Medicines before pred

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sweetmelody
Veteran Member


Date Joined Aug 2007
Total Posts : 650
   Posted 7/10/2008 5:54 PM (GMT -6)   
Can anybody list the 6-mp meds... or at least the most commonly known ones? I am tryin hard not to go back to pred, but i'm in a bad flare up and I want to ask my new dr about 6mp drugs, but I don't know what to ask or what the names are and everything. Any advice on which is the best or what to ask?

Diagnosed with Ulcerative Colitis March, 07






Medications:]Colazal 3 pills 3x a day</STRIKE>

<FONT color=black> Prednisone


Lialda - 2 pills in the morning w/ food.


jujub
Elite Member


Date Joined Mar 2003
Total Posts : 10407
   Posted 7/10/2008 5:57 PM (GMT -6)   
6-MP (Mercaptopurine) and Azathioprine (Imuran) are the two most commonly used drugs in the immunosuppressant category. Generally Prednisone is give for the first 2-3 months in declining doses, because it takes several months for the immunosuppressant drugs to become effective.
Judy
 
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Avascular necrosis in both shoulders is my "forever" gift from steroid therapy.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. In remission since April, 2006.
 
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Please remember to consult your health care provider when making health-related decisions.


dakotagirl
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Date Joined Apr 2006
Total Posts : 3402
   Posted 7/10/2008 6:06 PM (GMT -6)   
Background info to help you:
The first stage meds are the 5ASAs - Asacol, Colazal, Pentasa, Lialda, Sulfasalazine, Rowasa, Canasa, etc.
If those don't work, prednisone or steroid enemas are usually added to the mix.
If it it found that you are prednisone dependent or cannot tolerate 5ASAs, then immunosuppressants are added to the mix. (See Judy's post above.)
If immunosuppressants don't work (don't keep you in remission), the next step is biologics such as Remicade and Humira.
If all other meds fail, it's time to consider surgery.

That should give you more background on the meds.

Good luck talking to your doctor!
Pan-colitis and GERD diagnosed May 2003
Osteopenia (hip and spine) diagnosed Feb 2006
Status:  close to remission?!?!?
10mg Pred, Asacol 12 per day,  Azathioprine 100mg, Aciphex, Forvia, and Pro-Bio
Remicade: 1st infusion 06/17/08:  Next (3rd) infusion 08/12/08
 
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sweetmelody
Veteran Member


Date Joined Aug 2007
Total Posts : 650
   Posted 7/10/2008 6:15 PM (GMT -6)   
so there's basically no way of avoiding prednisone if you are flaring and 5 asas dont work?

Diagnosed with Ulcerative Colitis March, 07






Medications:]Colazal 3 pills 3x a day</STRIKE>

<FONT color=black> Prednisone


Lialda - 2 pills in the morning w/ food.


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 7/10/2008 6:25 PM (GMT -6)   
I wouldn't say that... most doctors will automatically try to put you on it (and even try to push you into it, in my experience.. unfortunately I'm a wimp under pressure) but you should certainly be able to refuse. If you don't wish to take prednisone, then you shouldn't have to.

Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar region of the spine from long term prednisone use. 

Currently unmedicated and flaring :(
Waiting for my appointment with the new GI on July 18th. Insurance finally kicked in, hooray!

 
 
 


sweetmelody
Veteran Member


Date Joined Aug 2007
Total Posts : 650
   Posted 7/10/2008 6:31 PM (GMT -6)   
yes but if i refuse... is there another way to stop the flare up?

Diagnosed with Ulcerative Colitis March, 07






Medications:]Colazal 3 pills 3x a day</STRIKE>

<FONT color=black> Prednisone


Lialda - 2 pills in the morning w/ food.


ediekristen
Veteran Member


Date Joined Apr 2007
Total Posts : 1366
   Posted 7/10/2008 7:01 PM (GMT -6)   
I went on Imuran without being on pred at the same time and it took awhile but I did seem to have some results from it. I think their idea is that if you take prednisone with it at first it will get you in remission quicker and then the Imuran is supposed to keep you in remission as and after you taper off the prednisone.

