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RE: Ursodil & UC

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In general, Urso is well tolerated by most patients. There are some who

cannot tolerate it. If I remember, Andi and Cheryl (ID) do not. It sounds

like you need to see the Dr. sooner - it may seem hard to believe, but it

CAN get worse.

From http://www.drugs.com/MTM/ursodiol.html

Other, less serious side effects may be more likely to occur. Continue to

take ursodiol and talk to your doctor if you experience

. nausea or upset stomach,

. diarrhea, or

. headache.

Arne

54 - UC 9/77 - PSC 4/00

Alive and (mostly) well in Minnesota

-----Original Message-----

From: [mailto: ] On

Behalf Of llduq@...

, Geoff and others,

I don't remember hearing that Urso can cause problems with UC. What kind of

information is available on this or is it more antecdotal information? I

looked at the PSC Literature and posted what I could find. None of these

talk about Urso complicating UC.

Anyway - any specific informatino would be helpful. Thanks for listening.

LINDA

(Mom of Suzanne, 16; UC 1/04, PSC 3/04)

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Dear ;

I am sorry to hear about Suzanne's continuing UC problems. Urosdiol

can have some side-effects in some patients, including:

Ursodiol ( Gastroenterology Patient Education)

http://www.gicare.com/pated/ursodiol.htm

Minor:

- diarrhea

- nausea

- vomiting

- gas

- metallic taste

- constipation

- rash

- headache

- muscle aches

Major:

- severe itching

- severe muscle or joint pain

- persistent cough

Actigall Datasheet (Medsafe)

http://www.medsafe.govt.nz/Profs/Datasheet/a/Actigallcap.htm

Adverse effects

Gastrointestinal

Actigall given in doses of 8-10 mg/kg/day rarely causes diarrhoea

(<1%). One study in which a placebo control was not used was

associated with a 6% incidence of mild, transient diarrhoea not

requiring termination of therapy or lowering of Actigall dose. One

patient with ulcerative colitis in the Actigall studies developed

diarrhoea on therapy.

Actigall [ursodiol] (MedlinePlus Drug Information (NLM/NIH))

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a699047.html

What side effects can this medication cause?

Side effects from ursodiol can occur. Tell your doctor if any of

these symptoms are severe or do not go away:

- diarrhea

- constipation

- upset stomach

- indigestion

- dizziness

- vomiting

- cough

- sore throat

- runny nose

- back pain

- muscle and joint pain

- hair loss

It might be good to talk with Suzanne's GI to determine if Suzanne's

urgency is due to the taking of ursodiol or to a true UC flare. I'm

not sure whether any tests can be done to prove that ursodiol is the

cause, other than to stop the medication and see if the symptoms

disappear? But only Suzanne's doctor could make that call.

Best regards,

Dave

(father of (20); PSC 07/03; UC 08/03)

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Hi ,

I found the following article earlier tonight:

Ursodiol for Hepatobiliary Disorders

http://www.annals.org/cgi/content/full/121/3/207

It says:

" Otherwise, ursodiol has been exceptionally well tolerated in patients with

primary sclerosing cholangitis, with few gastrointestinal adverse effects

even in those patients whose primary sclerosing cholangitis was associated

with ulcerative colitis. "

I guess I'm one of the few that had adverse gastrointestinal effects. I

tried twice within two weeks and each time I developed symptoms of cramps,

bleeding, and diaheria within a day or two but both times stopped before the

symptoms got worse. I'm pretty sure it was related to Ursodiol because each

time I stopped taking it the symptoms went away. My doctor and pharmasist

both warned that it was tough on the stomach. I also wasn't on any

medication for colitis at the time which may have made a difference. Anyways

good luck and if you find out any more info I'd be interested to know.

Geoff

>From: llduq@...

>Reply-To:

>To:

>Subject: Ursodil & UC

>Date: Thu, 09 Jun 2005 02:12:13 +0000

>

>, Geoff and others,

>I don't remember hearing that Urso can cause problems with UC. What kind of

>information is available on this or is it more antecdotal information? I

>looked at the PSC Literature and posted what I could find. None of these

>talk about Urso complicating UC.

>

>This has my attention because Suzanne is in her fifth week of a flare up

>with UC. Actually the flare up has lasted longer, she has been on cort

>enema for four - going into her fifth week. We are seeing a doctor in two

>weeks. If there is any specific literature on UC and Urso I would like to

>be able to share it with the doctor.

