I'm curious if anybody has found one type of mesalamine to be more successful than others... for example...
When my symptoms first started, I was very, very severe. My first GI prescribed Lialda which is a huge, hard coated pill). I didn't know at the time that there were other options, like Pentasa (granules) and Delzicol (hard coated, but smaller than Lialda).
It took me a long time to realize that Lialda was actually problematic because it was so large and hard and I was so inflamed.
I have since tried both the granules (Pentasa) and the smaller tablets (Delzicol), and I think that did contribute to healing a little more.
A major problem area for me, for whatever reason, has been the ileocecal valve (between the small and large intestine), where I can feel stuff moving and sort of getting stuck there. I think the Lialda especially would sort of have trouble moving through that area because it is a big hard tablet...
Eventually I tried the granules and the smaller tablets, and I think perhaps this was helpful.
So far, mesalamine hasn't gotten me into remission, but I do think it has helped reduce the symptoms. I think there is some sort of Lyme component to my gut inflammation (maybe affecting my liver also and causing SIBO and bile issues).
Anyway, the mesalamine seems to help, but I think the form is important, depending on one's situation and area and severity of inflammation.
Anybody relate to this, and experiment with forms? Crazy how many GI doctors I'd seen and none had suggested trying other kinds. I eventually just asked my General Practitioner to prescribe me different forms (she's pretty easy going and just goes along with what I suggest). The GI doctors I've seen (probably like 5+) never even mentioned that there were different forms of mesalamine.
It sounds like you need to connect with a gastroenterologist experienced in treating IBD, especially if your ileo-cecal valve is problematic. Where and when were you diagnosed with UC? Did you get lab reports from your most recent colonoscopy that indicate the extent of your inflammation? The doctors you see should base your prescription(s) on clinical findings, not on guess-work! The most competent endoscopist would pass the C-scope to your terminal ileum to insure a correct diagnosis. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Yeah I had pancolitis… salmonella early on (might have caused this to begin with), then c diff from the cipro intended to treat the salmonella (c diff/extended abx took it to a much worse level) All this started in 2018. A little better now but still very symptomatic. Most GI doctors are largely unhelpful in my experience. Often just cause more issues (cipro for example almost killed me)
Old Hat, how does Colazal compare to Mesalamine? Have you tried both and decided Colazal worked better for you? I’d never heard of it. Thought Mesalamine was the standard least intense drug for IBD. Is Colazal another similar option? Thanks
Old Hat, how does Colazal compare to Mesalamine? Have you tried both and decided Colazal worked better for you? I’d never heard of it. Thought Mesalamine was the standard least intense drug for IBD. Is Colazal another similar option? Thanks
Gotya! One of the medical experts' "known paradigms" for development of UC is prior infection by some types of organisms. (Mine likely from amebiasis.) Several yrs after UC DX I got a staph infection, likely facilitated by hydrocortisone immunosuppression; then dr. put me on Cipro to knock out the staph, which it did, but it made my UC inflammation much worse! RE mesalamine: sulfasalazine was the only 5-ASA available when I got DXed in 1980; didn't help. Nothing that succeeded it got me to remission with minimal side effects before Colazal, which was formulated especially to treat from descending colon downward. It's a large capsule with powder content, intended to cleave in the transverse colon. If you have ileo-cecal involvement, it's unlikely to help you-- probably Pentasa would be more effective for you. (Helps many patients with Crohn's colitis) I got no relief from Asacol, and later on researchers found that it requires colon pH (acidity) of level 7 or higher to process effectively! (Mine was level 6) Dipentum (1990s med, small capsules) relieved my inflammation but not fluid absorption; Colazal treats both! Apriso (ca. 2010+, large capsules) was originally intended for maintenance of remission; I can't tolerate it due to respiratory side effects; some docs now seem to RX it as an alternative to Lialda. Around 2013 some generic forms (Balsalazide disodium) of Colazal came to market, so it seems that most pharmas now dispense the generic made by Roxanne Labs because it's the cheapest. Your insurance might only pay for the generic; some members here on the forum take it in combo with Azathioprine and report that it works for them. (BTW, many of us need to beware of antibiotics making our UC worse!) / Old Hat (40+ years with left-sided UC; in remission taking Colazal)
Old Hat… that’s interesting to hear actually about Colazal. Like I said, I had pancolitis severely and everything that raw and painful… entire colon. Even though there seems to be some narrowing or tightness in the IC valve, there is still a lot of pain at times in the descending colon.
For a long time Lialda was just too much for me (still maybe not the ideal) because it caused pain in tender/raw areas. However I assume it is geared toward targeting the end of the colon since it’s such a heavy duty tablet…
It’s interesting to hear about Colazal being a powder but also working on the end of the colon… perhaps I should see about trying that as well. I wonder how they get it to target that area specifically as a powder, as opposed to a thick delayed release tablet…
I currently have Lialda and Pentasa (and delzicol) and kind of switch between them to see if they help get areas that the others cannot. Perhaps it’s worth trying what you are taking as well…
Things have been improving but pretty slowly. Less sensitive than I used to be but things are still out of whack. Even with bile/liver possibly and maybe it’s due to inflammation and creating a negative loop on how the system processes and recycles bile… not sure.
For a long time Lialda was just too much for me (still maybe not the ideal) because it caused pain in tender/raw areas. However I assume it is geared toward targeting the end of the colon since it’s such a heavy duty tablet…
It’s interesting to hear about Colazal being a powder but also working on the end of the colon… perhaps I should see about trying that as well. I wonder how they get it to target that area specifically as a powder, as opposed to a thick delayed release tablet…
I currently have Lialda and Pentasa (and delzicol) and kind of switch between them to see if they help get areas that the others cannot. Perhaps it’s worth trying what you are taking as well…
Things have been improving but pretty slowly. Less sensitive than I used to be but things are still out of whack. Even with bile/liver possibly and maybe it’s due to inflammation and creating a negative loop on how the system processes and recycles bile… not sure.
