Asacol failed..what next

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aned
Regular Member


Date Joined Mar 2009
Total Posts : 105
   Posted 7/24/2009 1:01 AM (GMT -6)   
I don't even know if I should say that Asacol failed.  I think it was significantly helping the UC.  I was actually having formed stool which I haven't seen in a couple of years.  No blood or mucous, still some cramping pain.  I stayed on it for six weeks hoping that the side effects would go away, but they did not.  I had a constant headache, a minor itchy rash and upper stomach pain the entire time I was taking it.  So, my question is, what next?  I will do anything to avoid steroids.  Thanks for any input.
37 y/o female
non-specific colitis dx. 2007
ulcerative colits dx. 2009
diverticular disease dx. 2009
Asacol-failed
Entocort-failed
Colazal-current, but not working yet


jujub
Forum Moderator


Date Joined Mar 2003
Total Posts : 10407
   Posted 7/24/2009 3:05 AM (GMT -6)   
What about the Colazal? Are you still taking it, and is it helping at all?

Usually the next step after the 5-ASA's is either an immunosuppressant (6-MP or Azathioprine) or Remicade.

If you have significant proctosigmoid disease, you should ask your doctor about rectal meds. Both Mesalamine and steroids are available for rectal use, and much less is absorbed systemically that way. Some people who don't tolerate the drugs orally do fine on them when taken rectally.
Judy
 
Ulcerative colitis forum co-moderator
 
Moderate to severe left-sided UC diagnosed 2001.
Flared for 5 years, finally in remission with Remicade since March 2006.
Avascular necrosis in both shoulders is my "forever" gift from steroids.
Colazal,  Remicade, Nature's Way Primadophilus Reuteri. 
"My life is an ongoing medical adventure"
 


TLB37
Regular Member


Date Joined Dec 2008
Total Posts : 79
   Posted 7/24/2009 1:43 PM (GMT -6)   
hi i could not take asacol it made my diarrhea worse alot worse . I'm on lialda and doing good on it . Maybe you could try it ??? Sorry you are having this trouble .
    Female 37
 
   20 years of Ulcerative Colitis
 
  meds,  2 Lialda, 3 Azathioprine, 1 Celebrex, Cymbalta, Mirtazapine,
               TLB ( :


Malkavian
Veteran Member


Date Joined Mar 2009
Total Posts : 1439
   Posted 7/24/2009 1:54 PM (GMT -6)   
It depends if it's the formulation or the mesalamine that is bothering you. If it's the formulation, you may want to try other mesalamine drugs. If you have problems with mesalamine, you probably want to try biologics or immunosupprents. If you can't tolerate 5-ASA's I would NOT recommend sulfsalazine, as 5-ASAs are a metabolic derivative of the sulfur compounds.

Some other, less strictly medical ideas to try are: helminth therapy, omega-3 supplements, probiotics, and any of the number of diets that are out there.
22, female, diagnosed 3/6/2009, symptoms for 2 years beforehand
Mild ulcerative colitis from rectum to mid transverse colon
Currently taking Asacol (1200 mg 3x/day), Rowasa and Calcium/D supplements


quincy
Elite Member


Date Joined May 2003
Total Posts : 30586
   Posted 7/25/2009 1:52 AM (GMT -6)   
Malkavian....actually, 5-ASA is a salicylate, not derived from or related to sulfur at all. In sulfasalazine, the 5ASA is coupled with or connected to a sulfur molecule which in turn becomes its vehicle so that the 5ASA can go through the digestive tract till it's dispursed freely into the colon.

So, if one is sensitive to aspirin or any salicylates, any of the 5ASA meds including sulfasalazine could cause a reaction.

Some people are sulfa sensitive and can use the 5ASA meds, but may find reactions to the enemas or suppositories because of the metabisulfates.

Just clearing that part up.

quincy
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


quincy
Elite Member


Date Joined May 2003
Total Posts : 30586
   Posted 7/25/2009 2:12 PM (GMT -6)   
I think for some it works, others it doesn't. I also think the factors involved with med failure could be not high enough dosage, patient compliance or incomplete med coverage which should include rectal meds.

Some patients' ph levels of the ileum might not be as per the medication needs to dispurse....hence the other 5ASA meds available where bacteria is needed to dissolve the coating or for time released meds to be used.
There are many options....just because Asacol isn't sufficient, it's not the end of the line regarding 5ASA meds.

I need to stress the use of rectal meds....because it just wouldn't be me if i didn't.


q
*Heather* Status: flaring...Asacol 3 twice daily; Salofalk enemas nightly
~diagnosed January 1989 UC (proctosigmoiditis)
~UC meds: Asacol (3 @ 2x daily); Salofalk enemas nightly for flares & taper to maintenance 
~Bentylol (dicyclomine) 20mg as needed; Ranitidine (reflux);  Effexor XR 75mg(depression);  Pulmicort/Airomir (asthma) 
~vitamins/minerals/supplementsProbiotics....(RenewLife Ultimate Flora Critical Care + Primadophilus Reuteri). @ bedtime
~various digestive enzymes as needed
~URSO for PSC (or PBC) 500mg X 2 daily (LFTs back to NORMAL!!)
My doc's logic.. "TREAT (FROM)BOTH ENDS"  worth it !!!
 


kops2da
Veteran Member


Date Joined Jun 2008
Total Posts : 2865
   Posted 7/25/2009 4:44 PM (GMT -6)   

Yes, try the rectal meds.  Unfortunately don't think they are going to do it for me.  I may have to go back on prednisone.  I am using Cortifoam twice a day and Anusol suppositories three times a day.  Gradually getting worse since stopping prednisone.  Probably addicted or whatever!

I tried all mesalamines, including rectal and could not tolerate them - side effects like the flu. 
Blood tests showed that I could not take high enough doses of 6 MP to heal me and get me into remission.  All these are worth trying and wishing they worked for me like some people.  Doctor told me I am too old to do Remicade so I think I hoping for going back on prednisone for a while and maybe getting into remission or nearly (something I can live with).

ElaineNY


 
Senior - diagnosed with proctosigmoiditis - 6/2008   
Cannot tolerate mesalamines.  New specialist (June) - Cortifoam and Anusol three times a day for now.  Hope it works! (finding it impossible to do three times a day however)
 
Probiotic Align, Prilosec for GERD, Gas-X, vitamins, Calcium/D
Tylenol for knees and arthritis.
 
 
 

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