re:switching from Asacol to Sulfasalazine

[Guest guest]

Decided to switch medication, not that Asacol is not working for me, nor do I have side effects but more based on cost and on what

Elaine said.I have tried to stop taking the Asacol but my body has shown me it is not ready for that.Has anyone switched? I remember reading that it takes 6 months for Sulfasalazine to take effect? I will ask my doctor but people's experience is more valuable to me.I am presently taking 6x400mg/day of Asacol and I see that Sulfasalazine comes into 500mg. They may not be comparable. Thanks for any input,ClaudeCD 2.5 yearsSCD and LDN 5

months

[Guest guest]

The dose of SSA is 4-8 500 mg tablets a day. I don't know how long they take to

work.

PJ

>

> Decided to switch medication, not that Asacol is not working for me, nor do I

have side effects but more based on cost and on what Elaine said.

> I have tried to stop taking the Asacol but my body has shown me it is not

ready for that.

>

> Has anyone switched? I remember reading that it takes 6 months for

Sulfasalazine to take effect? 

> I will ask my doctor but people's experience is more valuable to me.I am

presently taking 6x400mg/day of Asacol and I see that Sulfasalazine comes into

500mg. They may not be comparable. 

> Thanks for any input,

> ClaudeCD 2.5 yearsSCD and LDN 5 months

>

[Guest guest]

I switched when I was in high school. I was fine for a while but then it

stopped working and eventually I landed in the hospital. I switched back and

that helped but switching to Lialda (same med, just time released) helped more.

Best thing to do is listen to your body since everyone's reacts differently

Stcey

>

> Decided to switch medication, not that Asacol is not working for me, nor do I

have side effects but more based on cost and on what Elaine said.

> I have tried to stop taking the Asacol but my body has shown me it is not

ready for that.

>

> Has anyone switched? I remember reading that it takes 6 months for

Sulfasalazine to take effect? 

> I will ask my doctor but people's experience is more valuable to me.I am

presently taking 6x400mg/day of Asacol and I see that Sulfasalazine comes into

500mg. They may not be comparable. 

> Thanks for any input,

> ClaudeCD 2.5 yearsSCD and LDN 5 months

>

[Guest guest]

>> Decided to switch medication, not that Asacol is not working for me, nor do I have side effects but more based on cost and on what Elaine said.> I have tried to stop taking the Asacol but my body has shown me it is not ready for that.

Hi Claude,

This may be of interest to you. Elaine often quoted Dr. Present's protocol.

Azulfidine (sulfasalazine)

SCD discussion often centers around the benefits and effects of prescribed drugs. The following post centers around Dr. Present's article on Azulfidine, and includes Elaine Gottschall's highlighted notes (bold) regarding desensitization.

In short, Elaine prefers Azulfidine over Asacol.

Sulfasalazine

From Current Trends in Gastroenterology - 1984-85 "Specific Drug Management" by Dr. Present

The official drug of choice for the management of mild to moderate Crohn's colitis is sulfasalazine (Azulfidine). This drug is an azo-bonded combination of sulfapyridine and 5-aminosalicylic acid. The compound is split by bacteria in the colon (or possible small bowel, if colonic type microflora are present). At present the 5-aminosalicylic compound is believed to be the active agent. The mechanism of action of sulfasalazine is uncertain. Speculation has centered on its affinity for colonic connective tissue and sensoral membranes, its anti-inflammatory effects, and its inhibitory effect on prostaglandin synthesis. The anti-inflammatory effects may be related to the blockage of synthesis of products of the lipoxygenase pathway (responsible for bringing inflammatory cells into areas of the bowel). Although immunosuppressive factors have been cited, they may be less important with recent observations that sulfasalazine and its components do not alter T-cells, immunoglobulin-bearing B-cells, or skin test responses.

In mild to moderate cases of Crohn's disease, sulfasalazine therapy should be instituted gradually, initially 1 to 2 tablets (500 mg) daily and increased by 500 mg doses to 2 to 4 g daily. Sulfasalazine should be administered in four divided doses, with meals and with a light snack at night. Although there are numerous clinicians who advise dosages up to 12 g each day, I have found that the evidence of side-effects precludes this level of medication in most patients. Side-effects are often dose related, reflect serum sulfapyridine levels, which can be identified in individual patients and then used as a guide to the dosage of sulfasalazine. Nausea and headache, the earliest side-effects, can be alleviated by temporarily lowering the dosage. To avoid the development of upper gastrointestinal side- effects (heartburn, epigastric discomfort), the coated tablet (Azulfidine-EN) can be used. Such allergic manifestations as skin rashes and fevers are not uncommon, but do not constitute a contradiction to further usage of sulfasalazine. My colleague, Burton Korelitz, and I have demonstrated that approximately 90 percent of patients with Crohn's disease who have allergic reactions to sulfasalazine can be successfully desensitized. ****We use initial dosages of one-eighth to one-fourth tablet daily for one week, with subsequent doubling of dosages on a weekly basis until all patients reach therapeutic dosage. For example, we give one-fourth of a tablet daily for one week, then one-half tablet daily for one week, then one tablet daily for one week, and so on. Approximately three of four patients have shown clinical improvement following desensitization. Additional information on desensitization is provided in the chapter on ulcerative colitis therapy.****

Folate Deficiency is frequently encountered with sulfasalazine therapy and requires folic acid supplementation (1 to 3 mg per day). Other severe complications are rare and include bone marrow depression, hepatotoxicity, "sulfasalazine lung," and pericarditis. Hemolyticanemia is not a rare complication, but fortunately the drug does not always have to be discontinued, and hemolysis may improve with lowering of the dosage of sulfasalazine.

(There was an additional short paragraph on sulfasalaine's possible effects on male fertility)

Hope this helps,

Pat