Female, 23, Ulcerative colitis (pancolitis) since 1999; GERD; gastritis; osteopenia in femur head & lumbar region of the spine from long term prednisone use. 

Currently unmedicated and flaring :(
Waiting for my appointment with the new GI on July 18th. Insurance finally kicked in, hooray!

 
 
 


Anxious Mother
New Member


Date Joined Jul 2008
Total Posts : 1
   Posted 7/11/2008 10:08 PM (GMT -6)   
Thank you for this information. My son was diagnosed with UC in March 2008 (after an original university MD diagnosis of constipation). His GI is, in my opinion, too conservative. The doctor started with 2 Lialda per day on a 20 year old student who was completely bedridden with fatigue and pain. He is now up to the maximum dose of Lialda and the doc just added 50 mg Imuran. When I asked about adding prednisone the doc said it was inappropriate for anything but a flare up. This kid is anemic and has not slept all night in six months. He nearly passed out at work and will not be working this summer. People out there with more experience - is it time to see someone else? I am so worried about him. I worry about sending him back to university in September.

seconder
Veteran Member


Date Joined Jun 2008
Total Posts : 610
   Posted 7/12/2008 2:37 PM (GMT -6)   

Different doctors are going to give you different answers -- but within a certain rubric.

The prenisone isn't going to help with sleeplessness or anemia and probably isn't the best answer for fatigue, although it may take care of that initially.

Your son might try a different 5-ASA than Lialda.  Maybe the Imuran will be effective.

My first GI liked Asacol and that was about it.  His philosophy was to learn to live with whatever symptoms I had as a long as I took Asacol.

I've had a number of GPs and they been all over the place.

I've had my current doctor for a number of years and he's a big, big fan prednisone.  I avoided the pred and, by switching to another 5-ASA, I've discovered the Asacol wasn't working, so prednisone would have only made the situation worse.

I saw a new GI this week and he's a big fan of Imuran and thinks I should be on it rather than sulfasalazine.  I'm not going to take it the Imuran, but he suggested starting it without prednisone and doesn't like to use steroids at all.  He also said he counsels his teen and 20-something patients to consider surgery in the short term and usually doesn't suggest they take Remicade.

So -- four or five doctors and four or five opinions.  The best thing that has worked for me is to be informed and to know what to expect -- as best I can, anyway.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16404
   Posted 7/12/2008 3:23 PM (GMT -6)   
I have both crohns & UC. My gi started me on Imuran and it was at the 50mg dose and later he increased it to 100mg. I think just about everyone starts at 50mg and work their way up. For some reason it sticks in the back of my mind that Imuran is weight based, but I may not be correct. I have been having a bad flare with UC so he increased my Lialda to 4 a day. I have been on Lialda since June of 06 and Imuran since Oct of 02. I did Remicade for about 3 1/2 yrs and it sort of lost its punch we thought. Earlier this yr dx'd with a fistula that came out thru my stomach, so back on Remicade. I cannot take a steriod of any kind, but have been tolerating the Entocorte for a few yrs. Its not released until it hits the small bowel, so you don't have the bad side effects like with Pred. I hope your sons gets better. Get his dr to put him on B12, I am anemic and my dr says low B12 leads to anemia. Susie


Red_34
Elite Member


Date Joined Apr 2004
Total Posts : 23551
   Posted 7/13/2008 6:53 AM (GMT -6)   
You can also try using the hydrocortisone enemas if you don't want to be on the oral pred. Steroid enema's are much easier to handle side effect wise. But remember, if you don't want steroids then that is your choice. I have never ever been on oral steroids in the 16 years of having this. This was both mine and my GI's choosing. So if you were to go an immune suppressor, you can always try steroid enemas until the immune suppressor starts working.
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~Left sided Uc-'92-Colazal(9 daily),6mp(50-100mgs), Hydrocortisone E's, Prilosec,Biotin,Forvia,Pro-Bio**Unable to tolerate Asacol, Rowasa or Canasa**~Year-round allergies-Singulair, Allegra
~Secondary Reynauds Syndrome-'04-Norvasc~Spinal Stenosis~Sacroiliitis-epidural injections~bulging discs C5,C6&C7~1st epidural injection 7/15
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