Entocort verses budesonide

[Mr. Ballgo]

Hello- Newbie here. My doc prescribed budesonide. I am not a fan of meds, paricularly one that masks my condition. Rather figure out what is irritating me but I have read here that both meds and a restrictive diet is the key.

Is there a reason my GI gave me budesonide vs. Entocort? Is weaning off one easier than the other?

Many Thanks, this board is amazing.

And Tex, thank you so much for your kind welcome and the effort you put into this board. I guess Thanksgiving won't be so bad afterall. And, now I get to change my all my aliases!

Bass player, MC.

AKA, Brian

[tex]

Hi Brian,

The active ingredient in Entocort is budesonide. IOW, now that the patents on Entocort have expired, budesonide is available as the generic form of Entocort. The differences are the inactive ingredients, and the price. The generic is priced slightly lower than Entocort, but it's still ridiculously expensive. For one thing, AstraZeneca (the manufacturer of Entocort) actually sells the original Entocort capsules in generic packaging and pretends that it is a different version, but it is actually the original Entocort capsules, just priced to match the generic packaging. At least they were doing that the last time I checked. But there are 1 or 2 other generic manufacturers who also make budesonide, and they typically use different inactive ingredients.

Members here who do not have insurance usually order their budesonide from overseas pharmacies for pennies on the dollar. The most popular product is Budez-CR, from India. Some Canadian pharmacies buy the Budez-CR, mark it up about 40 %, and resell it to U. S. customers. Their price is still far below domestic prices. Many of the generics sold in this country at outrageous prices are available direct from India at reasonable prices, because many (maybe most) generics sold in this country are actually manufactured in India, and packaged for the big pharmaceutical companies to be sold in this country (at hugely inflated prices).

The diet changes seem tough (and in some cases overwhelming) at first, but eventually they become second nature. And they beat the heck out of the alternative, (living with the symptoms). You can skip the budesonide if you don't mind putting up with the symptoms while you figure out all of your food sensitivities so that your gut can begin to heal. Doing without the medication will not slow down your healing (in fact it will speed it up slightly), but the budesonide makes life much more pleasant because it will mask the symptoms to allow time for the diet to work it's magic at healing the digestive system. Unfortunately, the intestines heal rather slowly, but the younger we are, the faster we heal.

You're most welcome,
Tex

[BearcatRx]

Tex is correct. Generic vs brand difference is simply the inactive ingredients. With newly available generics, the price is usually about 90% what the brand is (while one company still has generic exclusivity). I haven't paid much attention to how long budesonide EC generic has been out but it cost me about 600 dollars a few days ago when I bought it. I'm the one who verified my own prescription and I don't even get a discount... geez. Lol.

[rcb0973]

Hi everyone, I am new to this app. I have fought Microscopic Colitis for 13 years with a totally uncooperative doctor (you're not going to die, so what's the big deal!) (a gluten-free diet for Microscopic Colitis is a farce). After 12 years of Entocort, and my general health getting worse and worse, I took the plunge and went on a full gluten-free diet (except oatmeal). It is really tough, but so is having MC. I reduced one 3 mg Entocort capsule per month, and now I have been Entocort free for a month. I feel very proud of my accomplishment, and only wish I had taken it years ago. What brought be to this point was my Medicare insurance refused to pay a dime for the Entocort, and the cheapest price I found for the non-generic Entocort which i needed was $2,500 per month, and the generic did not work for me.

I haven't had a single incident of diahrea, since I eliminated all MC prescriptions. I am now on a high level ProBiotic, which is going well.

If someone told me 6 months ago that I would ever be free from MC, I wouldn't believe it. Although there is certainly no guarantee that it won't come back, I'm taking life one day at a time.

Best Wishes,

Richard

[brandy]

Welcome Richard!

You are at the right place!

Richard
_________________
RICHARD C. BURKE
MICROSCOPIC COLITIS SURVIVER

Love your signature.

Brandy

[tex]

Hi Richard,

Welcome to our Internet family. Congratulations on your treatment success.

If you should experience a return of symptoms, try avoiding the oatmeal, also. Most of us here are also sensitive to oats, but it often takes a while before we begin to react to it. Hopefully, your symptoms will never return, but if they do, you might keep this in mind. If that doesn't work, dairy products should be the next to eliminate from your diet, because most of us are sensitive to the primary protein in all dairy products. We use almond milk and coconut milk in place of cow's milk.

It's a crying shame that GI specialists can't all enjoy at least 6 months or so of living with MC symptoms themselves. It wouldn't take very long before they would have a totally different attitude about the disease.

Thanks for posting, and enjoy your new life without MC symptoms.

