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5-ASA differences?

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Posted 11/2/2007 4:21 AM (GMT -8)
I've been wondering about this for quite some time now.  I've tried researching this but this ole foggy brain just can't comprehend all the medicalnese on most of these websites.  So I was wondering if someone can help me out here in plain english. 

What is the difference between all the 5-ASA's?  What I'm looking for is what does Asacol, Rowasa and Canasa have that Colazal does not.  Or visa versa.  What exactly is the difference between a mesalamine and a basalazide?  If it's the carrier in which it's dispersed, what is that carrier?  I'm looking for a technical answer that a layman can understand.

I am trying to find the culprit that causes me distress with mesalamines so I can take it to my doc.  Because he thinks that since I can tolerate Canasa that I should be able to tolerate Rowasa.  But truthfully, I think I'm starting to have an adverse reaction to Canasa now too.  Because I didn't take the suppository for 3 days, had good solid bms only 1 or 2 times a day.  And last night I did a suppository (for maintenance) and I have already been to the bathroom 5 times with mush and pain (no bleeding though).  He also says that Colazal is basically the same as Asacol - I only know that they are both 5-ASA's but I want to know the chemical differences.  Because obviously there has to be a difference if one is basalazide and the other mesalamine right?

Posted 11/2/2007 6:35 AM (GMT -8)
Colazal has a different bonding agent than Asacol. The bonding agent is what delivers mesalamine (the 5-ASA) to the colon. Without the bonding agents, mesalamine would be metabolized by the body BEFORE it could reach the colon & relieve the inflammation there.                                                                       

Rowasa is liquid mesalamine, but it has a sulfiting preservative added. I wonder why this type of preservative is used-- that is a BIG question-- because it is known to cause major allergic reactions! The FDA has banned its use on produce as it caused significant problems when used on lettuce a couple decades ago. Canasa apparently was upped in dosage from 500 to 1000 mgs of mesalamine a while back; I recall that THEREAREMIRACLES complained about this change in another thread last spring-- because the lower dose suppositories were discontinued & she thought that option should still be available to patients. / Old Hat (nearly 30 yrs with left-sided UC; currently on 3 Colazal daily; seem to be back in remission)

Posted 11/2/2007 7:36 AM (GMT -8)
Is the Sulfite perservative in Canasa as well? Is Sulfite the same as Sulfa or in the same category? Do you know what the bonding agent in Asacol is?

Thanks Old Hat, your knowledge is awesome :)
Posted 11/2/2007 8:57 AM (GMT -8)
Sulfa & sulfites are different chemicals. I don't know whether Canasa contains sulfites, but you can probably find out by GOOGLing the drug & finding its content list on the manufacturer's Website. RE bonding agent in Asacol: I don't know what it is, but I bet Quincy knows either straightaway, or she has found the best Website for checking it out. BTW, the bonding agent in Sulfasalazine-- sulfa, is likely the most problematic of agents in use on oral 5-ASAs because it can affect the patient's white blood cell development. Many thanks for your kind compliment, Sherry-- I've learned a bit over the years-- mainly thru CCFA info & conversations with my doctors, plus reading the package inserts of meds prescribed for me. / Old Hat

Posted 11/2/2007 9:09 AM (GMT -8)
LOL..unfortunately, my old computer contained all the awesome sites and I'm in the process of finding them. I had such good sites explaining the meds. arrrgh.

I do believe Canasa has metabisulfite in it as a preservative...it should be on the package info?

I'm just out the door...if I'm able to get the info from my other computer, I'll post it.

I'll get back to this thread when I'm home this evening.

quincy
Posted 11/2/2007 9:34 AM (GMT -8)
I was under the impression that 5-ASA's don't contain sulfa or do they? Do they just have a different form of it? I took Sulfasalazine several years ago but had to stop because I had a major allergic reaction - huge painful welts all over my body. I then took Bactrim (a few years ago) for a UTI and had severe abdominal pain that I had to stop it and later I found out that it contained sulfa. I get different reactions each time I'm exposed to sulfa. But now, I'm wondering if I have developed a sulfite sensitivity as well. Luckily many of the foods that contain high amounts of sulfites I don't eat anyway because it doesn't agree with my Uc - but now I am beginning to wonder if the reason it affects my Uc is because of the sulfites.

I tried finding the info about sulfite in Canasa but I couldn't make heads or tails from it. But, from what I could understand is that I couldn't find it! lol Is it considered an active ingredient or inactive? I know that the active ingredient is mesalamine - that I COULD understand. But I couldn't find anything about sulfite - maybe I overlooked it or didn't understand the terms.
Posted 11/2/2007 2:43 PM (GMT -8)
I just looked this up and read that all Asacol, Colazal, Dipentum, and Pentasa all DO NOT contain sulfa. I'm also allergic to sulfa and I've taken all of those 5-ASA drugs at one time or another.

But I can't find any info (in my quick search) about what the different bond agents are. Just that the major differences between the 5-ASAs is where the drug is released. For example, either just in the colon or in the small intestine and the colon. The basic element of 5-ASA molecules seems to be the same and the difference is the molecular structure and/or the coating which effects where the drug is broken down and released in the body.

From what I can tell, Canasa is a 5-ASA compound surrounded by a layer of some fat.

