Medication for First Flares

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Regular Member

Date Joined Apr 2008
Total Posts : 44
   Posted 4/15/2008 1:42 PM (GMT -6)   
As I'm reading more and more of the posts, one thing that strikes me is that many of the people who have been diagnosed relatively recently are on very strong meds. I was wondering if your doctors tried lighter meds (asacol, etc.) first and they didn't work, or if they went straight to the "nuclear weapons".

When I was first diagnosed, my GI gave me an Asacol prescription and sent me home. After about a year I flared again and Entocort and Canasa suppositories were added. I've never gone past that. Is it a normal process to get heavier meds first and my doc just did it differently?

dx UC Dec. 2001
currently in remission
Meds: asacol 6(400mg)/day
         entocort 3(3mg)/day
         canasa 1(1000mg)/day
         looking into probiotics

Veteran Member

Date Joined Dec 2005
Total Posts : 3238
   Posted 4/15/2008 1:47 PM (GMT -6)   
Hi! I started off on Colazal alone. It didn't do a thing. i continued to get worst and was then put on pred. After my second flare and becoming steriod dependent I was put on Imuran. So no I wasn't started on the 'nuclear weapons' right off the bat. I wish the Colazal alone would work for me but unfortunately it didn't.
Tabitha (Tab)

100mg Azathioprine, 2 Fibercon, Colazal-9 a day, Acidopholis Pearls, Nexium
Co-Moderator UC Forum

Veteran Member

Date Joined Apr 2006
Total Posts : 733
   Posted 4/15/2008 1:54 PM (GMT -6)   
I started on Sulfasalazine and the Rowasa. I read a study someone posted on here that stated that studies have found that starting with more aggresive meds from the beginning of diagnosis can result in a better outcome for patients. Maybe someone could find the study and post the link, I have no idea how to find it. Sooo... maybe that is why you are noticing that change?

I wish I had Remicade from the start, maybe I wouldn't have ended up with a fistulizing ulcer if I had been on it since day one, but who knows.
Diagnosed with Left-sided UC in 1995 at age 15, Prednisone, Rowasa & Hydrocort. Enemas, Proctofoam, Sulfasalazine, Asacol, Probiotics, Fish Oil, Aloe Juice, Canasa, Enotcort, Colazol, Anamantle, Remicade, etc... had 1 inch deep rectal ulcer 2004, put on Remicade, August 2007:Increased Remicade dosage-700mg every 6 weeks,diagnosed w/ Psoriatic Arthritis & Fibromyalgia Current meds: Clorazepate, Lomotil,  Tylenol pm, Lyrica started 1/17/08, Flagyl 750 mgs started 4/2/08, Humira started 4/4/08

Pooper Bowl Champ
Regular Member

Date Joined Jan 2008
Total Posts : 68
   Posted 4/15/2008 2:01 PM (GMT -6)   
I was put on Colazal from the very beginning 3-3x a day. That is the only med I have ever been on. I'm now on 3-2x a day and thing so far are fine. It has been 4 years now. Keeping my fingers crossed. about 3 weeks ago was switched to the generic Colazal. So far so good.

DX Pancolitis 3/2004
Colazol (Generic) 3 tabs 2x a day.

Veteran Member

Date Joined Jul 2006
Total Posts : 2105
   Posted 4/15/2008 3:00 PM (GMT -6)   
Asacol, then sulfasalazine, back to asacol, colazal, lialda, along with cortenema when flaring.  First bad flare flagyll did the trick, second went straight to pred.
Proctitis DX 1998
Lialda 1x day
Hydrocort Enema As Needed