The brandname Colazal has a pretty sturdy shell. (At least 1 of the generics doesn't, per comments made here some years back by UCers whose insurance would only cover generic.) Plus its contents are supposed to cleave via bacterial interaction in the transverse colon to project mesalamine into descending colon. According to past comments here RE Lialda, it doesn't help all pancolitis UCers to remission-- so your situation isn't unusual. But your doctors should have better insight toward guidance with these meds! Maybe you're hypersensitive to a secondary ingredient in Lialda so it doesn't work optimally for you. How long did you try Pentasa? I don't think that continuous switching between orals will solve your problem, based on previous member reports RE achieving remission via mesalamine. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
I had no issues with Lialda, but when it went generic and I was getting NorthStar brand, my body could not break down the enteric coating. I use Colazal now and it works great. That being said, my inflammation is only to 26-27 cm so just beyond the sigmoid. I did have a cecal patch when I was first diagnosed, but it hasn't been visible in any of my later scopes.
47 yrs old diagnosed with proctosigmoiditis 6/13/13
meds- Colazal (generic), 100 mg Imuran, Canasa as needed- supplements: curcumin, 2 g a day Allergic to sulfites. Currently gluten/dairy free
47 yrs old diagnosed with proctosigmoiditis 6/13/13
meds- Colazal (generic), 100 mg Imuran, Canasa as needed- supplements: curcumin, 2 g a day Allergic to sulfites. Currently gluten/dairy free
Old Hat said...
Gotya! One of the medical experts' "known paradigms" for development of UC is prior infection by some types of organisms. (Mine likely from amebiasis.) Several yrs after UC DX I got a staph infection, likely facilitated by hydrocortisone immunosuppression; then dr. put me on Cipro to knock out the staph, which it did, but it made my UC inflammation much worse! RE mesalamine: sulfasalazine was the only 5-ASA available when I got DXed in 1980; didn't help. Nothing that succeeded it got me to remission with minimal side effects before Colazal, which was formulated especially to treat from descending colon downward. It's a large capsule with powder content, intended to cleave in the transverse colon. If you have ileo-cecal involvement, it's unlikely to help you-- probably Pentasa would be more effective for you. (Helps many patients with Crohn's colitis) I got no relief from Asacol, and later on researchers found that it requires colon pH (acidity) of level 7 or higher to process effectively! (Mine was level 6) Dipentum (1990s med, small capsules) relieved my inflammation but not fluid absorption; Colazal treats both! Apriso (ca. 2010+, large capsules) was originally intended for maintenance of remission; I can't tolerate it due to respiratory side effects; some docs now seem to RX it as an alternative to Lialda. Around 2013 some generic forms (Balsalazide disodium) of Colazal came to market, so it seems that most pharmas now dispense the generic made by Roxanne Labs because it's the cheapest. Your insurance might only pay for the generic; some members here on the forum take it in combo with Azathioprine and report that it works for them. (BTW, many of us need to beware of antibiotics making our UC worse!) / Old Hat (40+ years with left-sided UC; in remission taking Colazal)
How is colon acidity tested? Is this a regular screening test one must have? Or just done to decide on the possible efficacy of a particular drug?
I asked my old GI about trying another mesalamine at one point. He said I could try if I wanted to but he didn't think it would likely help. I never ended up trying. Ive been on Delzicol (used to be named Asacol) since 2007.
I did have Lialda prescribed to me once just because the doctor thought fewer pills would be better but they are too large for me to comfortably swallow so I never tried them.
I wanted to add I've never had involvement in my ileum. That very well could mean something like Pentasa might work better for you.
When was your last scope and what are your symptoms? You might just need something stronger than mesalamine. Mesalamine helped me a lot for many years, until it didn't anymore.
38 yrs old; dxd UC March '07. Current meds: Started Xeljanz 6/15/21 - finally off steroids & in remission!; Delzicol. Calcium & Vit. D & K2; Multi w/iron. Past: Remicade (worked for only 9 wks); Imuran (horrible s/e); Humira, Entyvio & Stelara didn't work; Uceris; prednisone; Tramadol for flare pain; Rowasa enemas
I did have Lialda prescribed to me once just because the doctor thought fewer pills would be better but they are too large for me to comfortably swallow so I never tried them.
I wanted to add I've never had involvement in my ileum. That very well could mean something like Pentasa might work better for you.
When was your last scope and what are your symptoms? You might just need something stronger than mesalamine. Mesalamine helped me a lot for many years, until it didn't anymore.
38 yrs old; dxd UC March '07. Current meds: Started Xeljanz 6/15/21 - finally off steroids & in remission!; Delzicol. Calcium & Vit. D & K2; Multi w/iron. Past: Remicade (worked for only 9 wks); Imuran (horrible s/e); Humira, Entyvio & Stelara didn't work; Uceris; prednisone; Tramadol for flare pain; Rowasa enemas
Post Edited (Sara14) : 9/26/2022 10:01:24 AM (GMT-7)
Seeker275-- Colon acidity level can be assessed in a way similar to occult blood: small stool sample applied directly to special test paper. It's not done routinely as far as I know, but mainly contributes to understanding of a colon's processing efficacy. / Old Hat (40+ yrs with left-sided UC; in remission taking Colazal)
Hi, I want to say that Pentasa granules work for me better than the Pentasa pills. So I think there is a difference in the form of the medicine.