meds progression

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heatmiser
Veteran Member


Date Joined May 2003
Total Posts : 1671
   Posted 8/21/2009 10:46 PM (GMT -7)   
I am having a colonoscopy on Monday because of my current flareup. I have been on colazal for several years, and currently am taking 40mg prednisone, which has helped with some symptoms but not all. Other than that, cipro and flagyl that we tried a couple of months ago.

I think they are going to find this is my cd flaring when they take a look. I'm wondering what I can expect them to do next. Are they likely to increase the pred? How high of a dosage will they try before giving up on it? Will they try another 5-asa type maintenance med? I'm kind of worried they will want to put me on stronger meds with more risks and side effects. I'd like to be able to be in on this decision and not just blindly accept changes that I don't understand.

I realize it could be something other than cd, but what? If I took cipro and flagyl, would that take care of any infections? My cd was originally found in the colon only, and other than having trouble with diarrhea, my symptoms haven't changed other than it just doesn't want to get under control.

Thanks for your help.

Nanners
Elite Member


Date Joined Apr 2005
Total Posts : 14995
   Posted 8/22/2009 6:22 AM (GMT -7)   
I would think that they might suggest something like 6mp or Imuran. Many on this forum have had great success with either of these medications. Though they can take about 3 month to fully kick in. Hope that helps.
Gail*Nanners* Co-Moderator for Crohns Disease and Anxiety/Panic Forum
Crohn's Disease for over 33 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium  w/Vit D, and Xanax as needed. Resections in 2002 and 2005. Also diagnosed with Fibromyalgia, Osteoarthritis, and Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
It's scary when you start making the same noises As your coffee maker.
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

pimfram
Veteran Member


Date Joined May 2009
Total Posts : 506
   Posted 8/22/2009 9:20 AM (GMT -7)   
My progression was:

Antibiotics (flagyl and cipro)
Imuran
Remicade
Hopefully I won't need another step. *Knocks on wood*
Diagnosed with CD July 2007
Currently on Remicade, Imuran, probiotics, folic acid, multivitamin.


MAG102886
Veteran Member


Date Joined Jul 2008
Total Posts : 674
   Posted 8/22/2009 10:25 AM (GMT -7)   

Mine went

1. Cipro/Flagyl 2. 6MP/Asacol  3. Prednisone  4. Humira  5. Remicade  6. Imuran  7. back to 6MP

Now I'm starting a Cimzia +Methotrexate combo

 


Dianogsed with Crohns: At 16 years old. 22 years old now.
Surgeries:2 Bowel Resections, Gallbladder Removed, 3 Abscess Cleanings
Current Meds: 6MP, Vitamin B12 (injections), Nexium.
Next Surgery: Sept 4, 2009 to Take Down Abdominal Fistula!!
 

Sloth
Regular Member


Date Joined Sep 2004
Total Posts : 207
   Posted 8/22/2009 10:36 AM (GMT -7)   
Mine was:

Pre diagnosis: Cipro and Flagyl in case I had an infection

Post-diagnosis: 1. Asacol 2. Entocort/Cipro 3. Prednisone/Imuran (tapered off pred, stayed on the Imuran, went back on pred when I came out of remission)) 4. Humira (still on Imuran, and just started vancomycin for suspected C. diff)

If the Humira doesn't kick in, my doctor wants me on methotrexate next. I did very well on the Imuran. No real side effects, and it gave me 4 good years. I wish it still worked for me.
Diagnosed with Crohn's in April 2003 (first symptoms in 2001).
Current Medications: Imuran 125mg/day, Humira, Pred 2.5mg/day, Phenergan as needed for nausea, Bentyl as needed for cramping (have previously taken Asacol, Entocort, Flagyl, Cipro, and Cortifoam)
Dietary Supplements: Flax seed oil, Folic Acid, B12, Culturelle, Glucosamine/Chondroitin, Calcium +D


vitaka
Veteran Member


Date Joined Jun 2006
Total Posts : 887
   Posted 8/22/2009 11:58 AM (GMT -7)   
If you are flaring on your current meds, I highly doubt they would put you on a 5-ASA drug (or at least they wouldn't *only* put you on one), as that would not address the immediate problem. I also doubt they would increase the pred, but would instead try something new, maybe 6mp or Imuran as Nanners suggests.

During my last flare, I started off with Pentasa and prednisone, and when that didn't work to get the flare under control after a couple months, I was given the option of Remicade or a clinical trial. I did the trial, which put me in remission.
29-year-old PhD student, diagnosed with Crohn's ileocolitis in Feb. '06. During the summer of 2006, I completed the Adacolumn Apheresis clinical trial, which helped me enjoy 2+ years of remission and more than one year med-free. During spring and summer of 2009 the symptoms slowly but surely began to return, and now I'm flaring again. Waiting to see GI, back on 4g Pentasa/day.


