Azathioprine and Mesalamine concurrent use...

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CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 7/26/2008 1:38 PM (GMT -7)   
I started taking Azasan back in February. I've been wondering why I haven't seen much benefit from it since I've now been on it for five months. Supposedly, it starts to take a noticeable effect in three months, and hit max effectiveness at six months. So I start to do some research. I've found many places (don't have links handy, sorry) that have said to avoid taking azathioprine and mesalamine and/or mesalazine. I've been taking Pentasa this whole time. So I stopped taking the Pentasa just over a week ago, and I have seen *much* improvement. Not just in bowel problems, but also: less joint pain, less fatigue, less mental fog, more ambition, general overall better feeling of well-being.
 
For those of you that are also taking azathioprine or 6mp, does your doctor also have you taking some form of mesalamine and/or mesalazine?
 
The references I've found say to avoid the two together, as the mesalamine can inhibit the TPMT enzyme which is used by the body to convert azathioprine to the active chemical which actually performs the beneficial actions.
Just trying to be a "Regular Member".
 
Entocort 9 mg/day, Prednisone 20 mg/day, Pentasa 4 gm/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.


camjames
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Date Joined May 2006
Total Posts : 229
   Posted 7/26/2008 2:09 PM (GMT -7)   
At one point in time I was on Pentasa and Imuran (azathioprine). My GI actually discouraged the use of both of the medications due to an increase in liver toxicity and other side effects of Imuran. He did say though if I was to take a steady dose (same dose everyday with very good compliance) of pentasa so that it did not alter the blood results that tested for liver toxicity, then I could still take the pentasa. So after looking further into this, and reading what you found Crohnsdaddy, it sounds like both medications are metabolised by the same liver enzyme and that having both drugs in the body means Imuran will be metabolized slower, and will remain in the body longer, producing more side effects.  So it sounds to me like most of those symptoms were increased side effects of Imuran. If your feeling alot better now, then why fight it? Not to mention the effectiveness of pentasa/asacol is controversial for crohns disease as to whether it helps at all. Imuran is proven to be more effective according to my GI. However...im sure you will hear of people taking both pentasa and Imuran without problems. Hope this helps

Ides
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Date Joined Nov 2003
Total Posts : 7077
   Posted 7/26/2008 3:16 PM (GMT -7)   
Also, the improvement you got when you stopped the Pentasa could also be due to the fact that some people get increased symtpoms from the mesalamine drugs. We have quite a few people here that found the mesalamine drugs made their symptoms worse. My own mother was taking Colazal for her ulcerative colitis and kept complaining about explosive stools. I suggested she stop the Colazal and wouldn't you know it, her stools firmed up and her gas all but disappeared.
I am very interested in the information you provided stating that mesalamine can inhibit the TPMT emzyme that converts the azathioprine in the body.
 
PS. did you notice CrohnsDaddy that you are a Regular Menber?


Moderator Crohn's Disease Forum
CD, Ankylosing Spondylitis, lupus, small fiber peripheral neuropathy, avascular necrosis, peripheral artery disease, degenerative disc disease, and a host of other medical problems.
 


CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 7/30/2008 10:08 AM (GMT -7)   
Ides said...
Also, the improvement you got when you stopped the Pentasa could also be due to the fact that some people get increased symtpoms from the mesalamine drugs. We have quite a few people here that found the mesalamine drugs made their symptoms worse. My own mother was taking Colazal for her ulcerative colitis and kept complaining about explosive stools. I suggested she stop the Colazal and wouldn't you know it, her stools firmed up and her gas all but disappeared.
I am very interested in the information you provided stating that mesalamine can inhibit the TPMT emzyme that converts the azathioprine in the body.
 
PS. did you notice CrohnsDaddy that you are a Regular Menber?

In title only, unfortunately. Flaring the last two days. :/
 
I'm definitely not going to start up on the Pentasa again. I'm kinda surprised that my GI didn't even mention anything about taking these two drugs together. I'll mention it next appointment I have with him.
 
