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Crohn's Disease Forum » Books, Multimedia, Research & News » The Role of Mesalamine in Crohn's Disease


 
10-22-2012, 08:01 PM   #61
David
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Hi Tanya.

From what I've read, I think you may have that backwards. I believe 6mp tends to be less toxic than azathioprine/Imuran but it seems that doctors tend to prescribe the latter more often. Frankly, I'm not sure why that is but others may know and will hopefully chime in.

I hope you don't mind, but I moved what you had at the bottom of your post to your, "signature" so that you don't have to write it each time.
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10-23-2012, 06:59 PM   #62
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Personally I believe Asacol does work. Ive been on it for well over a year . Before that It was miserable , with all the symptoms common with IBD. I still have pain in the Ilieum area and shooting pain in my side but my bowel movements now are more predictable. My colonoscopies are always clear yet i was in pain constantly . I now watch what a nd when I eat i try to keep fit . I have given up on doctors as i dont believe Im a high enough risk for them to spend money on me. But Asacol mesalamine does it work , in my case yes it does.
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10-23-2012, 11:03 PM   #63
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Peter, quick question on the Asacol. You say that you have inflammation in the TI; does Asacol actually release in the TI, or does it only help the colon? David, any thoughts on this? I've heard that Asacol can be quite effective, but usually in UC.

I'm asking this partly because I'm on Pentasa, and pretty much only that at the moment. Doing OK, but wonder if I could be doing better, and I don't want to be a ticking time bomb either. I'd be interested if perhaps another mesalamine would work better for me. My guess is that I was prescribed Pentasa to start because my GI might have hypothesized that I had other inflammation elsewhere in the small intestine, based on the fact that I had some stomach pain from duodenal ulcers happening before my diagnosis. (An MRI later revealed that the rest of my small intestine didn't have any additional inflammation beyond the TI, so that was good.)

Gotta love the medication guessing game. ;)
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Current meds:
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Previous meds:
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10-23-2012, 11:06 PM   #64
David
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Asacol releases at a pH of 7 or greater. Where it releases in your intestine is dependent upon your pH and everyone is different. For a majority of people, that will be a release in your terminal ileum for treatment of inflammation in the colon. For some people, you're going to pass the pill in tact. Other people it'll release higher up.
10-23-2012, 11:14 PM   #65
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Any thoughts on one versus the other? Wasn't sure if you thought all forms of mesalamine were all kinda "meh" within the context of CD, or if that opinion was only reserved for Pentasa.
10-23-2012, 11:15 PM   #66
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I heard today that they prescribe imuran because the dosing options Re more flexible unlike the 6 mp so even though they are basically the same thing imuran is easier to adjust as far as dosing goes
10-23-2012, 11:23 PM   #67
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Any thoughts on one versus the other? Wasn't sure if you thought all forms of mesalamine were all kinda "meh" within the context of CD, or if that opinion was only reserved for Pentasa.
If I had a form of Crohn's Disease that wasn't Crohn's Colitis and was going to take a form of mesalamine, it would be Pentasa. If I had Crohn's Colitis and was going to take a form of mesalamine, I'd probably take Asacol.

I probably wouldn't take mesalamine though. DEFINITELY not by itself. But that's easy to say when I don't have to make such decisions

I've thought about taking a form of mesalamine for my lymphocytic colitis but have never quite gotten that desperate and am still on the diet and lifestyle approach to treatment.
10-24-2012, 02:36 PM   #68
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Hi David-

Thanks. Yes, I was going to copy that into my signature but lost track of time.

I will let you guys know when the doctor gets back to us about which is more toxic (Aza or 6mp). I'm sure it's complicated like all of this...

Anyone know anything, please do weigh in.

Tanya
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10-24-2012, 06:28 PM   #69
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Peter, quick question on the Asacol. You say that you have inflammation in the TI; does Asacol actually release in the TI, or does it only help the colon? David, any thoughts on this? I've heard that Asacol can be quite effective, but usually in UC.