Keeper
Veteran Member


Date Joined Jun 2008
Total Posts : 1058
   Posted 8/22/2009 1:59 PM (GMT -7)   
Have they checked for C difficile? It can mimic Crohn's symptoms and is often caused by a course of antibiotics. Taking immune suppressors when you have C diff won't work and would likely make the symptoms worse.

Another poster reported that they only got a positive test for C diff after they kept their sample refrigerated prior to submitting it. Not keeping it cold resulted in negative tests.

Sloth
Regular Member


Date Joined Sep 2004
Total Posts : 207
   Posted 8/22/2009 2:22 PM (GMT -7)   
To echo the previous poster, my gastro told me that C. diff is endemic amongst IBD patients now (in his experience). My C. diff test came back negative, but that happens, and as I was in the hospital recently, he wanted me on antibiotics for it. I've been on vancomycin for about 2.5 days now (Flagyl is the preferred treatment, but I don't tolerate it well at all), and I am seeing a decrease in blood and mucus, as well as frequency (and last night was the first night I didn't have to get up to go to the bathroom in the middle of the night since I don't know when). So, yes, if you haven't been tested for infection, I think it would be a good idea to rule it out.
Diagnosed with Crohn's in April 2003 (first symptoms in 2001).
Current Medications: Imuran 125mg/day, Humira, Pred 2.5mg/day, Phenergan as needed for nausea, Bentyl as needed for cramping (have previously taken Asacol, Entocort, Flagyl, Cipro, and Cortifoam)
Dietary Supplements: Flax seed oil, Folic Acid, B12, Culturelle, Glucosamine/Chondroitin, Calcium +D


GDen
Veteran Member


Date Joined May 2009
Total Posts : 703
   Posted 8/22/2009 5:57 PM (GMT -7)   
My GE starts off with prednisone, maxing at about 40mg/day. That didn't work with my second flare, so we went to Imuran. If that doesn't work, my GE goes to biologics, Remicade being his first choice. He's never mentioned antibiotics.

heatmiser
Veteran Member


Date Joined May 2003
Total Posts : 1671
   Posted 8/22/2009 9:31 PM (GMT -7)   
Can they tell if I have c.diff during the colonoscopy?

MAG102886
Veteran Member


Date Joined Jul 2008
Total Posts : 674
   Posted 8/22/2009 10:03 PM (GMT -7)   
C-diff does thicken the intentines or colon I think, I'm not sure if they can tell just by doing a scope, but a simple stool sample does the trick, they usually do 3 tests though, the come back false negatives a good bit of the time.

Dianogsed with Crohns: At 16 years old. 22 years old now.
Surgeries:2 Bowel Resections, Gallbladder Removed, 3 Abscess Cleanings
Current Meds: Cimzia, Methorexate, Vitamin B12 (injections), Nexium.
Next Surgery: Sept 4, 2009 to Take Down Abdominal Fistula!!  (On hold until current flare is under control, boo!)
 

sr5599
Veteran Member


Date Joined Aug 2007
Total Posts : 1202
   Posted 8/23/2009 1:22 AM (GMT -7)   
My progression was: Asacol, CortEnemas, Prednisone, Methylprednisolone, Imuran, 6-MP/Cipro/Flagyl, Remicade, Humira, MTX, Humira/Cipro/Flagyl/CortEnemas, Methylpred/Budesonide (compounded suppositories)/Cimzia. (in the midst Prochymal)

Honestly, if symptoms are bad enough, I don't understand why docs don't just get things under control with the biologics to start with. They sound scary, but compared to years and years of steroid use... Well, I'd prefer biologics, if they work.

I 'm in a constant flare to some degree, but in April this year I took a big dive. I was "sure" i had c-diff it was so bad. Thankfully (??) it was just CD and I was put back on oral steroids. I think anything down in the large intestine will show itself when they look in the scope. Good luck... I just had one a couple weeks ago now. Hope you're feeling ok with the prep!
--female dx as UC in '04 (1st symptoms in '03), switched to Crohn's in '05, 1 fistula, crohn's colitis, limited to large intestine  --rejected (reaction/didn't work): Asacol, AZA, 6-MP, MTX, Remicade, Humira, prednisone, Tysabri
--Prochymal in Phase III study (can't wait til it's approved!)
--Compounded budesonide 3mg/daily, Started Cimzia first dose 2/10/09.  Dx Osteoporosis 10/08 started Forteo 1/27/09

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