Tex

[fatbuster205]

It's a crying shame that GI specialists can't all enjoy at least 6 months or so of living with MC symptoms themselves. It wouldn't take very long before they would have a totally different attitude about the disease.
Tex

What a wonderful thought that is!
Anne

[Lilja]

Hi everyone, I am new to this app. I have fought Microscopic Colitis for 13 years with a totally uncooperative doctor (you're not going to die, so what's the big deal!) (a gluten-free diet for Microscopic Colitis is a farce). After 12 years of Entocort, and my general health getting worse and worse, I took the plunge and went on a full gluten-free diet (except oatmeal). It is really tough, but so is having MC. I reduced one 3 mg Entocort capsule per month, and now I have been Entocort free for a month. I feel very proud of my accomplishment, and only wish I had taken it years ago. What brought be to this point was my Medicare insurance refused to pay a dime for the Entocort, and the cheapest price I found for the non-generic Entocort which i needed was $2,500 per month, and the generic did not work for me.

I haven't had a single incident of diahrea, since I eliminated all MC prescriptions. I am now on a high level ProBiotic, which is going well.

If someone told me 6 months ago that I would ever be free from MC, I wouldn't believe it. Although there is certainly no guarantee that it won't come back, I'm taking life one day at a time.

Best Wishes,

Richard

What a wonderful story! You have all the reasons to be proud of yourself. Diet, knowledge and patience are the key words.

This is a wonderful board, full of experienced and knowledgeable people.

However, I'm astonished that Entocort is so expensive in the U.S. Why is that?

I pay USD 52.- for 100 capsules of 3 mg Entocort, and don't have health insurance. 99% of the Norwegians don't have health insurance (but we pay a h... of a lot of taxes in order to have free health care). Has it something to do with U.S. insurance?

Lilja

[tex]

However, I'm astonished that Entocort is so expensive in the U.S. Why is that?

I pay USD 52.- for 100 capsules of 3 mg Entocort, and don't have health insurance. 99% of the Norwegians don't have health insurance (but we pay a h... of a lot of taxes in order to have free health care). Has it something to do with U.S. insurance?

Lilja,

IMO, it's a combination of the greed of insurance companies, the greed of drug companies, and our corrupt legislators who are always willing to sell out their vote in order to get the campaign contributions they need to get reelected. IOW, our government looks the other way, so that the drug companies (and the insurance companies) can gouge the healthcare system of this country to their heart's delight. The governments of all other countries in the world are willing to intervene on the behalf of their citizens, to make sure that good health care is affordable for everyone. That will never happen in this country. It would be political suicide for legislators, so they are not likely to change their policies.

The politicians are smart enough to recognize the fact that on the average, most taxpayers of this country will never contribute enough money to politicians' reelection campaigns to get them reelected. So they cater to the most profitable corporations, and the wealthiest individuals, and then they make sure that they pass legislation that will guarantee that those corporations and individuals will always have plenty of money available to contribute to their political reelection campaigns. And those rich corporations and individual donors know better than to bite the hand that feeds them, so they keep the money flowing into those reelection campaign bank accounts.

As the new health care regulations are slowly being phased in, insurance companies are removing expensive drugs such as Entocort and many of the higher-cost cancer drugs from their lower co-pay tiers, and moving them up to the top tiers where the patient pays most or all of the inflated cost of the drugs. IOW, they are increasingly priced out of range of most consumers who are not wealthy.

$52.00 is a fair price for Entocort. IOW, AstraZeneca recovered their investment many years ago, and has made a fortune on this drug since then. They even sold all marketing rights to Prometheus Laboratories several years ago, so that Prometheus could also make a fortune on the drug. The main reason why Entocort (and most other prescription medications) are so expensive in this country is because in the U. S., pharmaceutical companies have a virtual license to steal. In order to persuade them to go along with health care bills (such as the most recent legislation, the "Health Care Reform Bill", passed a few years ago) the government makes no effort to control drug costs — drug companies are allowed to charge whatever the market will bear. Because of this policy, wealthy individuals (and those lucky enough to still have insurance that actually pays a significant share of drug costs) don't have to worry about drug costs, but most other people are out of luck, on many drugs, because they can no longer afford them under their current insurance.

There are a lot of good things about living in this country, but trying to get good, affordable health care, is not one of them, unfortunately, and it appears that our entire health care system is broken. Good healthcare is available, but too many of us can't afford it. In the U. S., if you have a terminal illness, your heirs may be out of luck, because the hospitals and drug companies will do their best to end up with most of your estate.

Tex

[Lilja]

Thank you Tex for explaining the background.

Lilja

[Mauschen]

Hi there, everyone!
I have tried the gluten-free route( 4 weeks , probably not long enough) but now I have a question: Has anybody tried to get results from following E. Gottschall's " Breaking the Vicious Cycle" diet? I am now about to reach the beginning of my 4th year of MC. And here is another question: Does anybody know about the connection between Prednisone and the onset of MC? I had two long treatments with Prednisone (for Polymyalgia) and within days of the run of Prednison I started with the Dreaded D!