>

>I am becoming very frustrated and dismayed with all of this. Her liver

>enzymes have been maintained in the normal range, but the UC is getting

>worse. She is going to the bathroom on an average of 8 times a day (bowel

>movements) and each one is with such urgency that she has not always made

>it. I want to help her and cannot. Also, I just found out that she took my

>husband's business car (a jeep with his business name plastered all over

>it) for a joy ride with some of her teen friends. I want to help her and

>strangle her ... I want her to have a normal teen age life, but I don't

>want her to get in trouble. I " m not asking too much am I?

>

>Anyway - any specific informatino would be helpful. Thanks for listening.

>LINDA

>(Mom of Suzanne, 16; UC 1/04, PSC 3/04)

>

>Cancer prevention in inflammatory bowel disease and the chemoprophylactic

>potential of 5-aminosalicylic acid.

>Bernstein CN, Eaden J, Steinhart AH, Munkholm P, Gordon PH.

>

> " Recent data have suggested some potential preventative benefit of using

>ursodeoxycholic acid in patients with ulcerative colitis and primary

>sclerosing cholangitis. "

>-

>Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative

>colitis and primary sclerosing cholangitis.

>Pardi DS, Loftus EV Jr, Kremers WK, Keach J, Lindor KD.

>

> " In addition, a recent report suggests that it also may decrease the risk

>for developing colorectal dysplasia in patients with ulcerative colitis

>(UC) and primary sclerosing cholangitis (PSC). "

>-

>Intestinal absorption of ursodeoxycholic acid in children and adolescents

>with inflammatory bowel disease.

>Fujisawa T, Kimura A, Ushijima K, Nakashima E, Inoue T, Yamashita Y, Kato

>H.

>

> " Malabsorption of ursodeoxycholic acid was not observed in any patients

>with ulcerative colitis. "

>

>-----------------------------------------------------

>Geoff,My daughter(18) can't take Urso,because it causes more uc

>problems for her.

>

>

>

>

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Geoff, , Arne & others,

Thank you for these quick replies. After reading what Geoff wrote (below), and

finding similar comments in the literature that suggest no adverse effects, I am

inclined to think that Urso is not impacting her UC negatively. She has been on

it for over a year - I can't say that there was any correlation between starting

Urso and a flare up. I am, however, still going to mention it to the Dr. I will

definitely (and always will) share any new information that I may get from the

Dr. That's the power of the group, sharing information.

We are meeting with the Dr. in two weeks because she is going to be out of

town. Suzanne's Dr. is at Children's of Pgh, and I have always felt comfortable

calling the office anytime, someone is always on call. So, if her symptoms to

increase significantly I will not hesitate to call and see someone else.

On another note - one of the things that Dr. Harpavat wants to talk about is

this group and writing the article about her work with bone density. I think

it's great because it gives me a chance to strengthen my relationship with her.

LINDA

(Mom of Suzanne, 16; UC 1/04, PSC 3/04)

------------------------------------------------------

I

tried twice within two weeks and each time I developed symptoms of cramps,

bleeding, and diaheria within a day or two but both times stopped before the

symptoms got worse.

Anyways

good luck and if you find out any more info I'd be interested to know.

Geoff

Hi ,

I found the following article earlier tonight:

Ursodiol for Hepatobiliary Disorders

http://www.annals.org/cgi/content/full/121/3/207

It says:

" Otherwise, ursodiol has been exceptionally well tolerated in patients with

primary sclerosing cholangitis, with few gastrointestinal adverse effects

even in those patients whose primary sclerosing cholangitis was associated

with ulcerative colitis. "

I guess I'm one of the few that had adverse gastrointestinal effects. I

tried twice within two weeks and each time I developed symptoms of cramps,

bleeding, and diaheria within a day or two but both times stopped before the

symptoms got worse. I'm pretty sure it was related to Ursodiol because each

time I stopped taking it the symptoms went away. My doctor and pharmasist

both warned that it was tough on the stomach. I also wasn't on any

medication for colitis at the time which may have made a difference. Anyways

good luck and if you find out any more info I'd be interested to know.

Geoff

>From: llduq@...

>Reply-To:

>To:

>Subject: Ursodil & UC

>Date: Thu, 09 Jun 2005 02:12:13 +0000

>

>, Geoff and others,

>I don't remember hearing that Urso can cause problems with UC. What kind of

>information is available on this or is it more antecdotal information? I

>looked at the PSC Literature and posted what I could find. None of these

>talk about Urso complicating UC.

