Diet and Health FAQ

Tagged As: Asacol Crohns Discussion

Question:
Talked to the doc today who wants to put me on 6MP.  Seems like the Asacol, Flagyl, and Rowasa I'm taking are working, but the bowel still isn't completely solid.  This miffs me a little - especially since I asked the doc that in prior cases I used sulfasalazine, and my body responded well - symptoms and signs of the disease were in remission in as little as a month after beginning the medication.  He was insistent on using the Asacol.  Does anyone have any recommendations?  Should I insist on going back on the sulfasalazine, or is that pointless?

Answer:
The way I understand it, the 6MP should KEEP you in remission, not necessarily treat active disease.  It is an immuno-suppressive and apparently keeps your body from attacking itself and flaring up once you go into remission.  I have heard really good things about 6MP, and will start back taking it in a few months in conjunction with my Remicade infusion to keep my CD in remission.  I just had surgery to remove 3 ft. of strictured small bowel and a portion of my colon where the terminal ileum joined, so I had to stop taking the 6MP for a while.  Anyway, get all the information you can about anything your doctor suggests.  This disease demands that you stay abreast of all information and learn to listen to your body.  Myself, I could not tolerate the Sulfa drugs or the Asacol or the Pentasa, but when I was on 6MP (before surgery) I had absolutely NO side effects at all.  It may be the best course for you.  Talk with your doc and even get a second opinion if you can afford it or if your insurance allows.    Also make sure you talk to your doctor about the blood tests that are required when taking 6MP.  It is vital that you have these tests done, as the tests determine how much of the drug your body is actually absorbing. The way my doc explained it is that if you are not absorbing enough, then you aren't doing any good and too much can be bad.  A normal starting dose for an average sized person is 50mg of 6MP once a day.  I tell you this only because my Pharmacy got the script wrong and told me to take 50 mg three times a day....a dosage my doc said would have landed me in the hospital. This drug is potent, but it can make a world of difference when used correctly! Asacol is an enteric coated mesaamine tablet, mesalamine being 2 5-aminosalicylic acid molecules bound together.  Sulfasalazine is one 5-ASA molecule bound to a sulphur molecule of some description. What is the matter with some of these docs???!!! Sulfasalazine is *much* more benign than 6MP. If it worked so well for you before, why did he change you to Asacol in the first place?! Asacol seemed to make my symptoms worse, but sulfasalazine worked very well for me. My GI at first was reluctant to give me sulfasalazine because he thought that the 5ASA in it might cause me problems since the Asacol did. Not long ago, my doc and I had a discussion about the sulfasalazine. He said that the amount of 5ASA that I'm getting in my 8 tablets of sulfasalazine has been shown in trials of 5ASA drugs like Asacol to be no more effective than placebo. He said that the sulfa part of the sulfasalazine was once thought to be benign, but he now believes that it is an active ingredient, and so do others. After my success with the drug he changed some of his other patients back to it and they responded well too. Before I agreed to 6MP I would INSIST on a trial of sulfasalazine. It is best to build up the dose gradually, in order to be sure to tolerate it well. (You probably already know that if you've taken it before, but perhaps others don't. I know my previous GI didn't seem to be aware of it!)