Thanks for your input!!
Marion

[tex]

Hi Marion,

Welcome to our Internet family. Yes, except for a lucky few, it takes most of us much longer than 4 weeks for the diet changes to bring remission. But you are well on your way, and please don't become discouraged just because it takes a while to recover. It takes some time for the anti-gluten antibodies to decay to a level where our immune system will stop reacting to them, and the intestines heal relatively slowly. The primary problem is usually the alpha gliadin peptide, and anti-gliadin antibodies have a half-life of 120 days. By comparison, most other food antigens have a half-life of only about 6 days.

Has anybody tried to get results from following E. Gottschall's " Breaking the Vicious Cycle" diet? I am now about to reach the beginning of my 4th year of MC.

Many, many members here have tried the Specific Carbohydrate Diet (SCD) originally developed by Elaine Gottschall. Out of all those members, I can't recall a single one who was able to resolve all of her or his MC symptoms by using the SCD, but maybe I'm overlooking someone. I don't claim to have a perfect memory. The problem with the SCD is that it allows (even encourages the use of) certain cheeses and yogurt, and most of us are sensitive to the primary protein in all dairy products, casein. Consequently we produce antibodies to casein, and those antibodies perpetuate the inflammation in our intestines (despite avoiding gluten and other foods).

Even most of those who do not produce antibodies to casein do better and recover much faster if they totally avoid all dairy products (during the recovery period), because all dairy products contain traces of lactose, and anyone who has enteritis (inflammation of the intestines) is automatically lactose intolerant until the inflammation disappears. So that's why the SCD isn't practical for treating MC.

Of course one could just remove dairy products from the SCD, and probably make it work. But when we remove dairy from the SCD, we end up with a paleo diet, so why not just begin with a paleo diet, and modify it to suit our needs? That in fact, is what many members here do. They begin with a paleo diet, minimize fiber content and fructose (fruit sugar), and avoid any particular foods that causes them to react (either based on EnteroLab stool tests, or trial and error testing based on an exclusion diet).

And here is another question: Does anybody know about the connection between Prednisone and the onset of MC? I had two long treatments with Prednisone (for Polymyalgia) and within days of the run of Prednison I started with the Dreaded D!

To be honest, while I'm aware of many medications that are known to cause MC, I have never seen a single case study where Prednisone was identified as a trigger for colitis. Many people are refractory to corticosteroid treatment (meaning that it is not effective for them), but I've never previously heard of corticosteroid-induced colitis.

That said, I can visualize at least one way that it could happen (theoretically, at least). Corticosteroids deplete vitamin D (because they suppress inflammation by exploiting the inflammation-suppressing qualities of the active form of vitamin D). Vitamin D deficiency is known to predispose to the development of inflammatory bowel disease, and a very low vitamin D level makes us surprisingly vulnerable to the development of an IBD, provided additional environmental conditions (most of which are very common) are present. However, for MC to present so quickly (almost immediately following the Prednisone treatment), you probably would have had to already be close to developing the disease, and the Prednisone just provided the final push. Do you happen to know what your vitamin D blood level was at the time of diagnosis? If it was in the sufficient range (above 30 ng/mL), then this scenario would not apply.

Anyway, those are my thoughts. Again, welcome aboard, and please feel free to ask anything.

Tex

[Overitmc]

I have a vitamin D defficiency but wondered if the 50,000 mg of vitamin D was making my D worse? Is that not typically the case? If not should I get back on it while testing the GF diet to see if that is the main problem or should I wait so I don't add too many variables to the equation?

The doctor I saw said I would need to take an over the counter vitamin D probably the rest of my life. Do you find that to be true with most MC people as well? Thanks for you comments in advance!

[tex]

Hi,

I'm not aware of any member here who has had diarrhea triggered by vitamin D, but many of us have had our recover hindered by a vitamin D deficiency, because IBDs deplete vitamin D, and without adequate vitamin D the immune system cannot function properly.

If you were taking 50,000 IU of vitamin D daily for several months, then yes, that could result in an overdose condition that could interfere with your recovery. But if you are talking about 50,000 IU per week, that's a fairly common dose that should be helpful for maintaining your vitamin D level while you are recovering.

It's always a good idea to test your blood level of vitamin D after taking that dose for a few months, to see if it needs to be increased, or decreased, or maintained at the same rate. Once we know how we respond to it, we can usually get by with 1 or 2 tests per year.

Your doctor's advice definitely matches our experience. Virtually all of us find that we need more vitamin D than "normal" people (normal being those who do not have an IBD), and we continue taking a supplement indefinitely. It seems that if we don't keep our blood level of vitamin D significantly higher than the normally-recommended "sufficient" level, our immune system just doesn't work as well as it should.

We typically need vitamin D, magnesium, and vitamin B-12 while we are recovering. Virtually everything else is best postponed until after we are in remission. Be careful with magnesium though, because too much oral magnesium in certain forms (such as magnesium citrate) can act as a laxative. Many members here use a magnesium lotion, oil, or spray on their skin, or use Epsom salts in a foot soak or even bathwater. We absorb magnesium well through our skin, and it will not cause D when topically applied.

You're very welcome, and good luck with your recovery program.

Tex