Reason why 1 treatment given over another by Dr?

[jlacey]

My daughter, who is 6, was only diagnosed with moderate Crohn's in November 2011.
The options given by the Dr to us were sulfasalazine or azathioprine. We chose to start at lower end of scale: sulfasalazine...and hope that it works to maintain the disease.
I have been reading up on other drug options and read this here....
Because the newer 5-ASA compounds, for example, mesalamine (Asacol and Pentasa), do not have the sulfapyridine component and have fewer side effects than sulfasalazine, they are being used more frequently for treating Crohn's disease and ulcerative colitis.

I don't know that much about the medicines...can any of you hazard a guess or know reasoning as to why my daughter's Dr would not have offered the drugs with lesser side effects?

Thanks for any help.
Jacqueline

 

[Terriernut]

Quite a few Drs nowadays are using the 'top down' approach with Crohns patients. My guess is that is why the difference. The top down hits the Crohns hard and fast. I'm so sorry your child has been ill. I hope the meds do the trick and things improve quickly!

Here is our Parents forum, you may find more on there:

http://www.crohnsforum.com/forumdisplay.php?f=49

 

[jlacey]

Thanks Misty.
Actually the pyramid for meds choices given by our Dr were...lower end and mildest-the sulfasalazine
Next step up...more aggressive...azathioprine
Last option...which we never even needed to consider was infusions.

Because of all the side effects and constant bloodwork of the azathioprine we opted to start at the mildest med -although wondering why the dr didn't recommend the meds without sulphur.

 

[Brrenda]

I have been on Sulfasalazine for years and years with no ill effects/side effects. One of the huge side effects for this drug is male infertility, which won't affect your daughter The other big one is depression in young men, again, not an issue for you.

The newer drugs are also more expensive. It's possible your doc just is used to starting here and knows it works well. I think you should ask him about that one as he'd be best able to tell you.

The side effects for Mesalazine are more than Sulfasalazine and some COULD be very bad. http://en.wikipedia.org/wiki/Mesalazine#Side_effects Maybe he wants to keep her on the one with the least side effects or possible side effects or complications for now since she's so young, too, who knows?

Do be careful getting her on Sulfasalazine. She's probably going to feel sick to her stomach for quite awhile until you get her stable on the dose. Took me about two months to get up to my regular dose and it wasn't fun but no side effects at all now.

 

[jlacey]

Thanks for the info
She has been taking it now since about mid December...no side effects that I can tell...but appetite is somewhat diminished...but that could be as a result of the weaning off prednisone...because she was starving 24/7 before started weaning. lol

And actually there is no talk of upping the dosage of the Sulfasalazine...i believe what she is taking now is the dosage she will stick with...liquid form 8mls 3x a day.

Meant to say on other post...Hi to a fellow Eastern Canadian lol

 

[Brrenda]

Hi. I take 3000 mg a day, 2 x 500 mg coated tablet three times a day. Started with one a day and slowly upped it to six. I sometimes take eight when I'm in a flare-up (and I remember to) to hopefully help.

I don't find this stuff affects my appetite at all (unfortunately!!)

 

[Terriernut]

Asacol kept me in remission for years (or close to remission) so the ''less effective'' drugs arent always so! I personally am not a proponent of the top down or middle down. I like the start low go slow. The only problem I had with that was that no one was monitoring me. That was my fault in a way, but what to do when you are moving all over the globe?

Just keep everything monitored and all digits are crossed here for your baby! (who by the way is gorgeous!!!!)
:heart:

 

[jlacey]

Because Sydney is younger they crush the pills and give it in liquid form...I believe her dosage is 400mg (if was pill form)...I am guessing that is daily dose...??
She takes 8ml 3x a day....

 

[Brrenda]

My pills are enteric coated and cannot be crushed. They are 500 mg each. Because she's so young and small, things may be very different, I really don't know.

 

[jlacey]

Ahhh thaks terriernut...I am kinda partial to her myself heehee
And yes myself and her father were both on same page...start low...didn't want her on a stronger drug if lesser one could maintain the disease.
We go back for check on Jan 23rd...and she had bloodwork to check what was happening on the 19th of December.