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Going onto a 5-ASA treatment

GoJohnnyGo

One Badass Dude
Back from my new doctor (GP) today. I really like this guy. Third visit now and developing a bit of a rapport with him. Not sure if he has a lot of Crohn's patients, but that's okay because he seems to be the overly-cautious type (so at least he'll be thorough). Because I've gone through severe stages of the disease before (albeit a long time ago), he knows I'm up on chronicling my symptoms. He's left it up to me as to when I want to start on 5-ASA (don't know which one he'll prescribe me yet). I'll wait a few days to see how my infection clears up and go from there.

At the same time, I'm going to start a food diary (thanks to reading about it here) and work backwards in a process-by-elimination manner. He thought that was a good idea.

I don't really feel a lot better, but I'm now getting somewhere!
 
The choice of which med you get will depend on where your disease is. Different ones are active in different parts of the digestive tract.
 

GoJohnnyGo

One Badass Dude
Colt said:
The choice of which med you get will depend on where your disease is. Different ones are active in different parts of the digestive tract.
Yeah, I think so. I think this new guy is listening to what I say. I feel a bit of distress up and down to the sides moreso than centralized in the groin area. Maybe that's the lower bowel (going by anatomy)? The pain also moves around to the back (to the point it was difficult today for me to bend down on the toilet and half the stuff splattered all over while I was trying to bend down to sit).

I do know that further blockages tend to recur near previous resections (in my case the jejunum and terminal ileum), but this feels like a different area.

I had a good day yesterday, but today was hell. Being the long weekend, my first opportunity to see him again is Tuesday morning 10:00 sharp. Really don't like the idea of going back on drugs after so long, but present circumstances dictate it. Eating right isn't working (very frustrating) and a vitamin and supplement regimen a month in hasn't produced enough of a difference (although in my opinion something worth continuing with).
 
I

Isla

Guest
Asacol: Treats the terminal ileum, and the upper 75% of the large intestine
Pentasa: Treats the large intestine only (usually only the lower 75%)
 

GoJohnnyGo

One Badass Dude
Yeah, I'm trying to research this. The last Crohn's-related drug regimen I had was post-surgery and it was Flagyl and Sulfa-something. Not really up on the new stuff.
 

GoJohnnyGo

One Badass Dude
Well, Asacol it is. One 400mg tablet three times a day to start with and see how it goes. He also suggested prednisone, but I'm willing to wait a bit on that.
 
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Isla

Guest
That seems an odd dosage unless you mean 2 400mg tablets, 3 times a day? For a total of 2.4 grams a day. That is the normal "remission" dose. It is what I am on and is working very well for me.
 

GoJohnnyGo

One Badass Dude
A total of three pills a day. That's what the bottle says.

Not really familiar with what normal dosages are. I'm supposed to see him in two weeks.
 
I

Isla

Guest
Ya that isn't a normal dose at all, I have done a lot of research on Asacol and I am not sure at that low of a dose that it will even help you. Though it could very well work for you. But it isn't the usual prescribing practice as tests have shown the best dosage is 2.4g a day, there is a step higher (more Asacol) which helps get a flare into the remission state in which you can drop back down to 2.4g a day. You can go to Asacol's website and find a plethora of information. Maybe you should look into it and print any pertinent information to bring with you on your next visit.
 
Did you ever hae any problems with side effects when you started another med.?
Maybe your doc is slowly getting your body used to the meds.
 

GoJohnnyGo

One Badass Dude
ladyB said:
Did you ever hae any problems with side effects when you started another med.?
Maybe your doc is slowly getting your body used to the meds.
Nope. I've never been on any sort of crohn's medication before -- outside of Flagyll post-surgery 18 years ago. I have no known allergies nor adverse reactions to any medications.

Gee now I'm quite perplexed.

I did tell him that I am in considerable pain -- 8/10 on a personal threshold.
 
What did he say about your pain?

My GI just said "you'll have good days and bad days" Really irritates me!
 
teeny5 said:
What did he say about your pain?