Regular Member

Date Joined Mar 2008
Total Posts : 274
   Posted 4/15/2008 4:00 PM (GMT -6)   
GangGreen, like you I was only on Asacol after my very first flare and diagnosis. I lasted 3 years in remission on the Asacol alone. I just started this flare in March and since have started Entocort and Mesasal. They tried a higher dosage of the Asacol alone first to no avail and so now.. I guess they are just trying out new things until I get my appointment for another colonoscopy to see what's going on inside there !!! I often had the same question as you tho............
Ulcerative Colitis Diagnosed May 2004
400mg Asacol 3 times per day.... increased to 6 400mg per day Mar.11
Asacol changed to Mesasal 500MG 3 times per day April 1
Entocort 3 pills once a day
Daily Vitamin for Women and Folic Acid

Veteran Member

Date Joined Mar 2008
Total Posts : 1766
   Posted 4/15/2008 6:56 PM (GMT -6)   
My GI at first wanted to put me on steriod medication but I would not let him. So he just prescribed Asacol and that seemed to do the trick (at least for the first 6 months).
 Female, Age 19, Dx w/ UC August 2007
9 Asacol/day, 1000 mg Canasa

Elite Member

Date Joined May 2003
Total Posts : 30842
   Posted 4/16/2008 10:15 AM (GMT -6)   
I've only used Asacol and Salofalk retention enemas for over 19 years.

There are some patients on here with more powerful meds initially..doesn't seem to do the trick.

My flares have only been limited to the very lowest part of the rectum for a very long time since I treat at the very earliest symptoms by increasing the Salofalk and taper to a maintenance.

Sucks to use them....but the alternatives don't have me convinced to skip out of that regimen yet.

Did I mention 19 years and counting?

*Heather*Status: mini flare Dec 28... tapered to every 4th night
~diagnosed January 1989 UC (proctosigmoiditis)
~5ASA: Asacol (6 daily) + Salofalk enemas (increase for flares tapered to maintenance)
~Bentylol (dicyclomine) 20mg as needed
~Probiotic 3(Natural Factors Protec) bedtime + 1 (Primadophilus Reuteri) occasionally
~multi-digestive enzymes as needed ....zymactive 3 - 5x daily
~Ranitidine,Pariet (reflux) Effexor XR 75mg;  Pulmicort/Airomir (asthma)
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!

Elite Member

Date Joined Mar 2003
Total Posts : 10407
   Posted 4/16/2008 4:04 PM (GMT -6)   
I went on Remicade only after Colazal, steroids and Imuran all together failed to get me adequately well. My first meds were Asacol and Rowasa, but anything with Mesalamine gives me horrid D, gas and cramping. I just can't tolerate it. I do think most docs start out with the more conservative treatment, but they're tending to move on faster rather than letting people suffer for long periods of time if the first-line drugs fail them.
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
Co-Moderator UC Forum
The information I share on this forum is based only on my own experience and study. It is important to consult your health care provider when making health-related decisions.

Eva Lou
Veteran Member

Date Joined Sep 2006
Total Posts : 3442
   Posted 4/16/2008 4:22 PM (GMT -6)   
started on Rowasa enemas, 1 a day. Worked great but I wanted something "easier" to take- switched to Asacol, 2 tabs 4xday. Worked great also for about 3 years... worked so great that I stopped taking Asacol & used the enemas nightly. Went into the worst flare, on pred for about 6-8 months, got it under control. Off pred about 2 months, flare came right back. Went back on pred & also on Imuran, 100mgs day. Stayed on pred for about 6 months, was unable to taper off or get the flare under control. Started Remicade about a year ago, at the 5mgs per kg dose. Worked great for awhile, was able to get off pred. Remicade began to lose effectiveness about 7 months ago, flared again pretty badly, back on pred & switched to the higher Remicade dose, 10mgs per kg. Still on the higher Remicade dose, last took pred in February, things are going alright...not great, but manageable. Have already discussed trying Humira if & when Remicade totally loses effectiveness. Now, I feel that we waited a long time to start Remicade, but my GI doctor tends to be more conservative, in some ways. He has no qualms about using the "heavy-hitters" once you're on them, but starting 'em up can take a while!

diagnosed with UC '02
Asacol- 8 tabs/day
Remicade infusions
Imuran- 100mgs/day

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