Mesalamine Question

I am going through a flare now, scared and kind of going crazy. Please read my updated signature for the details.

As I am tapering of prednisone, I was prescribe Lialda, 2 per day. I am also taking canasa. Canasa has been effective for a while and kept me in remission for 2 years. Although I did notice that it takes sometime for it to start working. With Rowasa I did have a positive experience in the past. However, 2 years ago I was going through a flare and noticed that Rowasa helped the first day, but later symptoms returned again. I wasn't sure why this was happening and thought that the inflammation was probably to much for Rowasa to handle. Now that I started taking Lialda, 4 days now, it seems like I noticed initial improvement (BMs are no longer as watery.) However, every morning I am paranoid if I notice any changes in my BMs - analyzing if Lialda is helping.

Ultimately, I am wondering if mesalamine is likely to work after I haven't been taking oral meds for more than 2 years. Canasa was very effective for those two years... If not Lialda, would it be worth trying other brands?

Prednisone is a good temporary rescue medication that buys us time while our other medications have time to work. Best practice is to be 90 percent or more healed before tapering to a low dose of prednisone. If you are still having watery stools than your taper is likely premature and will result in a reappearance of uc flare symptoms when you get to the 15mgs/10mgs range of pred doses. I'd slow your taper schedule, it should be dynamic based on your individual response.

Are 4 lialda a day and a canasa suppository enough to control you uc symptoms? Unknown, for some it's enough for others it isn't. It's the million dollar question that only time can answer based on your disease severity and individual response to those medications. Although, you'd be better off with Rowasa enema than suppository. Canasa covers only the rectum. As you have pancolitis, the Rowasa has more medication and goes to at least the sigmoid colon (but as far as the splenic flexure where the large intestine turns and goes across your stomach).

Uc can get more severe over time and that may necessitate stronger medications like immunomodulators (Imuran/azathioprine or 6mp). Certainly, try the 4 lialda + Rowasa combo first and upon an unsuccessful taper consider adding immunomodulators.

It is a million dollar question, indeed. I am wondering how long does it take to know if mesalamine is working?

If you started at 40 mg of pred on 9/4 and you are already down to 20 mg that is a pretty fast taper. The fastest taper I was ever on was dropping 5 mg every 5 days but that would have taken 20 days to get down to 20 mg after starting with 40. How often are you tapering?

Also, max dose of Lialda is 4 pills/day. You are taking a maintenance dosage when you are still flaring -- usually not a good idea.

You should talk with your doc or maybe find a new one -- really surprised at the pred taper and the Lialda dosage.

I suggest get back on the Rowasa while tapering the pred....or use a steroid enema at night and canasa during the day.

q

Sorry but that prednisone taper is going to amount to absolutely nothing. Much too fast.I would strongly question this doctor. Is he/she a gastroenterologist?

Nobody here has agreed with this gastroenterologist's approach. We're not doctors but have al flared and gone through tapers ourselves, many times. Your doctor is suggesting some unconventional things, and if it were me I'd say red flags raised and I'd ask questions.

I'd say the norm is staying at 20 mgs, going 4 lialda a day and nightly Rowasa for at least a few more weeks, while waiting for a good response and decrease within your symptoms.

The best prednisone tapers are very flexible and based entirely on patient response. Once you're healed, you drop to low doses but not ever before then. Everyone hates prednisone but when we do go on it, we want it to be effective.