My GI just said "you'll have good days and bad days" Really irritates me!
Well let's just see how well the doc would handle one of our 'bad' daays...
Then see what action he would take
 
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Isla

Guest
Well he said he has an appt. in 2 weeks. Lower doses are indicated if there is a possibility of impaired renal function. Though the 1.6 g dose a day is to have UC put into remission, not CD. Everywhere I have read 2.4 g / day is indicated for those with CD not UC.
 

GoJohnnyGo

One Badass Dude
Definitely not renal concerns. I was tested for that. I am at a loss right now. Could the druggist got the prescription wrong?
 
I

Isla

Guest
It has happened to me before. So I would say it is a possibility but not a likelihood though. I would just wait the 2 weeks and ask your doctor then.
 

GoJohnnyGo

One Badass Dude
To be quite honest, given a choice, I'd rather be under-medicated than over-medicated. Not that I don't trust the medical profession, but we are a society of pill-poppers and sometimes I wonder why.

Thanks for bringing it up though, I'll definitely ask him.
 
I've been on one 400mgs tablet three times a day... and it worked well for years... until my latest problems 18 months ago. The Doc is quite emphatic about the dosage, so no mistakes there. If I have a "bad patch" I just double the dosage for a while and it usually clears up. And no mention of any renal problems... ever!
If it works I wouldn't worry about it... if it doesn't work, you need to see the doc again!
 
I maxed my Asacol dose out at four times that Agent, I've actually never heard of a dose that low, I was started out at double your dose (3 times a day still, just the pills were multiplied)...I've been off it for 9 months almost though, it was thought to be too uneventful for the severity.

Try Lialda if you can look into it, it's essentially a one a day Asacol dosage, more or less...
 

GoJohnnyGo

One Badass Dude
Agent X20 said:
I've been on one 400mgs tablet three times a day... and it worked well for years... until my latest problems 18 months ago. The Doc is quite emphatic about the dosage, so no mistakes there. If I have a "bad patch" I just double the dosage for a while and it usually clears up. And no mention of any renal problems... ever!
If it works I wouldn't worry about it... if it doesn't work, you need to see the doc again!
Well, that puts my mind at ease a bit.

Here I went to bed thinking maybe the doctor was taking my symptoms lightly. Now that I think about it, he's taking a cautious approach because those are the vibes I'm giving off (turning down the prednisone for instance). Dosages can always be upped, and obviously I know better than to expect an instant alleviation of symptoms.
 
My doc seems quite cautious. Maybe I give off that "I don't like taking tablets" vibe. On the other hand, he's made it quite clear to get back in touch asap if things start getting worse!
 
Mine seems the same way...though I am really peeved right now because I have been worse and he hasn't returned my calls yet! I think it is better to have one that is cautious than one that is just giving you a ton of meds you don't need.
 
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Isla

Guest
Remember Asacol can take 6 or more weeks to start taking effect. So if you want to stick on this low dose, I suggest you try it for 2-3 months before thinking you need a higher dose.
 

GoJohnnyGo

One Badass Dude
Does the pain get worse before it gets better?

Because that's what's happening and it's wearin' me out.
 
That's what I thought...went to Urgent Care yesterday and they changed my meds. Now I am like a whole new person. I think the Asacol just wasn't working...despite my GI insisting it was.
 
I

Isla

Guest
Well if you are pre-6th week mark then yes you could be feeling worse before you start feeling better. If you are like 100 times worse, something is wrong and you need urgent care but if you can stick it out to a full 8 weeks on Asacol, then do so it very well may work for you. After 8 weeks if you are the same or still getting worse then it is definitely back to the drawing board for you.
 
What is Pentasa?
Doctors have been using the drug, Azulfidine, for over 50 years to treat inflammatory bowel disease. In some ways the Azulfidine molecule is half aspirin-like and half like the antibiotic sulfa. Some patients have an adverse reaction to Azulfidine, mostly due to its similarity to sulfa compounds. Scientists were able to remove the sulfa-like portion of Azulfidine, while maintaining the full beneficial effect. The result was meslamine, an aspirin-like antiinflammatory drug. Approved by the FDA in 1987, mesalamine comes in different formulations and delivery systems - one of which is named Pentasa.

