Sorry if this has already been discussed.... I searched the board several times looking for threads relating to this and really didn't have much success.
Quick recap: I was diagnosed with CC 8 years ago. Put on Asacol and it worked wonders and kept me "better than normal" for most of those 8 years. Weaned myself off, had a a flare up, and now I am back on Asacol. However, it's not working like it did last time (not totally surprised) and after four months of this flare my doc suggested that we try Entocort. I told him I wanted to give the Asacol a little more time first because I THOUGHT I was finally starting to see improvement but it's always two steps forward, one step back, and this recent backward step has been a doozy and this has been going on too long.
So I am toying with the idea of calling him and saying "OK, I'm ready to try Entocort" but this is the proposal I'm thinking about suggesting: Can I stay on the Asacol and add the Entocort, rather than trading one for the other? Then in a few months I will wean off the Entocort and still have the Asacol in my system. My thinking is that I need a break and my gut and intestines need a chance to "heal", thus, my desire to add the Entocort. And from what I've read I should expect a return of symptoms after I remove the Entocort, but my hope is that after the Entocort has reduced/removed the inflamation for a few months the Asacol will then be able to KEEP it reduced / removed.
Does this sound like a feasible solution? Are there any dangers to taking both at the same time? When I Google taking the two together it seems has been done so I'm tempted but wanted to run it by the folks here first since you all know a LOT more about this than the doctors or me.
Thanks in advance.
Sue
Asacol AND Entocort?
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Asacol AND Entocort?
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
I was diagnosed with CC in 2002 I think. I went on entocort when it became legal again in the US. Asacol made me sick as a dog. My GI doc said one drug or the other.. not both together.. and I don't know how long it will take for your body to clear the asacol... not a doctor just a just a 68 yr old granny:)
I was on entocort for several years.. started with three a day.. took forever to get to 2 a day and longer to get to one and then off.. spontaneous remission I think. You only absorb 10% or less of the entocort.. since it doesnt release til it gets to where it works:) (there is a tiny hole in the capsule.. small enough I never could see it)
I have slipped out of remission twice and went back on entocort at one a day for a week or so ... No one knows whether a drug will work again after you go off it. My GI doc says I am lucky so far.
Do check about the timing of the switching between drugs..
grannyh
I was on entocort for several years.. started with three a day.. took forever to get to 2 a day and longer to get to one and then off.. spontaneous remission I think. You only absorb 10% or less of the entocort.. since it doesnt release til it gets to where it works:) (there is a tiny hole in the capsule.. small enough I never could see it)
I have slipped out of remission twice and went back on entocort at one a day for a week or so ... No one knows whether a drug will work again after you go off it. My GI doc says I am lucky so far.
Do check about the timing of the switching between drugs..
grannyh
Thanks for the feedback, ladies. Wow.... so your doc said NOT to take both at the same time.... interesting. I'm going to have to do a lot more reading before I talk to my doc because he pretty much leaves the decisions up to me.
All I know is that I FEEL like I have a lot of inflammation lately, not only in the lower intestines but even in my stomach. A slug of Pepto actually helps immediately so I think everything is just raw and irritated right now. Granted, I have been under non-stop, intense emotional stress for the past four months so I know it's all related. I think the stress is going to dissipate soon but that doesn't guarantee the colitis will jump right into normalcy....quite the contrary.
So you would suggest going OFF Asacol before starting Entocort, huh?
Sue
All I know is that I FEEL like I have a lot of inflammation lately, not only in the lower intestines but even in my stomach. A slug of Pepto actually helps immediately so I think everything is just raw and irritated right now. Granted, I have been under non-stop, intense emotional stress for the past four months so I know it's all related. I think the stress is going to dissipate soon but that doesn't guarantee the colitis will jump right into normalcy....quite the contrary.
So you would suggest going OFF Asacol before starting Entocort, huh?
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Hi Grannyh,
May I suggest that you check out two replies written by Tex. If you go to the Main Message Board, page 2, you will find Tex's replies dated 7/21 and 7/22 under the topic Collagenous Colitis vs. Microscopic Colitis. He also addresses Lymphocytic Colitis.