Still, in the Canasa info it says for doctors to be sure to know whether a patient is allergic to sulfa. I think that's because 5-ASA is actually a part of what sulfasalazine breaks down into. Here's what I read online that finally got me to understand where the 5-ASA drugs came from:

Sulfasalazine has been used in the treatment of ulcerative colitis for over 55 years. It is split by bacterial action in the colon into sulfapyridine (SP) and mesalamine (5-ASA). It is thought that the mesalamine component only is therapeutically active in ulcerative colitis.
---

Red, is there any chance you could stop using rectal meds completely and be ok?
Also, I know your doctor said that Asacol and Colazal are essentially the same-- and they seem to be-- but there are different drugs for a reason: people respond better to different drugs. I'm not sure why your doctor wouldn't want you to try a different one if it seemed that the one you're taking isn't keeping you in remission.
Posted 11/2/2007 5:40 PM (GMT -8)
Thanks Julee :) I was diagnosed 15 years ago and at that time Colazal wasn't even in existance yet. Colazal was only approved in 2000. So I didn't have many choices at the time other then Sulfasalazine, Asacol (Rowasa and Canasa) or steroids. So when I started showing adverse reactions to Asacol in 2004, my GI quickly switched me to Colazal. It's not that he's hesitant about me starting medications, I just find it baffling that he keeps saying that Asacol and Colazal is basically the same. I agree that they're the same since they're both 5-ASA's but he never expanded on his comments. I still have bleeding issues that pop up if I go too long without any rectal med and I can't tolerate Rowasa just like Canasa is doing to me now. The only other rectal med option at the time would be steroid enemas or foam and I sooooo don't want to start back on steroids! But the bleeding issues that I was having was during a transition period of my 6mp - my GI increased my dosages and my symptoms have improved greatly so I may go and see if I can do without the rectal meds for a while. I also recently started a probiotic so I'm hoping this will help keep things at bay for me as well.
Posted 11/2/2007 6:36 PM (GMT -8)
Oh I forgot to mention that I have absolutely no ill effects from the Colazal. It has managed to keep severe flares away since I started it.
Posted 11/2/2007 8:47 PM (GMT -8)

julee70 said...
I just looked this up and read that all Asacol, Colazal, Dipentum, and Pentasa all DO NOT contain sulfa. I'm also allergic to sulfa and I've taken all of those 5-ASA drugs at one time or another.

But I can't find any info (in my quick search) about what the different bond agents are. Just that the major differences between the 5-ASAs is where the drug is released. For example, either just in the colon or in the small intestine and the colon. The basic element of 5-ASA molecules seems to be the same and the difference is the molecular structure and/or the coating which effects where the drug is broken down and released in the body.

From what I can tell, Canasa is a 5-ASA compound surrounded by a layer of some fat.

Still, in the Canasa info it says for doctors to be sure to know whether a patient is allergic to sulfa. I think that's because 5-ASA is actually a part of what sulfasalazine breaks down into. Here's what I read online that finally got me to understand where the 5-ASA drugs came from:

Sulfasalazine has been used in the treatment of ulcerative colitis for over 55 years. It is split by bacterial action in the colon into sulfapyridine (SP) and mesalamine (5-ASA). It is thought that the mesalamine component only is therapeutically active in ulcerative colitis.
---

Red, is there any chance you could stop using rectal meds completely and be ok?
Also, I know your doctor said that Asacol and Colazal are essentially the same-- and they seem to be-- but there are different drugs for a reason: people respond better to different drugs. I'm not sure why your doctor wouldn't want you to try a different one if it seemed that the one you're taking isn't keeping you in remission.

I would have to disagree with your note regarding sulfasalazine. Those who can tolerate it tend to experience a much more dramatic improvement than those on 5-ASA drugs. It would be logical to conclude that this might be attributed to sulfapyridine's antimicrobial properties.
Posted 11/3/2007 12:34 AM (GMT -8)
http://www.medicinenet.com/ulcerative_colitis/page4.htm

http://www.umm.edu/altmed/drugs/mesalamine-082350.htm

Hi....the above site will help differentiate the different 5ASA meds.

http://www.rxlist.com/cgi/generic/canasa.htm

This one is specifically for Canasa....they contain NO metabisulfites as do the 5ASA retention enemas.  They're in a fatty ester base.  Maybe you're sensitive to them?  Page 6 has that info..

q

 

Posted 11/3/2007 5:48 PM (GMT -8)
Bumping this for Red...
Posted 11/4/2007 5:42 AM (GMT -8)
Thanks Heather - I haven't had a chance to check out those websites yet because I had a Halloween party to go to and I have a bday party to go to later. I will look them over later tonight to see if they make any sense to me! :)
Posted 11/5/2007 4:57 AM (GMT -8)
Heather, these websites only contain info on mesalamine? I didn't see anything on basalazide or did I miss it? Got a good site up your sleeve for Colazal? 
Posted 11/5/2007 11:18 AM (GMT -8)
http://www.rxlist.com/cgi/generic/balsalazide.htm

this is quite indepth...read all the pages 1 - 7

q

Posted 11/9/2007 9:43 AM (GMT -8)
I was in an investigational study for the FDA approval of Asacol back in 1988-89 and I seem to recall that they explained to me that Asacol has a resin coating on the outside with 5-ASA on the inside. The outer coating was designed to dissolve with the specific ph value present in the cecum, at the start of the colon. The azulfadine that I took before the Asacol used sulfa mixed with the 5-ASA to the 5-ASA from dissolving too soon. I hope my memory is working and I'm not too far off.
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