brother's a pharmacist.....the granules don't have fillers? there's some sweetener in it, isn't there?

q

I am taking oral pentasa just to clear my conscience, i am sure the enemas work far better since i sometimes notice the tiny pills in the toilet.

They actually taste like cardboard, i don't think they even have a taste, the sachets contains tiny pills/ granules they do have a thin enteric coating

http://1.bp.blogspot.com/_u1Hc5VE48Zs/TIZOOsj2jeI/AAAAAAAAECE/eXMLSDtsHAU/s1600/Uso+de+Pentasa+Sach%C3%AA.jpg

the pills however have these as inactive ingredients ( i quote from Patient Information Leaflet) :

https://www.medicines.org.uk/emc/PIL.18002.latest.pdf

Ferring said...
Each tablet contains 500mg of the active ingredient, mesalazine
(also known as 5-aminosalicylic acid or 5-ASA) It also contains
the following inactive ingredients: povidone, ethylcellulose,
microcrystalline cellulose, magnesium stearate and talc.

and sachets (https://www.medicines.org.uk/emc/PIL.18000.latest.pdf) :

Ferring said...
What PENTASA Sachet contains
Each sachet contains mesalazine 1g.
The other ingredients are ethylcellulose and povidone.

quincy said...
Cool...no sweeteners. I know the Pentasa capsules can be taken sans capsule...so maybe that's what the granules are anyway.

maybe it's the asacol ones that have that or Salofalk granules maybe. No granule types are available in Canada.

You will see the casings in the toilet since they're light enough to float. They don't dissolve, but break open at the very least. Do you take them in anything such as apple sauce or honey or whatever?

Enemas..again..aren't meant to cover the entire colon....full dosage oral, I think you should be safe ;)

Keep us posted on the rectal routine.

q

i don't think the pentasa granules or the pills (which is basically granules held together with a filler) have a coating that doesn't dissolve, because i once bit on a single granule by mistake and it melt.

i prefer the pills easier to swallow, but according to the leaflet you are supposed to empty the sachet on your tongue then follow it up with water, i tried adding them to a glass of water before, Big mistake the granules stuck to the sides & bottom of the glass (they don't dissolve or anything).

i know enemas can't cover the entire colon, i think they can reach as far as the splenic flexure if you lay on your belly for an hour after taking the enema, but the descending colon is the most troublesome area i think, i will keep the full oral dosage, better be safe :)

Sure i will keep you posted !

Dreadsteel, glad to hear things are working out!

You can probably find xanthan gum at a grocery store that caters to westerners. This is commonly added to baked goods for people who are eating gluten-free. I know that in Italy it is quite easy to find gluten-free products at pharmacies where they have a special place for people with celiac disease to buy ingredients - maybe there's such a place in Egypt?

he refused as there are enemas available.

Not sure this is a valid reason as I have had a compounding pharmacy make a solution for which there are ready-made items also available (to eliminate pre-cancer on skin).

I wonder if Skips' Pharmacy in So FL would do this. They are the one people go to for mail-order Naltrexone (is the the right word-please correct me) to treat UC.

kazbern said...
Dreadsteel, glad to hear things are working out!

You can probably find xanthan gum at a grocery store that caters to westerners. This is commonly added to baked goods for people who are eating gluten-free. I know that in Italy it is quite easy to find gluten-free products at pharmacies where they have a special place for people with celiac disease to buy ingredients - maybe there's such a place in Egypt?

Thanks, Celiac Disease is extremely rare in here so i couldn't find the xanthan gum easily, i have talked to the chemicals company hopefully they get back with a reasonable price and quantity, i hope i don't have to buy a ton of it lol

deltaforce said...
US Pharmacy won't do it. They don't even have a recipe. I asked a friend of mine who works in a compounding pharmacy and he refused as there are enemas available.

To OP,
If you keep down the road and if it keeps helping you, once in remission consider adding NAC. There was a trial going on using NAC. Just a caution, don't do it when you are in flare, it will STING.
Very well done with the enema.

That's strange, any experienced pharmacist should be able to put a recipe for it, and it could be far more expensive to buy the enemas compared to compounding them i think, i don't actually have such enemas available here so i had to do something.

Regarding NAC that seems interesting could you link me such trial, all i could find are experiments on animal models like :

www.scielo.br/scielo.php?pid=S2237-93632012000300004&script=sci_arttext

www.ncbi.nlm.nih.gov/pubmed/19034653?ordinalpos=2%20&%20itool=EntrezSystem2.PEn\

thankfully i have been doing great lately "knocking on wood", my latest lab results on 31th of Jan 2015 are

ESR : 1st_hour: 4mm/hr , 2nd_hour: 11mm/hr
CRP : -0.6 mg/L
Calprotectin: 62 mg/kg


i intend to repeat the tests after my "experiment" with the DIY enemas a month away

cheers

kazbern said...
Or maybe it's time for a trip to Italy!

You know it has been my ultimate dream to live in Venice, but i wouldn't mind bora bora either

i can only dream....