I am now... Not doing so hot today. Disappointing.
Do the two drugs work better than one?
Rich
Anyone taking both Entocort and Asacol?
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Rich wrote:Do the two drugs work better than one?
Nope. And furthermore, it's foolish for doctors to prescribe that combination, because many of us react adversely to one or the other of those drugs, and if you are taking them together, and have an adverse reaction to one, the other will not be able to overcome it, (so that increases your odds of having an adverse reaction from 1 out of 2, to 3 out of 4), and there is no way to tell for certain, which one is the problem. Making a WAEG, though, if the diarrhea is worse, the Asacol is the problem, (often, because it contains lactose), and if the symptoms are neurological, it's probably the Entocort. Note that if you happen to be sensitive to both drugs, it's possible that you might still be able to tolerate one at a time, but the combination will compound the symptoms, and probably make the situation intolerable.
Don't feel like the Lone Ranger. Doctors frequently make that mistake, because mathematics is usually not their strong suit.
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.
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wonderwoman
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tex writes
What would be the neurological symptoms you talk about. My Sciatica is back again. Would that be considered neurological????
I had been gluten free and on Balsalazide from middle of February until July 30 and had D under control until middle of May when uncontrollable D started again. I started on Entocort July 30. I had immediate success with it and I have been down to one Entocort a day since September 13. I still have only one BM a day, a little softer consistency but not mushy or D. I still am 100% GF but have had a little cows milk feta cheese. I do try to avoid soy also.
Three or four years ago I was on high doses of Ibuprofen & Naproxen for a long period of time for the sciatica and don't want to have to go that route again. I am trying to think when the sciatica began again and it is possible it started around I time I started on Entocort. I never connected the two until Tex mentioned neurological symptoms. Could the sciatica be triggered by the Entocort?
If it is from the Entocort would you suggest I go off Entocort and back on the Balsalazide? I have almost a three month supply of Balsalazide here that I had refilled July 9, as well as the 300 Entocort from Canada that I haven't opened yet.
Looking forward to comments.
if the symptoms are neurological, it's probably the Entocort
What would be the neurological symptoms you talk about. My Sciatica is back again. Would that be considered neurological????
I had been gluten free and on Balsalazide from middle of February until July 30 and had D under control until middle of May when uncontrollable D started again. I started on Entocort July 30. I had immediate success with it and I have been down to one Entocort a day since September 13. I still have only one BM a day, a little softer consistency but not mushy or D. I still am 100% GF but have had a little cows milk feta cheese. I do try to avoid soy also.
Three or four years ago I was on high doses of Ibuprofen & Naproxen for a long period of time for the sciatica and don't want to have to go that route again. I am trying to think when the sciatica began again and it is possible it started around I time I started on Entocort. I never connected the two until Tex mentioned neurological symptoms. Could the sciatica be triggered by the Entocort?
If it is from the Entocort would you suggest I go off Entocort and back on the Balsalazide? I have almost a three month supply of Balsalazide here that I had refilled July 9, as well as the 300 Entocort from Canada that I haven't opened yet.
Looking forward to comments.
Charlotte
The food you eat can be either the safest and most powerful form of medicine, or the slowest form of poison. Ann Wigmore
The food you eat can be either the safest and most powerful form of medicine, or the slowest form of poison. Ann Wigmore
Hmmm...
My neuro symptoms have subsided... Guessing it was the imodium, etc. that I took along with it. Regardless, regarding my mind, I am back to my forgetful, neurotic self :)
The BM looseness has increased somewhat.
Perhaps that is still diet related.
Haven't been able to see doctor again so his nurse gave me Asacol. Nurse Ratchet... Remember her?
But I so so doctor again in a couple weeks so I think I am going to make a command decision to drop the Asacol for now.
So, Tex, with your history moderating this board, you do believe it is rare to be prescribed both at the same time?
This LC is such a head trip.
As always, thanks for your prompt attention, help, and concern everyone. This is the beginning of my two to three weeks from hell. With Tex's recent post about stress and MC, I personally believe there is a correlation. I'd like to try an experiment where I sit on a beach for a year.
While I'm venting, you know what stresses me out? All these, no offense those who do this, travellers who so loudly speak on their cell phones in close proximity to me. I rue the day they make cells phones available in flight. Of my soap box. Thanks for listening.
My neuro symptoms have subsided... Guessing it was the imodium, etc. that I took along with it. Regardless, regarding my mind, I am back to my forgetful, neurotic self :)
The BM looseness has increased somewhat.
Perhaps that is still diet related.
Haven't been able to see doctor again so his nurse gave me Asacol. Nurse Ratchet... Remember her?
But I so so doctor again in a couple weeks so I think I am going to make a command decision to drop the Asacol for now.
So, Tex, with your history moderating this board, you do believe it is rare to be prescribed both at the same time?
This LC is such a head trip.
As always, thanks for your prompt attention, help, and concern everyone. This is the beginning of my two to three weeks from hell. With Tex's recent post about stress and MC, I personally believe there is a correlation. I'd like to try an experiment where I sit on a beach for a year.
