Prednisone, Flagyl, Asacol not working! Whats next?

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Regular Member

Date Joined Jan 2006
Total Posts : 303
   Posted 10/14/2007 9:42 AM (GMT -6)   
Well after my 3rd flare the meds are nolonger working, I did 20 days of flagyl, 30 days of pred , and contunue to be on asacol 3pills three times a day.
Once I discontinued the flagyl and pred, my ilieum blockage and pain has returned. Whats next for me. I have an appointment this wed.
Does asacol work for anyone?
I hear other drugs mentioned here Imuran, Remicade, Humira, entocort. Can anyone tell me about their experiences with these drugs?
Thank you

Veteran Member

Date Joined Dec 2006
Total Posts : 1986
   Posted 10/14/2007 9:58 AM (GMT -6)   
You may have to go to the next tier of drugs, the immunosuppressants (Imuran, 6MP, etc.). Usually they will put you on Prednisone or another steroid (entocort) until these drugs kick in because it can take months.

Lately though, more and more doctors are going the immunosuppressant along with biologicals (Remicade, Humira) right away.

You need to educate yourself on the different kind of treatments so you can discuss the options with your doctor based on your disease.

I like steroids for short term only, they did work for you while you were on them, the question is: can you stay on them for the months it may take for Imuran or 6MP to kick in?

Immunosuppressants have a list of side effects, but I haven't had any except for some elevated enzymes so others will have to speak up.  I like these drugs for the next tier (my opinion), before you bring out the big guns (Remicade, Humira). 

Remicade and Humira work well for many people, Remicade is limited in my opinion because most people will build antibodies to it eventually (which I did) which not only prevents it from working well, but can cause many side affects.  I don't know much about Humira as it was too expensive for me to try, but it seems to be working for a lot of people.  I do think it's pretty new, so the side effects aren't well known yet. 

All these drugs have side effects, it will be up to you to decide what you can live with, what you're willing to try. 

Hopefully one or a combination of these drugs will help you, if not, surgical intervention is always an option, but in my opinion, depending on the severity of the disease, surgery should be a last option (there are times when it's the only option, but that doesn't seem to be the case yet).  In most cases, a surgeon won't do surgery unless you've tried all/most of the other options without results (unless again, it's an emergency situation). 



49 years old, CD since I was a child.    
Six resection surgeries, permanent ostomy, adverse reactions to Remicade finally off of Prednisone, back on 6MP for maintenance, hoping for a long remission from this last surgery. 

Post Edited (JudyK89) : 10/14/2007 9:16:32 AM (GMT-6)

Regular Member

Date Joined Jan 2006
Total Posts : 303
   Posted 10/14/2007 5:45 PM (GMT -6)   
I just read this. Why would my doc prescribe asacol for me if my problem is in the ileium? From what I understand Asacol is released in the colon. Pentasa is used to treat the small intestine...
"Therefore the Pentasa preparation is more useful for Crohn's patients who often have inflammation of the small intestine. The average small bowel transit time is approximately 3-4 hours in healthy volunteers.

Asacol is a delayed release enteric-coated tablets which generally releases the active ingredient only in the colon."

Regular Member

Date Joined Aug 2007
Total Posts : 277
   Posted 10/14/2007 6:04 PM (GMT -6)   
I was on Asacol but it too didn't seem to work. (My crohn's is located between the small and large intestine) So I got bumped up on Imuran on Oct 3rd. I think it's kicking in because I am able to slowly eat more and my bm's are not swinging between C and D as much. =0)

I hope you find your right mix of meds. I really didn't want to get bumped up to Imuran because of the fact it's an immune suppressant but if that is what it takes to make this thing go into remission.... bring it on! =0)
Newbie - 35 yrs old Diagnosed: 08/03/07
Asacol 3x day
Imuran 50MG 3 x day
Lamictal 125 MG/day for bioloar II

