Imuran dosage?

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73monte
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   Posted 6/23/2009 11:30 AM (GMT -7)   
My daughter had a blood test for (Metabolites?). I think that this shows the therapeutic dose of Imuran. She has been taking 75mgs. per day, and seems to be doing well. The Nurse called today and said that the bloodwork showed that the dose was too low, and that the GI has recommended that she go to 100mgs. per day. 
 
I was wondering if anyone has any imput about the appropriate dose of Imuran. Does 100mgs seem high? Would there be any liklihood of incresed side effects to going up to that amount? 
 
Thanks, Tom. 
My daughter was diagnosed Feb. 19/07, (13 yrs. old at time of diagnosis), with Crohn's of the Terminal Illium. Has used Prednisone and Pentasa. Started Imuran (02/09), had an abdominal abscess (12/08). 2cm of Stricture.


Rider Fan
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   Posted 6/23/2009 11:33 AM (GMT -7)   
That's not too high. Clinical trials demonstrated 2.5mg/kg to have the highest efficacy while minimizing side effects.
32 y/o male. Dx'ed in 1999. No surgeries.

Current meds: Humira 2/27/09. 5mg prednisone. Udo's Choice Probiotics (30 billion). Can't tolerate any iron supplements or infusions.

Tried SCD, didn't work, now avoiding gluten and dairy.


Go Saskatchewan Roughriders!


beave
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   Posted 6/23/2009 11:41 AM (GMT -7)   

^^ That's right.

By the way, 2.5mg/kg works out to be slightly more than body weight in pounds.

So, for example, a person weighing 150 pounds would typically respond best on 150 mgs of Imuran, with 125 or 175 being reasonable doses as well (allowing for normal variation in metabolism of the drug).

As for side effects, they *are* dose dependent, ie, they do increase as you increase the dose.  But 100mgs is still fairly low, so I wouldn't be too worried about that.  The only way to know is to try.

73monte
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   Posted 6/23/2009 11:51 AM (GMT -7)   
Thank-You (beave and Rider Fan),
 
She weighs about 120lbs, so I guess that seems appropriate.
My daughter was diagnosed Feb. 19/07, (13 yrs. old at time of diagnosis), with Crohn's of the Terminal Illium. Has used Prednisone and Pentasa. Started Imuran (02/09), had an abdominal abscess (12/08). 2cm of Stricture.


Nanners
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Date Joined Apr 2005
Total Posts : 14995
   Posted 6/23/2009 11:51 AM (GMT -7)   
Beave is correct the dose is related to her weight. There is no set dose that everyone takes, its related to each individual. If her doc is saying its too low, then she has not reached her "theraputic" dose. Good luck!
Gail*Nanners* Co-Moderator for Crohns Disease and Anxiety/Panic Forum
Been living with Crohn's Disease for 33 years. Currently on Asacol, Prilosec, Estrace, Prinivil, Diltiazem, Percoset prn for pain, Zofran, Phenergan, Probiotics, Calcium  w/Vit D, and Xanax as needed for my anxiety.  Resections in 2002 and 2005. Also diagnosed with Fibromyalgia, Osteoarthritis, and Anxiety. Currently my Crohns is in remission, but my joints are going crazy!
*Every tomorrow has two handles.  We can take hold of it by the handle of anxiety, or by the handle of faith"*

ISF13+
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Date Joined Jun 2009
Total Posts : 202
   Posted 6/23/2009 11:57 AM (GMT -7)   
I'm currently on Imuran 150mg a day.  I've been tested for the metabolism aspect of the drug several times now.  I've generally had to increase my dosage also.  I haven't had any side effects that I know of from the Imuran.  It's a fairly benign drug as far as my body is concerned.

Crohn's Disease. 
Diagnosed 13+ years ago. 
Been in remission for short periods of time but each time I come out of remission my disease seems to have spread.  No longer isolated in my ileum, now from stomach down to rectum.
Current Medications:  Humera 40mg injections every other week, Imuran 30mg, Levsin, Welchol, Prednisone (started weaning off, now going back up in dosing).Canesa suppositories
Misc:  I recently joined a local crohns disease support group that meets monthly.  It has been great talking to and meeting other people who share the same disease.  I hope to continue gaining insight through this forum as well.


Lady G
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Date Joined Sep 2006
Total Posts : 321
   Posted 6/23/2009 11:58 AM (GMT -7)   
yes its an appropriate dose, I am on 150 mg and that is still considered therapeutic and not a high or heavy dose, no worries, just keep getting the proper bloodwork done while she is on the imuran
 


MMMNAVY
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   Posted 6/23/2009 2:15 PM (GMT -7)   
I have been on 250
Forum Co-moderator - Crohn's Disease:_All comments have the caveat contact your local health care provider.