While I'm venting, you know what stresses me out? All these, no offense those who do this, travellers who so loudly speak on their cell phones in close proximity to me. I rue the day they make cells phones available in flight. Of my soap box. Thanks for listening.
Charlotte,
Typical adverse neurological effects of Entocort include problems such as balance issues, vision problems, dizziness, etc. Sciatica is usually caused by a pinched nerve - I doubt that Entocort could cause sciatica.
Tex
Typical adverse neurological effects of Entocort include problems such as balance issues, vision problems, dizziness, etc. Sciatica is usually caused by a pinched nerve - I doubt that Entocort could cause sciatica.
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, it's somewhat common, because the doctor presumably plans to knock out the symptoms with the Entocort, and then quickly phase it out of the treatment, leaving the Asacol as a maintenance drug. The problem is that the doctor usually wants to stop the Entocort too quickly, and the patient relapses, or the patient can't tolerate one of the drugs.Rich wrote:So, Tex, with your history moderating this board, you do believe it is rare to be prescribed both at the same time?
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.
What Tex described is the way my GI started me off only he began with Pred & Asacol...... Had a little trouble coming off the Pred so he ramped down the Pred while ramping up the Entocort and taking Asacol all the way through.
The Pred/Entocort time was 6 months (including the ramp down time for Entocort) so maybe that's why Asacol continued to work for me. I, however, didn't have a problem with any of the drugs except I didn't like the Pred at all. I'm now down to 1 Asacol a day. Present GI would like me to try and come all the way off but I'm chicken. I think he feels that 1 a day is really ineffective but I vividly remember when Peg was down to 1 a day and the D returned full force after going off the 1 Asacol. Apparently, that made a BIG impression on me. Anyway, the Asacol never worked for her again (as far as I know) and that's why I'm such a big chicken. I do follow diet restrictions (gluten & soy) to a degree but I'm not above "falling off the wagon", so to speak.
I'm not telling you this to try and get you to follow my example. I'm a pretty poor example. I should go full out on the diet and drop the 1 Asacol. Maybe someday.
Good Luck,
Shirley
The Pred/Entocort time was 6 months (including the ramp down time for Entocort) so maybe that's why Asacol continued to work for me. I, however, didn't have a problem with any of the drugs except I didn't like the Pred at all. I'm now down to 1 Asacol a day. Present GI would like me to try and come all the way off but I'm chicken. I think he feels that 1 a day is really ineffective but I vividly remember when Peg was down to 1 a day and the D returned full force after going off the 1 Asacol. Apparently, that made a BIG impression on me. Anyway, the Asacol never worked for her again (as far as I know) and that's why I'm such a big chicken. I do follow diet restrictions (gluten & soy) to a degree but I'm not above "falling off the wagon", so to speak.
I'm not telling you this to try and get you to follow my example. I'm a pretty poor example. I should go full out on the diet and drop the 1 Asacol. Maybe someday.
Good Luck,
Shirley
When the eagles are silent, the parrots begin to jabber"
-- Winston Churchill
-- Winston Churchill
Unfortunately, you are quite correct. Because of her experience, (and others), I am totally convinced that anyone with MC, who has been taking a maintenance medication on a long-term basis, should never, ever stop that medication completely, (long enough for all of it to clear their body), unless they are absolutely sure that they will never have to rely on that drug for a treatment at any point in the future. For those who have detected all of their food sensitivities, and eliminated them from their diet, and whom are convinced that they can reliably keep them out of their diet, then it is reasonable for them to expect to control their symptoms by diet alone.Shirley wrote:Anyway, the Asacol never worked for her again (as far as I know) and that's why I'm such a big chicken.
For those who aren't sure that they can be 100% faithful to the diet, though, the situation is much more treacherous. An occasional slip is rarely a serious problem, but ignoring a food sensitivity on a fairly regular basis is like walking on quicksand. At some point down the line, a relapse is bound to occur, and there is an increasing probability that when it does, the drug that worked previously, will prove to be ineffective, on subsequent flares. It may work the first time, and it might work a second time, but eventually that drug will no longer bring remission at any safe dose. As long as the drug is used on an uninterrupted basis, it should continue to be effective, (even at extremely low dosage rates). Once the last of it clears the body, though, the "tolerance threshold", (defined below), is usually kicked up a notch.
Note that I am not suggesting that a medication is necessary for long-term remission. I am merely theorizing that when a maintenance drug is used on a long-term basis, the body seems to build up a "tolerance threshold" for the drug. This means that if the drug is discontinued, and then reintroduced, it may not be effective, unless a larger dose is used, to overcome the "tolerance threshold". After a few replications of the cycle, the required dose may be higher than the label allows, and so that drug can no longer be safely used at a therapeutic level.
IMO, this is why many/most patients with IBDs find themselves in the position of repeatedly stepping up to increasingly more powerful drugs, as time passes. Most GI specialists prefer to treat a flare aggressively, and then let the patient coast until another flare erupts. Unfortunately, though, this keeps ratcheting up the drug requirements, in order to achieve remission.