My GI explained it to me, after a colonoscopy with biopsies, as follows: "A layer of collagen forms under the lining of the colon and that makes it difficult for the colon to absorb the fluid (water) which can cause the inflamation and D." Sometimes locating a photo or drawing on the internet helps to visualize the condition.....it helpws me. Of course, we have to consider our food intolerances and much more.
Hope this helps!
Carol
May I suggest that you check out two replies written by Tex. If you go to the Main Message Board, page 2, you will find Tex's replies dated 7/21 and 7/22 under the topic Collagenous Colitis vs. Microscopic Colitis. He also addresses Lymphocytic Colitis.
My GI explained it to me, after a colonoscopy with biopsies, as follows: "A layer of collagen forms under the lining of the colon and that makes it difficult for the colon to absorb the fluid (water) which can cause the inflamation and D." Sometimes locating a photo or drawing on the internet helps to visualize the condition.....it helpws me. Of course, we have to consider our food intolerances and much more.
Hope this helps!
Carol
Don't Forget to Laugh Today!
Sue,
A lot of GI docs prescribe the two together (especially GI docs who are relatively inexperienced at treating MC, and those who don't understand mathematics very well. The problem with doing that (IMO) is that it is redundant (they are both anti-inflamatories), and many patients have an adverse reaction to one or the other. The downside to taking both together is that the combination usually will not give any better control than one or the other alone, and if the patient is sensitive or allergic to one or the other, when the two are taken together, that quadruples the odds of having an adverse reaction. Therefore, statistically, taking both together is a rather poor risk, since there's little to be gained, but the odds of a failure quadruple. The problem is that if the patient reacts adversely to either one, the other drug will not be able to overcome the adverse reaction of the first, so the combination treatment will fail to benefit the patient.
That said, I'm guessing that the GI docs who prescribe the two together have in mind exactly the plan that you described (that weaning off Entocort will hopefully be easier).
Tex
A lot of GI docs prescribe the two together (especially GI docs who are relatively inexperienced at treating MC, and those who don't understand mathematics very well. The problem with doing that (IMO) is that it is redundant (they are both anti-inflamatories), and many patients have an adverse reaction to one or the other. The downside to taking both together is that the combination usually will not give any better control than one or the other alone, and if the patient is sensitive or allergic to one or the other, when the two are taken together, that quadruples the odds of having an adverse reaction. Therefore, statistically, taking both together is a rather poor risk, since there's little to be gained, but the odds of a failure quadruple. The problem is that if the patient reacts adversely to either one, the other drug will not be able to overcome the adverse reaction of the first, so the combination treatment will fail to benefit the patient.
That said, I'm guessing that the GI docs who prescribe the two together have in mind exactly the plan that you described (that weaning off Entocort will hopefully be easier).
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
I'm not sure that your GI specialist actually understands how the disease works. A layer of collagen does not form in the subepithelial region of the colon in response to CC. The collagen bands are already there, in everyone's colon. They are strictly a normal feature of the lamina propria. When CC is present, those collagen bands become significantly thicker, and it's true that the thickening can stiffen the walls of the colon, but that does not cause the diarrhea. The diarrhea is caused by the presence of increased numbers of inflammatory T cells that infiltrate the lamina propria and the rest of the mucosal membrane with all types of MC. If that were not the case, then patients who have LC would have no reason to have diarrhea (and we know that their symptoms are basically the same as someone who has CC). It appears that the collagen band thickening is due to the presence of the increased numbers of inflammatory T cells. IOW, the lymphocytic infiltration (which is the diagnostic marker of LC) is the direct cause of symptoms such as diarrhea, and additional laboratory markers such as thickened collagen bands.Carol wrote:My GI explained it to me, after a colonoscopy with biopsies, as follows: "A layer of collagen forms under the lining of the colon and that makes it difficult for the colon to absorb the fluid (water) which can cause the inflamation and D."