I'll see if I can find/post a link to the TPMT enzyme reaction, Ides...
Just trying to be a "Regular Member".
 
Entocort 9 mg/day, Prednisone 20 mg/day, Pentasa 4 gm/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.


CrohnsDaddy
Regular Member


Date Joined Oct 2007
Total Posts : 235
   Posted 7/30/2008 10:13 AM (GMT -7)   

 

Use with Aminosalicylates: There is in vitro evidence that aminosalicylate derivatives (e.g., sulphasalazine, mesalazine, or olsalazine) inhibit the TPMT enzyme. Concomitant use of these agents with IMURAN should be done with caution.

The above is from http://www.rxlist.com/cgi/generic/azathioprine_ad.htm. This was just after a quick search, but there are other references that do specifically say "mesalamine", which isn't surprising, as it is also a type of aminosalicylate.



Just trying to be a "Regular Member".
 
Entocort 9 mg/day, Prednisone 20 mg/day, Pentasa 4 gm/day, started Humira 1/22/08, started 100 mg of Azasan (Imuran) 2/20/08. I'm convinced that Prednisone is the root of all evil, and primarily responsible for global warming.

Post Edited (CrohnsDaddy) : 7/30/2008 11:21:54 AM (GMT-6)


Julie1014
Veteran Member


Date Joined Oct 2005
Total Posts : 1245
   Posted 7/30/2008 4:51 PM (GMT -7)   
CrohnsDaddy, that's interesting information. I take both Asacol and Imuran.
Diagnosed with Ulcerative Colitis (Pancolitis) 10/25/05
New Diagnosis of Crohn's March 2006
Asacol 3 pills three times a day
Remicade 10mg/kg every 4 weeks
Prednisone 12mg a day
Imuran 75mg
Miralax as needed, Cortisone enemas as needed
Prevacid 30mg
Paxil 40mg daily (for Panic disorder)
Xanax .5mg as needed (for anxiety attacks)
 
 
 
 
 


carnations4ever
New Member


Date Joined Jun 2015
Total Posts : 10
   Posted 1/30/2016 5:37 PM (GMT -7)   
I have been on Pentasa now for 8 months and started Azathioprine in November. The Pentasa has not been working for me and my GI kept me on it anyway. It seems the Pentasa made me feel worse with side pain and so I decided to stop it myself. The pain on my side stopped and I felt better. The Aza seeme to be working and I go to my GI on Feb. 16,2016, but first I have to go and get blood work on the 9th of Feb. I take 50mg of Aza and I don't know if he will up it. I have no side effects and take it at night at around 8pm. Does anyone know if you can cut the 50mg in half to take one half in the morning and the other at night? I have had Crohn'sfor 52 years with 3 resections and one exploratory. The ileum first appendix with it and part of the large colon. After that more small bowel the last was March of 2015.
I had a ct scan in August because of pain and found inflammation and a narrowing in the same area where I had my last surgery. This I did not like. Thank you for listening and for this forum and I feel I can vent here. At times this disease has really gotten me down, but I tell myself you Crohn's will not beat me!

Dx 1963 meds: Azathioprine, vitamind3 5000iu, multivitamin w/minerals, dha600mg, resveratrol 100mg, and cq10 100mg, ranitidine 75mg when needed

73monte
Veteran Member


Date Joined Mar 2007
Total Posts : 1496
   Posted 1/30/2016 7:08 PM (GMT -7)   
First of all, you've brought up a very old thread, (2008). You might want to start a new one.

Secondly, congratulations for being able to battle this disease for 52yrs. That's quite an accomplishment, considering when you were diagnosed, there were likely very few meds other than Prednisone.

As for your questons. Pentasa, has been considered a very ineffective treatment for quite some time now. You should just simply stop using it. As far as the Aza goes. You should really have a metabolite test done. This will determine the optimum dose for you. Everyone is somewhat different. At the right dose, there are many who get very good results with just 6mp or Imuran.

You've been very lucky to avoid taking biologics as of yet. Depending on your symptoms you might start to consider that route as well.
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