>

>This has my attention because Suzanne is in her fifth week of a flare up

>with UC. Actually the flare up has lasted longer, she has been on cort

>enema for four - going into her fifth week. We are seeing a doctor in two

>weeks. If there is any specific literature on UC and Urso I would like to

>be able to share it with the doctor.

>

>I am becoming very frustrated and dismayed with all of this. Her liver

>enzymes have been maintained in the normal range, but the UC is getting

>worse. She is going to the bathroom on an average of 8 times a day (bowel

>movements) and each one is with such urgency that she has not always made

>it. I want to help her and cannot. Also, I just found out that she took my

>husband's business car (a jeep with his business name plastered all over

>it) for a joy ride with some of her teen friends. I want to help her and

>strangle her ... I want her to have a normal teen age life, but I don't

>want her to get in trouble. I " m not asking too much am I?

>

>Anyway - any specific informatino would be helpful. Thanks for listening.

>LINDA

>(Mom of Suzanne, 16; UC 1/04, PSC 3/04)

>

>Cancer prevention in inflammatory bowel disease and the chemoprophylactic

>potential of 5-aminosalicylic acid.

>Bernstein CN, Eaden J, Steinhart AH, Munkholm P, Gordon PH.

>

> " Recent data have suggested some potential preventative benefit of using

>ursodeoxycholic acid in patients with ulcerative colitis and primary

>sclerosing cholangitis. "

>-

>Ursodeoxycholic acid as a chemopreventive agent in patients with ulcerative

>colitis and primary sclerosing cholangitis.

>Pardi DS, Loftus EV Jr, Kremers WK, Keach J, Lindor KD.

>

> " In addition, a recent report suggests that it also may decrease the risk

>for developing colorectal dysplasia in patients with ulcerative colitis

>(UC) and primary sclerosing cholangitis (PSC). "

>-

>Intestinal absorption of ursodeoxycholic acid in children and adolescents

>with inflammatory bowel disease.

>Fujisawa T, Kimura A, Ushijima K, Nakashima E, Inoue T, Yamashita Y, Kato

>H.

>

> " Malabsorption of ursodeoxycholic acid was not observed in any patients

>with ulcerative colitis. "

>

>-----------------------------------------------------

>Geoff,My daughter(18) can't take Urso,because it causes more uc

>problems for her.

>

>

>

>

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Dear ,

My son also has urgency and hits the BR 8 times a day. He takes 1,250mg

of urso and even though he has been on asacol, prednisone and imuran,

nothing has controlled his UC which is why he is having a colectomy. I

, too, wondered about the Urso but my son's GI keeps telling me that it

is not the Urso.

Lee

> , Geoff and others,

> I don't remember hearing that Urso can cause problems with UC. What

> kind of information is available on this or is it more antecdotal

> information? I looked at the PSC Literature and posted what I could

> find. None of these talk about Urso complicating UC.

>

> This has my attention because Suzanne is in her fifth week of a flare

> up with UC. Actually the flare up has lasted longer, she has been on

> cort enema for four - going into her fifth week. We are seeing a

> doctor in two weeks. If there is any specific literature on UC and

> Urso I would like to be able to share it with the doctor.

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Mom of Suzanne

I don't know about the literature, but I too have had this problem. I was

told by my hep. that it is the first time he has seen it and is likely a set

of bad luck (UC, J pouch and Chronic Pouchitis). He is a young man so don't

know that this is super significant, although he sees quite a number of

PSCers. You don't have to pour over the literature to find the possibility

however. The PDR (Physicians Desk Reference) is a 4000+ page reference book

used in medical settings. Under URSO and the side effects in the gastro

section, it notes in the top three within this area, and you guessed it,

diarrhea.. As I understand it, for this to appear in the PDR it had to be

reported by some " subjects " when the original trails for the drug were being

conducted. I gather it is a rare complication. I could tolerate lower doses

(those now proven NOT to change the course of PSC) but not the high dose

regimen.

All the Best

jd, 44

UC 1973, Jpouch 2000, Chronic Pouchitis 2001, PSC 2004, Stage 3

ston City, IL

krmpotich@...

Ursodil & UC

> , Geoff and others,

> I don't remember hearing that Urso can cause problems with UC. What kind

of information is available on this or is it more antecdotal information? I

looked at the PSC Literature and posted what I could find. None of these

talk about Urso complicating UC.

>

> This has my attention because Suzanne is in her fifth week of a flare up

with UC. Actually the flare up has lasted longer, she has been on cort enema

for four - going into her fifth week. We are seeing a doctor in two weeks.