I'm asking this partly because I'm on Pentasa, and pretty much only that at the moment. Doing OK, but wonder if I could be doing better, and I don't want to be a ticking time bomb either. I'd be interested if perhaps another mesalamine would work better for me. My guess is that I was prescribed Pentasa to start because my GI might have hypothesized that I had other inflammation elsewhere in the small intestine, based on the fact that I had some stomach pain from duodenal ulcers happening before my diagnosis. (An MRI later revealed that the rest of my small intestine didn't have any additional inflammation beyond the TI, so that was good.)

Gotta love the medication guessing game.
As David has says Asacol is supposed to release at a PH of 7 , this actually proved an issue for me as I was taking Wheat Grass tablets to help with acid . This changed the PH in my stomach and probably my intestine also so using Asacol was problematic. I stopped with the Wheat Grass and was taking 4x800mg Asacol a day and inside a few weeks the D had nearly stopped and the bleeding had gone. Im left with constant pain in the LRQ which never stops and long periods of just feeling like a train wreck but its the best of a bad job I think. I have gone back on the Asacol again to try to bring things under control again as my Doctor says "you had all the test and they cant say anything definite apart from inflammation of the TI and possibly an inflammed Appendix" If the Asacol works for you then keep taking it , he said. So Thats what I do , I have read loads about the beliefs about it working or not , personally I could not live or work with out it .
I think how or where the Asacol is released is going to be specific to your body and its acidic level;s at given places ie Stomach ,TI and anus.
My Doctor maintains its for the Colon and not the TI, but I would surprised if he new where that was.

Good luck
Peter
10-25-2012, 09:13 AM   #70
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I've been thinking about this thread quite a bit (pentasa is the same as sulfasalazine, I think?)
I'm taking 3gm/ day - initially prescribed as 1.5 gm BD, but 1 gm TDS seem to maintain an even keel a bit better for me.
I understand it's an essentially topical treatment - I think 2 key issues in choosing appropriate treatment regimes are the location and the severity of the individual person's disease. I have Crohn's colitis(with subsequent severe iritis)
On initial diagnosis I commenced tapering oral prednisone and low dose 6mp while waiting for enzyme metabolism analysis. When that was normal I started increasing the 6mp as instructed, but felt significantly less well. I had also been doing a lot of reading of the medical literature by that stage, and felt the intestinal side of my CD really wasn't that severe..
After changing GI consultants I stopped the 6mp, and began maintenance sulfasalazine.
I suspect it's all about relative balance - my GI system is pretty quiet with the topical "lotion".. if my gut is fine my eyes are ok; and as for the grumbling joints, well I'll work around it!
For me, a more "systemic" treatment feels like overkill at this stage, but I recognize that it's all about balancing disease severity vs medication side effects
"If it ain't broken, don't fix it!!"

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10-26-2012, 08:27 AM   #71
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While sulfasalazine is a 5-ASA compound, it is not the same as Pentasa. It's a sulfa drug (which many are allergic to) as it breaks down into 5-ASA and sulfapyridine in the colon. It actually helps many with arthritis, it's too bad it's not helping yours
10-30-2012, 05:46 PM   #72
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I was on it for 9 months. My new GI does not feel it was doing anything so she recommend that I stop taking it and will be switching to Imuran.
11-24-2012, 08:01 AM   #73
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Pentasa works for me. I found out the hard way when Insurance ran out. I ended up in ER with inflammation in the ileum. While I'm supposed to take 2Gms/day, I only take 1 and since I'm back on it, and it's all I take for my Crohn's, I'm feeling pretty good.


Dennis
11-24-2012, 08:56 AM   #74
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I went back on pentassa with the imuran and have just started humira.. seems like a lot,but I am hoping I can drop something soon!! I as having a pretty nasty flare, and GI felt it was time to move up to the next level.
11-24-2012, 04:39 PM   #75
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I find these posts really useful! I had surgery in April and was then diagnosed with crohns, the gi put me on 4g pentasa on discharge. I'm now having a flare and am on taper of prednisolone and it annoys me to think that the pentasa might have been like a band aid. The research that said 60% of people have leisions at the surgery site after 1 year is scary!!!

