Left sided colitis - looking for advice on mesalazine

I have UC up to the splenic flexure diagnosed recently via colonoscopy. The Doctor wanted to start me on oral mesalazine the same day but when I explained the reaction I had to the mesalazine enema (diarrhea worsened and severe abdominal pain) he said I might not tolerate the oral mesalazine either. I am still waiting for my follow up appointment with a GI Consultant to start a proper treatment plan and my GP is concerned about the length of time this is taking. I have been taking predsol enemas for several weeks and recently the Dr who did my colonoscopy switched me to the budesonide enemas which I've had some difficulty with.

In the meantime my GP has contacted the IBD Nurse at my local hospital who is going to give me a phone call tomorrow. Apparently she wants me to stop the steroid enemas now, which I'm really nervous of doing because they have worked really well in stopping bleeding etc. And she wants to start me on Asacol orally but wants to check what my reaction was to the mesalazine enema first.

Just wondering what the best type of mesalazine is for left sided colitis and maybe that would have the least side effects?

From what I've learnt on this forum there are quite a few different types ie asacol, pentasa which I have been trying to read up on but cannot find any information on what the differences are between all the different types.

Sorry I am asking so many questions recently but this is all very new to me and I have received such excellent advice on here which I am very grateful for

with left-side, later release, like lialda, might be a little better, but the one to try 1st is not clear-cut

---

11/08: ischemic colitis and scope perf colon. 12cm colon/ileocecal resected. IV antib:sepsis.
01/10: Dx: Mod. UC pancolitis. Rx: Lialda 3x.
02/11: Major flare w/antib:sinus. Rx: 40mg Pred taper. 6mp.
07/11: Histol remiss rt/trans; worse sigmoid. Rx: Rowasa & hydrocort
---
Curr: 1-2 soft-formed stool, no urgency: Lialda 2x, NO PRED, probiotics, Vit-D/C

I've recently reacted to both the enemas and oral 5-ASAs, so it was the mesalamine that caused my reaction, but for what it's worth, balsalazide (Colazal) is supposedly very effective for treating the left side.

---

--
F, 39. Diagnosed Feb. 8, 2017 - mildly active UC through sigmoid colon
Prednisone currently tapering, at 25mg (tapering 5mg every 7 days). Cortifoam 2x daily.
Previously tried Rowasa and Balsalazide with bad reactions - evaluating next steps re: meds.
Norethindrone (mini-pill)
Diet: modified low-residue, strict gluten-free/dairy free - daily multivitamin and D supplements. Considering VSL#3.

Trixy's Got Butt Trouble said...
I have an allergy to sulfa, I bet that's why the enemas aren't working for me anymore. Here I thought it was the generic brand that I was getting. Rowasa does come in a sulfa free formula - at least I remember seeing it one time. I have yet to get my hands on it.

Yes there is a sulfate-free version called "sfRowasa" but I often read about people having trouble getting their hands on it. Specialty pharmacies and mail-order pharmacies often have much better luck than our local, brick-and-mortar pharmacies.

---

Moderator Ulcerative Colitis
John, 38, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; 75mgs 6MP, 4.8g Mesalamine DR, and rowasa
UC causes complicated relationships with colons :::: we have trust issues ::::

Thanks, Ipoop! I can't even get Rowasa anymore. They only have generic at all the pharmacies I check, even Cigna Home Delivery can't get it. UGH!!

---

UC, moderate-sever
4800 mg Asacol & Rowasa-stopped working
Remicade-Caused Drug Induced Lupus
200mg Imuran
40mg Nexium
Prednisone @ 20mg/day
LDN - 4.5/day
Vitamins D, B12, C
Probiotic 2x's/day/10billion CFU's
Iron Pill
Supplements by Standards Process prescribed by Chiro based on weekly testing
Gluten egg dairy soy corn free diet
Homemade Fermented Foods

LouLou, good luck and smart to try the cautious approach. Just be vigilant about your symptoms and if your UC seems to get worse, stop I'm starting Remicade sometime this week and though I didn't expect to be thinking about a biologic so soon after diagnosis, I am at peace with our decision.

Regarding the steroid enemas, I have been on prednisone (now 25mg) since diagnosis in early February, and just added Cortifoam this week. Is there a reason they're pushing to get you off the steroid enema so soon? I understand the rectal steroids can be used for a longer period of time more safely than oral prednisone?

---

--
F, 39. Diagnosed Feb. 8, 2017 - mildly active UC through sigmoid colon
Prednisone currently tapering, at 25mg (tapering 5mg every 7 days). Cortifoam 2x daily.
Previously tried Rowasa and Balsalazide with bad reactions - evaluating next steps re: meds.
Norethindrone (mini-pill)
Diet: modified low-residue, strict gluten-free/dairy free - daily multivitamin and D supplements. Considering VSL#3.

Thanks, LouLou! Yes, this is a long term medication - for remission (hopefully!) and then maintenance. My understanding is that I may/will develop antibodies to it at some point, at which time they will increase dosage or switch to another biologic. There are several of them being used to treat UC right now, and more medications coming through clinical trials, so hopefully there will be many options to choose from before surgery - hopefully, though, Remicade will work! My fingers and toes are all crossed.

Smart to double check about your steroid enemas. I think it's good to be a strong advocate for yourself, especially if you think something doesn't sound quite right!

---

--
F, 39. Diagnosed Feb. 8, 2017 - mildly active UC through sigmoid colon
Prednisone currently tapering, at 25mg (tapering 5mg every 7 days). Cortifoam 2x daily.
Previously tried Rowasa and Balsalazide with bad reactions - evaluating next steps re: meds.
Norethindrone (mini-pill)
Diet: modified low-residue, strict gluten-free/dairy free - daily multivitamin and D supplements. Considering VSL#3.

loulou82 said...
DBwithUC thanks, I'll ask the IBD Nurse about Lialda.

In some countries lialda is known as mezavant. Same company makes them both, essentially the same med but named different.

---

Moderator Ulcerative Colitis
John, 38, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; 75mgs 6MP, 4.8g Mesalamine DR, and rowasa
You know you have UC when you walk the dog and both end up pooping in the bushes.

until you get something oral figured out, please ignore the nurse and continue with the enemas -

---

dx'd with pancolitis 12/21/03
current supplements:vit D, cal/mag, Psyllium Seed powder/Heather's Acacia fiber/ L-Glutamine/Hemp powder slurry 1x/week - grain free/paleoish diet that includes 100% grass fed beef, raw goat milk, & local organic free range eggs, lots of all natural well water, exercise, sleep as much as possible & enjoy this great life that God has blessed me with !