At least, that's the way I see it.
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.
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Joefnh
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Good topic Tex Hoosier and all others. I did have dizziness during the first 3 weeks of taking the Entocort last April. The first week I really would not trust myself driving. Those symptoms did resolve within 3 weeks and have not been a problem since. Recently I have been transitioning over to Imuran and will begin to taper off of the Entocort starting during the second week of October.
A question for you Tex, with both the Entocort and the Imuran being immune system suppressants, should I be tapering off of the Entocort sooner? The Imuran is designed as a immune system suppressant and does not have the anti-inflammatory properties of a steroid, or does it given the reduced white cell count? My concern would be suppressing the immune system too much. I should note my GI doctor is taking blood samples each week.
--Joe
A question for you Tex, with both the Entocort and the Imuran being immune system suppressants, should I be tapering off of the Entocort sooner? The Imuran is designed as a immune system suppressant and does not have the anti-inflammatory properties of a steroid, or does it given the reduced white cell count? My concern would be suppressing the immune system too much. I should note my GI doctor is taking blood samples each week.
--Joe
Joe
Joe,
Until you take Entocort for a long-term period, (like a year or more), you are not likely to experience any significant immune system suppression from it. At six months, the effect should be negligible, for all practical purposes.
Imuran is indeed considered to be an anti-inflammatory drug. Your white cell count is probably a pretty good measure of how much the Imuran is suppressing your immune system.
The blood tests are to monitor your liver enzymes, to make sure the Imuran isn't causing serious liver damage. Weekly testing is a good idea. Some doctors don't watch it that closely, but that can be risky, especially early on. After you've been taking it for a while, the tests can probably safely be spaced out longer, once your response is better understood.
Tex
Until you take Entocort for a long-term period, (like a year or more), you are not likely to experience any significant immune system suppression from it. At six months, the effect should be negligible, for all practical purposes.
Imuran is indeed considered to be an anti-inflammatory drug. Your white cell count is probably a pretty good measure of how much the Imuran is suppressing your immune system.
The blood tests are to monitor your liver enzymes, to make sure the Imuran isn't causing serious liver damage. Weekly testing is a good idea. Some doctors don't watch it that closely, but that can be risky, especially early on. After you've been taking it for a while, the tests can probably safely be spaced out longer, once your response is better understood.
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, too, am taking Asacol and Entocort. When I was first diagnosed with MC and began the Asacol, it began working immediately. I tapered down from 6 a day to 4 a day with no repercussions . . . until early this summer when I flared again, due in part to stress related to my mother's passing. My GI suggested I up the Asacol back to 6 a day - no results - then to 8 a day. I still don't think that made a difference. What did make the difference was the Entocort he put me on a month ago. So, I am taking both now. I don't seem to have any side effects from either.
At my doctor visit this past week, I mentioned to him that I didn't think the Asacol was working any more, and that I knew that there are other drugs in the Asacol family that maybe he should switch me to. He seemed willing to go that route, but first wanted to test me (bloodwork) for Celiac. So I am waiting for those results. However, after hearing your explanation, Tex, of how Asacol and other MC maintenance meds can stop working after awhile, I definitely think I may need to make a change.
By the way, I think he's testing me for Celiac, because I told him that I went GF, and it seems to be helping me. He says he has no experience with his MC patients being helped by GF diets! But then again, in asking whether I could have MC and Celiac, he said the odds are very low there, also. Have you ever heard of anyone having both conditions?
At my doctor visit this past week, I mentioned to him that I didn't think the Asacol was working any more, and that I knew that there are other drugs in the Asacol family that maybe he should switch me to. He seemed willing to go that route, but first wanted to test me (bloodwork) for Celiac. So I am waiting for those results. However, after hearing your explanation, Tex, of how Asacol and other MC maintenance meds can stop working after awhile, I definitely think I may need to make a change.
By the way, I think he's testing me for Celiac, because I told him that I went GF, and it seems to be helping me. He says he has no experience with his MC patients being helped by GF diets! But then again, in asking whether I could have MC and Celiac, he said the odds are very low there, also. Have you ever heard of anyone having both conditions?
Yes indeed - we have probably at least half a dozen members with both MC and diagnosed celiac disease, (I'm just guessing here, because it would take a lot of time to comb through all the archives to track everyone down).Butterfly wrote:Have you ever heard of anyone having both conditions?
Over 4% of celiacs have MC, according to this study:
http://www.ncbi.nlm.nih.gov/pubmed/19631283
And about 15 % of people who have MC, also have celiac disease, according to this study:
http://www.ncbi.nlm.nih.gov/pubmed/11246349
If you have been on the GF diet long enough to see some benefits, though, those blood test results will probably be negative, even if you do have celiac disease. The blood tests are not very sensitive, and they're notorious for false negative results, unfortunately. Please let us know how they turn out, because there's always a chance that they could be positive.
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.
