Asacol (mesalamine) is one of the safest drugs we have to treat ulcerative colitis. Very occasionally it makes diarrhea worse, and rarely does it cause some hair loss. Both of those adverse effects occur early, within a few weeks or months, and are reversible. Very rarely, Asacol can cause kidney and liver damage. Fortunately, these effects are also reversible when the drug is stopped. For this reason, you should have kidney and liver blood tests periodically – at least annually – while you are on Asacol. Even with these adverse effects, the benefits of Asacol far, far outweigh the risks. Q2. I have had ulcerative colitis for the past five years, and I am on Imuran daily. I have developed very itchy skin all over my body, but no rash present. Can this be associated with the Imuran or the ulcerative colitis? Itchy skin, without a rash, could very well be a side effect of a colitis medication like Imuran (azathioprine). There’s also the possibility that you have primary sclerosing cholangitis, a liver disease in which bile ducts become narrowed or scarred. This condition is seen in about 2 percent of ulcerative colitis patients, and can also cause severe itching. Other symptoms include jaundice, general discomfort, appetite loss and indigestion. Your physician should order liver tests and explore alternative medical options to treat your colitis. Q3. After taking Remicade infusions for over a year, I had a reaction last week that consisted of severe itching, facial tingling and I guess some sort of generalized anxious feeling. I had pre-medicated as usual with 25 mg Benadryl (diphenhydramine) and 1,000 mg Tylenol (acetaminophen). The nurse stopped the treatment, gave me IV Benadryl and two doses of Solu-Medrol (methylprednisolone). After one hour, the soles of my feet and my palms continued to itch severely, but the other symptoms improved. The treatment was resumed at a slower rate of infusion and I was able to complete it. Now they tell me I must see the doctor before I can resume the treatments. Do you think it will be possible to continue the treatments with a more aggressive pre-medication plan? I have had ulcerative colitis for 30 years and am now 47 years old. The last medication regimen was mercaptopurine and mesalamine orally plus frequent mesalamine enemas. It did not keep me in remission. I have been free of colitis symptoms for over a year on Remicade. Any thoughts? It sounds as though you have developed antibodies to infliximab (Remicade). It is possible for you to keep taking infliximab, but you’re correct in thinking that you’ll need to make some changes. You will have to be pre-medicated with steroids, restart 6-mercaptopurine, and keep to a regular infliximab schedule. Each of those maneuvers can minimize your infusion reaction, but if not, you will need to stop the infliximab and find an alternative treatment. Q4. Is Humira (adalimumab) an effective treatment for ulcerative colitis? I am being treated for ulcerative colitis and rheumatoid arthritis and the treatments seem to overlap: Lialda (mesalamine), Imuran (azathioprine), and Humira, as well as Lyrica (pregabalin) and Cymbalta (duloxetine). Are these combinations beneficial to both diseases? Currently, Humira is being tested for effectiveness in treating ulcerative colitis but has not been approved by the Food and Drug Administration for that use. The mechanism of action is similar to Remicade (infliximab), which has been approved for ulcerative colitis, so I suspect that Humira is having some beneficial effect on your colon. Both medications are biologic therapies that block tumor necrosis factor, or TNF, a protein that causes increased inflammation. Lialda, which fights inflammation, and Imuran, which suppresses the immune system, also are helping your colon as well as your arthritis. Q5. My father has had colitis for many years. He is 77 years old and had a heart attack at 55. He also has chronic lymphocytic leukemia (CLL). He is considering starting Remicade (infliximab) treatment for his colitis. He is suffering a great deal from the colitis. Do you think this treatment is wise for him to pursue? Thank you. Remicade shouldn’t be used for people with a malignancy, like CLL. That’s because Remicade may be associated with some cancers, and it is not advisable to give it to patients with a recent history of cancer or to patients who are undergoing therapy for cancer. This has to do with the general effects of Remicade in inhibiting the body’s immune system, which may contribute to an increased risk for the development of cancer. I would suggest that alternative treatments be considered. Q6. I was diagnosed with ulcerative colitis three years ago and am now thinking of getting pregnant. My GI doctor has assured me that my current medication (Asacol) will not have any adverse affects on the pregnancy. However, he did say that I would not be able to breastfeed if I stayed on the medication. Are there any studies that have been done on pregnancy and UC? I just want another opinion on it all. Asacol (mesalimine) and all other 5-aminosalicylic agents are safe to take during pregnancy and while breastfeeding. As you might know, there have been very little studies on medication use in pregnant women with inflammatory bowel disease. Still, based on data from animal studies and sporadic reporting to the Food and Drug Administration, 5-ASA agents, steroids, and infliximab (Remicade) are classified as category B and considered safe. Most other IBD medications are classified as category C, which means that controlled animal studies have shown adverse fetal effects but there are no known human effects or that there are no controlled animal or human studies. These drugs are often used when needed during pregnancy. Azathioprine and 6-mercaptopurine are classified as category D and should only be used during pregnancy when deemed necessary. Methotrexate is category X and should never be used during pregnancy. As for breastfeeding, there is a risk that a metabolite (metabolized byproduct) of mesalamine could cause diarrhea in nursing infants. The American Academy of Pediatrics says this medication should be given to nursing mothers with caution. Q7. My son is a 41-year-old male. He was diagnosed with ulcerative colitis years ago. During his last round in the hospital two years ago, the doctor put him on Remicade (infliximab) as he wasn’t responding to the medication he was being given. The Remicade treatment price tag doubled in the last year. What happens if he goes off the Remicade? When he was in the hospital, the doctor would not give him a definite answer as to whether it was Crohn’s or colitis. Are there any alternatives? He was not on any medication when he had his last attack! Remicade is a very effective medication for both Crohn’s disease and ulcerative colitis. However, once started, it should be given as scheduled maintenance. If there is a gap between doses of more than three months, your son would be at risk for an infusion reaction during the next dose. Humira (adalimumab), another anti-tumor necrosis factor antibody like Remicade, is now FDA approved for Crohn’s disease and is effective in patients who cannot tolerate Remicade. Humira is not FDA approved for ulcerative colitis. If Remicade cannot be given as scheduled maintenance, perhaps a 5-ASA product like mesalamine and an immunosuppressive, like azathioprine, would maintain his remission. Q8. I have been diagnosed with collagenous colitis and am wondering if cholestyramine would be of some help before I go back on Entocort at a lower dosage. Thank you. Entocort (budesonide) is the best therapy for collagenous colitis, but has some long-term side effects in a few people. These can include bone loss, high blood pressure, reduced resistance to infections, weight gain and skin problems. Pepto Bismol (bismuth subsalicylate) also had been shown to be effective. Other therapies, like Imodium (loperamide) and cholestyramine, likely will slow down the diarrhea and can provide short-term relief but have not been conclusively shown to be effective in clinical trials. Learn more in the Everyday Health Ulcerative Colitis Center.