Veteran Member

Date Joined Oct 2004
Total Posts : 3042
   Posted 10/15/2007 6:01 AM (GMT -6)   
Hi I would talk to your doctor about Imuran. I am on Imuran and Remicade. These 2 drugs are
working wonders for me. Yes Imuran does take some time to kick in. I agree with Judy you
may have to take pred until the Imuran takes effect.
Hi, I am teddybearweiser, I am a male.
I was diagnosed with crohns disease when i was admitted to the hospital
in 1992, in Jan of 1993 I was back in the hospital for surgery for my crohns. I had part of my right colon resectioned with ilecolonstomy.
 My GI doctor has me on Asacol, Dicyclomine,Imuran,Celebrex and Remicade. B-12 injection once a month.
My Internest doctor has me on Lisnopril-HTCZ and Folic Acid. Diagnosed
with Osteoarthritis July 2007

Veteran Member

Date Joined May 2003
Total Posts : 2480
   Posted 10/15/2007 10:04 AM (GMT -6)   
I''ve been on imuran for many years. I'm still on imuran but it has never put me in remission. Other drugs and a resection haven't put me in remission either, so now I'm trying The Maker's Diet and probiotics. I don't do the diet 100%, but I still notice a difference.

Elite Member

Date Joined Apr 2005
Total Posts : 14995
   Posted 10/15/2007 2:17 PM (GMT -6)   
I take Asacol and it works well for me. BUT......I have had two resections. Before my resections I used Pentasa with success.
Been living with Crohn's Disease for 32 years.  Currently on Asacol, Prilosec 60 mg, Estrace, Prinivil, Diltiazem, Percoset prn for pain and Calcium.  Resections in 2002 and 2005.  Recently diagnosed with Fibromyalgia and doing tests to see if I have Inflammatory Arthritis or AS.

Veteran Member

Date Joined Apr 2006
Total Posts : 1884
   Posted 10/15/2007 7:15 PM (GMT -6)   

If your Crohn's is only in the terminal ileum then Entocort might do the trick. My daughter has been on Entocort nonstop since July 2006 - on only one pill a day since May 2007. And is in full remission. No side effects whatsoever. She has the blessing of a Mt Sinai doc to continue on Entocort.

So we love Entocort, and will stick with it until safer meds are developed, particularly those that do not suppress the immune system. 


Veteran Member

Date Joined Apr 2006
Total Posts : 1884
   Posted 10/15/2007 7:17 PM (GMT -6)   
Asacol is released in the terminal ileum and the colon, so it was OK for the doc to prescribe it for you.  Pentasa, on the other hand, is released throughout the entire small intestine - not just the terminal ileum.

Veteran Member

Date Joined Jan 2004
Total Posts : 598
   Posted 10/16/2007 8:03 AM (GMT -6)   
Asacol was the first drug my doctor prescribed for me as a trial. I had partial remission of my pain and he said that was because some of the asacol gets into the end of the small intestine even though its formulated for release in the large intestine. So then he tried pentasa and I had complete remission of pain. However, I felt better systemically on asacol than I do on pentasa so I wish I could still take that and have it work as well as pentasa for pain. You might want to ask to try pentasa to see if you have greater improvement based on each drug's mechanism of action. It is true that pentasa works locally because I have seen no improvement in the other problems like the tendonitis in my feet. If there was significant systemic absorption I would think I would notice an improvement or at least some kind of change.

I plan to ask about the immunosuppressants on my next visit. Pretty sad that a patient has to suggest treatments but that's the way it is sometimes so.....
10 years, many tests, 3 gi doctors, Pentasa 1000mg 3x day
diovan, simvastatin and now trying good ol' zoloft

Veteran Member

Date Joined Jul 2007
Total Posts : 2142
   Posted 10/16/2007 1:31 PM (GMT -6)   

Jumping over from the UC forum. Just started Imuran today and GI wants to put me on remicade doing the test for that to help get me some relief because he says it will take time for the Imuran to kick in.

I can't take the 5ASA b/c of my kidneys and the Prednisone is not working for my UC.

I am afraid of taking these drugs especially since I was in the <1% for the hypersensitivity to the 5ASA's but I just can't keep on going as badly as I have been.

I would love to hear experiences....