My gi said we'll try prednisolone in addition to pentasa to treat this flare, see if it works, and if not then we'll try something else stronger than pentasa. What should I be asking for?

By the way, since I've dropped down to 25g of prednisolone I've had flare symptoms again, which makes me think I may have to go for the stronger meds option!
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11-25-2012, 12:12 PM   #76
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I took my first normal crap in four months within just a week of starting Mesalazine. I'm usually the first to call something a coincidence, but I can't say that's what I'm seeing here.
11-25-2012, 12:17 PM   #77
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I took my first normal crap in four months within just a week of starting Mesalazine. I'm usually the first to call something a coincidence, but I can't say that's what I'm seeing here.
I think it can definitely help some people, especially in the short term. Long term use of only mesalamine in Crohn's Disease is VERY worrisome to me unless the patient is monitored EXTREMELY close.

With that said, in your story thread you stated:
I was referred to the hospital and saw my gastro mid October, who sent me in for a Colonoscopy and MRI, both of which I had done within the last week. The Colonoscopy found indicators of UC, but the doctor said that Crohn's was more likely in my case, and the MRI's findings were also consistent with Crohn's.
If you do indeed have just Ulcerative Colitis OR UC and Crohn's (rare, but possible) then I would expect the mesalamine to work pretty well on the UC which could also explain your symptom improvement.
12-01-2012, 02:27 AM   #78
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I think it can definitely help some people, especially in the short term. Long term use of only mesalamine in Crohn's Disease is VERY worrisome to me unless the patient is monitored EXTREMELY close.
I was on pentasa for 2-3 months and did work...but then I stopped it and try to control the desease with diet changes and lifestyle, just as you do..and I still do great. Do you think its alright if I continue wothout pentasa cause i am more worried about about the side effects of it in a long run.
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12-01-2012, 10:28 AM   #79
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Ds was on pentasa for a month at dx.
It did nothing.
Moved on to stronger drugs.( 6-mp, Mtx , and now remicade).
We added asacol later since his disease is from one end ( esophagus to rectum).
Hoping it would at least treat the rectum / colon while trying to figure out a better systemic med for the rest of his gut.
Now that remicade is working the Gi suggested dropping the asacol once we know he is stable in a few months
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12-01-2012, 10:43 PM   #80
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I was on pentasa for 2-3 months and did work...but then I stopped it and try to control the desease with diet changes and lifestyle, just as you do..and I still do great. Do you think its alright if I continue wothout pentasa cause i am more worried about about the side effects of it in a long run.
The side effects of Pentasa are pretty negligible. Certainly less than un-managed Crohn's disease. If you're not on ANY medications then I personally would suggest utilizing it as it's better than nothing for sure. But if you're not comfortable with it, discuss your feelings with your doctor and see what they come up with.
12-02-2012, 03:42 AM   #81
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The side effects of Pentasa are pretty negligible. Certainly less than un-managed Crohn's disease. If you're not on ANY medications then I personally would suggest utilizing it as it's better than nothing for sure. But if you're not comfortable with it, discuss your feelings with your doctor and see what they come up with.
but your previous post said that you would be VERY worried if you had to use mesalamine for a long time.
12-02-2012, 08:32 AM   #82
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Interesting information...I asked my GI about this last year (on both Salofalk and Imuran)and basically the thinking is that the Imuran is more effective than the Salofalk I recall that he mentioned that there is some thinking that the Salofalk limits the potential polyp growth.

Interesting on the Leukopenia that may occur with both Imuran and 5-ASA, my white cell count went up after they upped my Imuran dosage to 200 mg/day, and the dosage was dropped to 150mg/day.
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12-02-2012, 09:26 AM   #83
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but your previous post said that you would be VERY worried if you had to use mesalamine for a long time.
I'd be even more worried if I had Crohn's disease and wasn't on any medication.

When I say I would be worried about long term use of mesalamine, not because of the side effects, but because it just plain doesn't hold the disease off long term for the vast majority of people. If someone is only on Mesalamine, they need to be monitored VERY closely for uncontrolled inflammation. Of course, everyone should be for that matter.
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