ASACOL Safe?

I have been dx'd with early cirrhosis and early portal hypertension.  US states mildly hetergeneous echogencity...everything else is normal size.

I also have proctitis/colitis...my gastro prescribed asacol...800 mg 2 tabs twice daily.  I looked at the drug pamphlet and I see that it can affect liver enzymes.  I dont need that since I already have mildly abnormal values.  I called my gastro to tell him my concern and he said it would not hurt me.  I am supposed to be on them indefinitely.  

I also take 5 mg prednisone for my r/a.  

Just wondering how this will affect the liver.  I know I am not on the higher side of the doses given but still...

I hate to see elevated liver values.  

P

[rpooo]

Hi Paula,

Your gastroenterologist is a specialist of the digestive system in which the liver plays a big role. He/she is not as specialized as a Hepatologist with your cirrhotic condition so I can understand your concern. The thing that puzzles me is you mentioned you have early cirrhosis/early portal hypertension low platelet count and yet you have grade two varices. Your platelet count may be low due to the biologic response modifiers but grade two varices is a symptom of more advanced cirrhosis and portal hypertension in which case your US results would likely indicate an enlarged spleen. I don’t see any need to repeat the EGD because the result are no doubt accurate and the same with the ultra sound but a second opinion would certainly be worth your while.

The severity of liver dysfunction, as assessed by the Child-Pugh classification—an index of liver dysfunction (i.e.- class A,B or C) based on serum albumin concentration, bilirubin level, prothrombin time, and the presence of ascites and encephalopathy should be established before an assessment can be made to take these medications. This assessment should be made by an Hepatologist at which point he/she can coordinate treatment decisions with your gastroenterologist.

Below are warnings I found on drugs.com:


Before you take Asacol, tell your doctor  if you have kidney or liver disease, a stomach condition called pyloric stenosis, a heart condition such as congestive heart failure, or a history of allergy to sulfasalazine (Azulfidine).

http://www.drugs.com/asacol.html

Before taking Remeron, tell your doctor if you have bipolar disorder, liver or kidney disease, seizures, heart disease, a history of heart attack or stroke, or a history of drug abuse or suicidal thoughts.

http://www.drugs.com/remeron.html

I don’t know the severity of your other health problems or understand them so you may consider to trust your gastro doctor for now but this is my take on your current cirrhotic condition and I hope in some way it will help. Take care.

Randy

[rpooo]

Hi Paula,

Your gastroenterologist is a specialist of the digestive system in which the liver plays a big role. He/she is not as specialized as a Hepatologist with your cirrhotic condition so I can understand your concern. The thing that puzzles me is you mentioned you have early cirrhosis/early portal hypertension low platelet count and yet you have grade two varices. Your platelet count may be low due to the biologic response modifiers but grade two varices is a symptom of more advanced cirrhosis and portal hypertension in which case your US results would likely indicate an enlarged spleen. I don’t see any need to repeat the EGD because the result are no doubt accurate and the same with the ultra sound but a second opinion would certainly be worth your while.

The severity of liver dysfunction, as assessed by the Child-Pugh classification—an index of liver dysfunction (i.e.- class A,B or C) based on serum albumin concentration, bilirubin level, prothrombin time, and the presence of ascites and encephalopathy should be established before an assessment can be made to take these medications. This assessment should be made by an Hepatologist at which point he/she can coordinate treatment decisions with your gastroenterologist.

Below are warnings I found on drugs.com:


Before you take Asacol, tell your doctor  if you have kidney or liver disease, a stomach condition called pyloric stenosis, a heart condition such as congestive heart failure, or a history of allergy to sulfasalazine (Azulfidine).

http://www.drugs.com/asacol.html

Before taking Remeron, tell your doctor if you have bipolar disorder, liver or kidney disease, seizures, heart disease, a history of heart attack or stroke, or a history of drug abuse or suicidal thoughts.

http://www.drugs.com/remeron.html

I don’t know the severity of your other health problems or understand them so you may consider to trust your gastro doctor for now but this is my take on your current cirrhotic condition and I hope in some way it will help. Take care.

Randy

[PaulaAnn]

The US showed all organs nornsl size and no mention of portal hypertension...no enlarged spleen, gallbladder, pancreas, etc all normal sized. i switched to the new gastro because my old gastro did not get back to me on my results .. called and they didnt call back. Had to go to medical records myself to pick up my results. no ascites, jaundice, he, no fatigue.  My labs albumin normal, ast is mild abn at 39  alt normal...biii total is 1.1 H  pt is normal.  When I check the MELD score it is 7.  I know labs can change.  

I have had rheum arth since 1983.  

I did call my gastro ..saw him on the 5th and called him yesterday to remind him of my liver concern and he said the asacol would be okay.  I also have a question for Dr Schiano to get his thoughts.  

Thank you...I will do some more checking...I did get the pamphlets from my drugstore concerning the asacol and checked online.  

UGH....I just dont want to do more damage.

[PaulaAnn]

Thank you Randy...the good Dr Schiano said that the Asacol and the Remeron are okay to take.  

Thank you for your response...its nice that so many people care to take the time.  

My r.a is severe so I am complicated.  I told ny rheumy I was a mess but he said, no you're JUST a challenge.  Ya think?

Paula

[HectorSF]

You need to treat the underlying cause of your cirrhosis now. Cirrhosis is a progressive illness that if untreated can in time be fatal. The longer you wait to treat the higher the rest of a poor outcome.

You should go to a liver clinic or a liver transplant center. That your doctor doesn't seemed concerned about cirrhosis shows a lack of knowledge of liver disease, Your other illness are I'm sure problematic. But cirrhosis is potentially fatal. Ask Dr Schiano. Please take it seriously before your options start to run out.

Good luck!
Hector

[PaulaAnn]

I will Hector..am going to fax some info to Dr BARNES at Cleveland Clinic .. I dont know if they have transportation there and back.  will have to find out.

There is a hep clinic here and will seek a lv bx , transjugular or fibroscan. I may start off there.  

I sent Dr S all my reports and he said it looks like early cirrhosis...or non cirrhotic portal hyper .  Cirrhosis though..so need to find out what I can do for it.  

Will definitely be asking for a biopsy....or one of the others.  

Thank you...Paula

[PaulaAnn]

I'm not sure about being able to go the liver bx route with the lower plats so wondering which of the other two procedures would be good...transjugular or the fibrosure..fibroscan.  

Thanks.  

[tdig]

How were you diagnosed wtih early cirrhosis. Have you had a biopsy? What labs make them think this is so? My labs are all normal but US said Fatty Liver which I believe is same as heterogeneous liver? I have been freaking out about Cirrhosis and have an appt tomorrow to discuss labs/US with Dr. Thanks!!

[tdig]

How were you diagnosed wtih early cirrhosis. Have you had a biopsy? What labs make them think this is so? My labs are all normal but US said Fatty Liver which I believe is same as heterogeneous liver? I have been freaking out about Cirrhosis and have an appt tomorrow to discuss labs/US with Dr. Thanks!!

[PaulaAnn]

i had an egd and they found esophageal varices.....  My US was mildly hetergeneous and then when I talked to the dr after he didnt call me about the results...he looked up the report and went onto tell me ....oh you have fatty liver.  I said, really...well, what about the varuces you found when I had the EGD and you scheduled the US for me BECAUSE of that?  He said..oh you had varices???  Oh okay..well then you have cirrhosis....  hats why I now have a new gastro.  

Good luck. please keep us posted.