Beth, 32
UC Diagnosed March 2000
Imuran 100mg 1xday;Remicade tests pending;Hydrocortisone enemas 1xday;Lialda 2.4mg 1xday since 8/24/07 ;prev. Asacol 4800mg day
Calcium and Vit D 500mg 3xday.
Minimal Change Disease (Kidney Disorder) Diagnosed Sept 2007
Prednisone 60mg 1xday, Simvastatin 20mg 1xday, Diovan 80mg 1xday. Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.

Regular Member

Date Joined Oct 2007
Total Posts : 106
   Posted 10/16/2007 1:32 PM (GMT -6)   
I'm on Remicade right now, I tried everything else and saw no change. Ive only had 3 treatments but so far the only thing its helped me with is joint pain. My tummy still hurts all the time and I'm so tired of it!
DX: Crohns in March 2007
Meds: Remicade

Regular Member

Date Joined Oct 2007
Total Posts : 294
   Posted 10/19/2007 11:17 AM (GMT -6)   
OMG this is what is happening to me...My 3rd flare in 4 months and the regimine of Entocort and Flagyl does not seem to be working this time...Im very nervous that the disease has gotten around these drugs somehow and is kicking it up a gear on my body...I hate this disease with all my passion.....I hate it I hate it I hate it!

New Member

Date Joined Oct 2007
Total Posts : 7
   Posted 10/19/2007 11:39 AM (GMT -6)   
I had an acute flare up last week that sent me to the hospital. I was dehydrated but fortunately not anemic or deficient.  Started Prednisone same day and at 10 days out finally getting some control. Decreasing dosage from 60mg/wk to 10mg. 6th week. The side affect that bothers me is insomnia.
I haven't gained any weight since losing about 8 lbs. only because I 'm trying to stay on an "any free" diet, eg. Gluten, wheat, dairy, corn etc. at this time and mega doses of vitamins. It's worth a try, anything is!
I am thinking about trying Probiotics in a few weeks when it all settles down.  Does anyone have any experience with Probiotics?
Trudy, diagnosed with CD May, 2006. Three flare ups since, IBD at least ten years prior. Switched from 6 Asacol per day to one Lialda - a new drug in the Asacol family once a day.  Prednisone for 6 week to hopefully getting it in remission.

Stoma Girl
Regular Member

Date Joined Oct 2007
Total Posts : 55
   Posted 10/19/2007 1:19 PM (GMT -6)   
Hi, nipping over from the Ostomy forum..

I had Crohn's and tried pretty much everything and none of it worked.. pentasa, pred, azathioprine, remicade (which worked the first time but then not again), and then tried some stuff like methotrexate and thalidomide. Although those didn't work for me, tests show that they do for some people, so it's worth investigating..

Also apparently the chemicals in certain cacti used in Tequila are beneficial, as is nicotine. Another drug to read up about is Low Dose Naltrexone which I didn't try but now wish I had! :)

Good luck!
Never Give Up, Never Surrender
.. Stoma Girl ..
.. Ileostomy following Crohn's Disease, 2007, aged 18 ..
.. Time between diagnosis and operation - one year ..
.. Journal of stoma-affected life : ..

Regular Member

Date Joined Oct 2007
Total Posts : 82
   Posted 10/25/2007 1:21 PM (GMT -6)   
I don't know if this helps you or not, but I had been on Asacol for many years.  Before that, it was Dipentum, Pentasa, Rowasa and the old asulfadine (however you spell it - the sulfa drugs).   Unfortunately, during flare-ups, the Asacol would shoot through me so fast that the pills didn't even dissolve.  
Then, my gastro switched me to Colozal, which fixes that problem.  They're capsules, not caplets, so they dissolve faster and better than Asacol.  I think all of the above-mentioned drugs are basically the same, with meselamine being the active ingredient.  But I could be wrong...

Veteran Member

Date Joined Oct 2004
Total Posts : 3932
   Posted 10/25/2007 1:29 PM (GMT -6)   
Pentasa worked very well for me, during the early years. Its a bit less effective now, but still better than the others. Dipentum was UTTERLY USELESS...
Seriously, inquire about Humira or Remicade. Or as said above you could try Immuran. Has your doc also tried Cipro in combo with any of your other meds??

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