Pentasa is a man-made compound that is taken by mouth to treat inflammatory disorders of the colon such as Crohn's disease, and other inflammatory conditions. It is sometimes given in conjunction with other medications such as the steroid, prednisone. Another common name for mesalamine is 5-aminosalicylic acid, or 5-ASA. Each capsule of Pentasa contains about 250 mg of mesalamine. The shelf life is 3 years.

Targeted Delivery
One of the unique features of Pentasa is the fact that the pill does not release its medication until it reaches the diseased area. Each tablet has a special plastic coating which delays release of mesalamine until the tablets reach the end of the 20 feet of small intestine, or the ileum. This allows delivery of most of the medicine right where the problem lies - the ileum and right colon. How mesalamine works is unknown, but it appears to be topical rather than systemic. Once released in the colon, mesalamine is minimally absorbed. Most of it works directly on the lining of the ileum and colon - like putting a salve on a rash. Eventually most of it is excreted with the stool. Studies have shown that Pentasa can help bring a case of Crohn's under control and help maintain a remission over time. Realize that inflammatory bowel disease rarely goes into permanent remission, but the risk of flare-ups can be substantially reduced by continued use of Pentasa at the maintenance dose as directed by your doctor.

What Pentasa is not.
Pentasa is not a steroid like prednisone. It is not habit forming; it does not cause drowsiness. Since it lacks the sulfa-like properties of Azulfidine, most patients intolerant or allergic to Azulfidine and other sulfa drugs can be safely treated with Pentasa. In addition, Pentasa does not reduce a man's sperm count as does Azulfidine. There are no known interactions with other medications. As yet, there is no generic substitution available.

How does Pentasa differ from Asacol
Both Pentasa and Asacol are prescription forms of mesalamine. The difference between Asacol and Pentasa is in the outer chemical coating. Oral Pentasa has a unique formulation. The active ingredient is contained in coated microgranules, which enables a prolonged release of the active substance throughout the intestinal tract, from duodenum to the rectum. Therefore the Pentasa preparation is more useful for Crohn's patients who often have inflammation of the small intestine. The average small bowel transit time is approximately 3-4 hours in healthy volunteers.

From...
 
Not to make Isla angry by contradicting her, but this seems to suggest that you should get some benefit from the drug right away since its somewhat topical. I would talk to my doctor if you saw no improvement.
 

GoJohnnyGo

One Badass Dude
Update:

I just got back an hour ago from seeing the doctor. I had planned to see him Monday, but I needed a form filled out for work, so we discussed it anyway. He's just being cautious. Since I was only finding minimal relief so far, he's doubled the dosage.
 

GoJohnnyGo

One Badass Dude
My Asacol pills are a reddish brown. They've got the brand name on 'em, so I know they aren't a generic.

He wants me to increase incrementally the dosage over a few days and not all at once.
 
Mine are reddish brown too, and actually called "Asacol" on the packet. I hope they work.. they sorted me out for a long time, and with no noticable side effects. I think I only flared up again 18 months ago because I was stupid and trying to do too much
 
I was told there's no generic asacol, hence it's raping expenses.

Also, Asacol doesn't always have all the benefits and nothing wrong compared to Sulfasalazine (what I'm on now, but not as my primary treatment)...Asacol was highly suspect at making me worse, not better, because it can make the small bowel secrete MORE fluid, and with severe Crohns in the colon, it can't reabsorb the fluid like it's supposed to, hence, worsened diarrhea. That's the theory anyways, on why I was not a good candidate for it, but hey, if it works.

I think that even though it's topical, it may be the type that takes weeks/months to work...like acne medicated creams/oinments...the dermatologists will tell you you won't see a difference the first week...same thing I imagine.
 
K

KaraLynn

Guest
[FONT=verdana,arial,helvetica,sans-serif]Has anyone ever been treated with 5-ASA enemas?
[/FONT]
 
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