The actual mechanism that causes the D with MC originates in the small intestine. When the intestines are inflamed (by T cells), increased quantities of electrolytes (especially sodium) are present in the fecal stream, and this chemical imbalance tend to interfere with water and nutrient absorption, and it results in D. Yes, with all inflammatory bowel diseases, both the small intestine and the colon are inflamed (though most GI docs are not aware of that). Normally, the colon removes water from the fecal stream and recycles it, but with MC the mode of diarrhea is typically a form known as secretory diarrhea, in which electrolytes and water are actually infused into both the small intestine and the colon (IOW water is injected rather than removed), and this is the reason why the volume of BMs is so high with MC. The electrolyte problem originates in the small intestine and when the corrupted fecal stream reaches the colon, it promotes additional electrolyte and water infusion, which compounds the D. The process has virtually nothing to do with the thickened bands that are present with CC. The inflammatory cells mentioned in the following quote from the research article at the link below are T cells.
In general, the types and distribution of inflammatory cells were similar in patients with normal and thickened collagen tables. Stool weight correlated with lamina propria cellularity but not with collagen table thickening. The multimodal distribution of collagen table thickening and the lack of correlation with age, duration of symptoms, or inflammation suggest that microscopic colitis and collagenous colitis are discrete conditions, although the inflammatory changes in the two conditions are similar. Moreover, because stool weight correlates with lamina propria cellularity but not with collagen table thickening, diarrhea probably is caused by the inflammatory changes and not by collagen table thickening per se.
http://www.ncbi.nlm.nih.gov/pubmed/1451972
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Well that certainly gives me more to think about. I didn't call the doc to discuss it today but might tomorrow, but now that you've given me more insight I've got more research to do.tex wrote:Sue,
A lot of GI docs prescribe the two together (especially GI docs who are relatively inexperienced at treating MC, and those who don't understand mathematics very well. The problem with doing that (IMO) is that it is redundant (they are both anti-inflamatories), and many patients have an adverse reaction to one or the other. The downside to taking both together is that the combination usually will not give any better control than one or the other alone, and if the patient is sensitive or allergic to one or the other, when the two are taken together, that quadruples the odds of having an adverse reaction. Therefore, statistically, taking both together is a rather poor risk, since there's little to be gained, but the odds of a failure quadruple. The problem is that if the patient reacts adversely to either one, the other drug will not be able to overcome the adverse reaction of the first, so the combination treatment will fail to benefit the patient.
That said, I'm guessing that the GI docs who prescribe the two together have in mind exactly the plan that you described (that weaning off Entocort will hopefully be easier).
Tex
Thanks for the feedback.
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Sue,
If you already know that you do not react adversely to either drug, then using them concurrently shouldn't be a problem. I would still recommend a very slow taper of the Entocort, though, because relapses following the discontinuation of budesonide (IMO) are due to a rebound in mast cell numbers, and as far as I am aware, the 5-ASA-based drugs do not necessarily suppress mast cell numbers (corticosteroids suppress inflammation by suppressing mast cell numbers). Mesalamine is known to suppress prostaglandins and leukotreines.
Tex
If you already know that you do not react adversely to either drug, then using them concurrently shouldn't be a problem. I would still recommend a very slow taper of the Entocort, though, because relapses following the discontinuation of budesonide (IMO) are due to a rebound in mast cell numbers, and as far as I am aware, the 5-ASA-based drugs do not necessarily suppress mast cell numbers (corticosteroids suppress inflammation by suppressing mast cell numbers). Mesalamine is known to suppress prostaglandins and leukotreines.
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
No adverse reaction to the Asacol but I've never tried Entocort. However, if I take both and notice negative side affects it will be safe to assume they are from the Entocort.
The thought of neurological side affects terrifies me.... it's honestly the only thing holding me back. Lord knows I have enough of those issues already and would really be miserable if any of them become exascerbated by Entocort. Perhaps a SMALL starting dose and then build myself up, and then slowly take myself off?
Sue
The thought of neurological side affects terrifies me.... it's honestly the only thing holding me back. Lord knows I have enough of those issues already and would really be miserable if any of them become exascerbated by Entocort. Perhaps a SMALL starting dose and then build myself up, and then slowly take myself off?
Sue
Sue
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!
Diagnosed November 2004, Used Asacol and Lialda, sometimes worked, sometimes made it worse. Entocort always works but hate it. Remission only lasts 3-6 months and then back on Entocort. Enterolab test July 2017, now gluten free. Time will tell!