If there is any specific literature on UC and Urso I would like to be able

to share it with the doctor.

>

> I am becoming very frustrated and dismayed with all of this. Her liver

enzymes have been maintained in the normal range, but the UC is getting

worse. She is going to the bathroom on an average of 8 times a day (bowel

movements) and each one is with such urgency that she has not always made

it. I want to help her and cannot. Also, I just found out that she took my

husband's business car (a jeep with his business name plastered all over it)

for a joy ride with some of her teen friends. I want to help her and

strangle her ... I want her to have a normal teen age life, but I don't want

her to get in trouble. I " m not asking too much am I?

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Geoff

We are in the same boat... except my Hep was suprised, not warning of this

side effect, and my long time RPh. said what the -ell is this being

prescribed for and what is it!

All the Best

jd, 44

UC 1973, Jpouch 2000, Chronic Pouchitis 2001, PSC 2004, Stage 3

ston City, IL

krmpotich@...

> even in those patients whose primary sclerosing cholangitis was associated

> with ulcerative colitis. "

>

> I guess I'm one of the few that had adverse gastrointestinal effects. I

> tried twice within two weeks and each time I developed symptoms of cramps,

> bleeding, and diaheria within a day or two but both times stopped before

the

> symptoms got worse. I'm pretty sure it was related to Ursodiol because

each

> time I stopped taking it the symptoms went away. My doctor and pharmasist

> both warned that it was tough on the stomach.

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Lee

It is correct that it is rare. It is not correct that it doesn't happen. It

can happen, to be sure. I tested it several times and there was a definite

cause and effect. I'm sure you have seen my recent posts on this topic. My

experience was so clear and extreme, even without a bumb colon in place, the

only logical option was to not take URSO.

All the Best

jd, 44

UC 1973, Jpouch 2000, Chronic Pouchitis 2001, PSC 2004, Stage 3

ston City, IL

krmpotich@...

Re: Ursodil & UC

> Dear ,

> My son also has urgency and hits the BR 8 times a day. He takes 1,250mg

> of urso and even though he has been on asacol, prednisone and imuran,

> nothing has controlled his UC which is why he is having a colectomy. I

> , too, wondered about the Urso but my son's GI keeps telling me that it

> is not the Urso.

> Lee

>

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JD,

I guess it is too late to test it now.

On the other hand his frequency was extreme before the urso too which

is probably why his GI doesn't blame the urso. Still, I guess it is in

the back of my mind that maybe the reason the asacol , imuran and

prednisone didn't work is because of the urso.

However, I suppose it is more likely that his colon was already so

damaged that the drugs were never absorbed right as evidenced by

undigested pills.

Lee

> Lee

>

> It is correct that it is rare. It is not correct that it doesn't

> happen. It

> can happen, to be sure. I tested it several times and there was a

> definite

> cause and effect. I'm sure you have seen my recent posts on this

> topic. My

> experience was so clear and extreme, even without a bumb colon in

> place, the

> only logical option was to not take URSO.

>

> All the Best

>

> jd, 44

> UC 1973, Jpouch 2000, Chronic Pouchitis 2001, PSC 2004, Stage 3

> ston City, IL

> krmpotich@...

>

>

> Re: Ursodil & UC

>

>

> > Dear ,

> > My son also has urgency and hits the BR 8 times a day. He takes

> 1,250mg

> > of urso and even though he has been on asacol, prednisone and

> imuran,

> > nothing has controlled his UC which is why he is having a

> colectomy. I

> > , too, wondered about the Urso but my son's GI keeps telling me

> that it

> > is not the Urso.

> > Lee

> >

>

>

>

>

>

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Lee

I think in your situation you are precisly right. What I would add is that

removal of the colon should restore some large measure of health perhaps as

early as while still in the hospital, but he may still not be able to

tolerate the URSO post colon. Keep us all posted as to how it goes.

All the Best

jd, 44

UC 1973, Jpouch 2000, Chronic Pouchitis 2001, PSC 2004, Stage 3

ston City, IL

krmpotich@...

Re: Ursodil & UC

JD,

I guess it is too late to test it now.

On the other hand his frequency was extreme before the urso too which

is probably why his GI doesn't blame the urso. Still, I guess it is in

the back of my mind that maybe the reason the asacol , imuran and

prednisone didn't work is because of the urso.

However, I suppose it is more likely that his colon was already so

damaged that the drugs were never absorbed right as evidenced by

undigested pills.

Lee

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