I will find a way or make one. –Phillip Sidney 1554-1586

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Make sure your suffering has meaning…


beave
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Date Joined Mar 2007
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   Posted 6/23/2009 2:42 PM (GMT -7)   
If she weighs 120 pounds, she might even need to move up to 125mgs to hit the therapeutic dose.   She can try 100 mgs for a while and see how she does, and even retake the metabolites test again if you can get it approved, and then go to 125mgs only if she's still low.

Eva Lou
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Date Joined Sep 2006
Total Posts : 3432
   Posted 6/23/2009 3:04 PM (GMT -7)   
I take 150 mgs per day & I weigh 115 lbs. Have been at that dose for about a year now, after upping it from 100mgs per day. I have noticed that the higher dose helps, & my labs always come back relatively good. We did the prometheus testing prior to upping the dose, & found that I wasn't at the full therapeutic value.
diagnosed with UC '02
meds-
Asacol- 8 tabs/day
Remicade-10mgs/kg- since 4/07
Imuran- 150mgs/day
various probiotics
Fiber supplement
 
 
 


73monte
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Date Joined Mar 2007
Total Posts : 1494
   Posted 6/23/2009 5:44 PM (GMT -7)   
Beave and Eva Lou, 
 
I've heard of the Prometheous testing but not really sure what it is. Is it the same as the metabolites test?
 
I'm in Canada so I can get her tested as needed.  The bloodwork is sent to Sick Kids in Toronto, and takes about 3 weeks to get the results. 
 
Couple of questions:
 
1. Is it safe to assume that the medication is working, even though not at the optimal dose? 
 
2. Since it's been well tolerated so far, safe to assume that uping the dose will not incur any issues?
 
Tom.
My daughter was diagnosed Feb. 19/07, (13 yrs. old at time of diagnosis), with Crohn's of the Terminal Illium. Has used Prednisone and Pentasa. Started Imuran (02/09), had an abdominal abscess (12/08). 2cm of Stricture.


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 6/23/2009 5:57 PM (GMT -7)   
I can answer #2, Monte, and no it is not safe to assume that. I reacted once we raised the dose and had to go off the med. Don't panic if that happens, because it sounds as if Holly is in the early stages of treatment and has many other meds she can try. Also, it sounds to me (for what *that's* worth) as if she is on a low dose, so it sounds reasonable to me that the docs are thinking about raising the dose.

Best wishes,

Ivy.
Co-Moderator Crohn's Forum.

New meds thread


FallColors
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Date Joined May 2007
Total Posts : 1220
   Posted 6/23/2009 7:12 PM (GMT -7)   
Here's how my GI described 6MP to me and I think 6MP is a form of Imuran. The 6MP is actually toxic to you (liver and pancreas). You need to naturally produce an enzyme that breaks 6MP down into the metabolites that will help you. When you first start taking 6MP, you have to blood test confirming you have the enzyme and have adequate levels. Having the enzyme is genetic. No enzyme (about 2% of the population) means no 6MP for you. If you have the enzyme, it breaks the 6MP down and frees the metabolites to do their therapeutic thing on your immune system.

You start off with a low dose of 6MP, and they take blood tests as the doses increase. They increase the dose until they can tell that you have a level of metabolites that will provide the therapy that you need. The frequent blood tests are checking red blood cell count and liver enzyme levels because these predict your level of metabolites -- and the tests are cheap. Too high a blood count and liver enzymes means too much 6MP is remaining, so they reduce the dose. At times they do test for the metabolites but this in an expensive test. They have years and years of experience with 6MP and have determined the cheaper test works well in predicting your metabolite levels.

The dose you take is directly related to your enzyme production and not about your actual weight. They have found that the typical therapuetic dose is 2.5 mg/day/kg of body weight. But they need to do the blood tests to really determine the correct dose for you. You shouldn't feel it is wrong to take more or less than the 2.5 -- you need to find your own dose that gives you the right amount of metabolites. I am on the heavy side and 100 mg per day is my therapuetic dose. Go go enzymes!!

Hope this helps!
Diagnosed with Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


beave
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Date Joined Mar 2007
Total Posts : 1091
   Posted 6/24/2009 11:21 AM (GMT -7)   

^^ 100mg of 6-mp or 100mg of Imuran?  There is a difference.

The standard dosing of 6-mp is 1.5mg/kg, while for Imuran it's 2.5mg/kg.


ISF13+
Regular Member


Date Joined Jun 2009
Total Posts : 202
   Posted 6/24/2009 12:55 PM (GMT -7)   
Yes, its the Promethius Lab that does the testing.....
Crohn's Disease. 
Diagnosed 13+ years ago. 
Been in remission for short periods of time but each time I come out of remission my disease seems to have spread.  No longer isolated in my ileum, now from stomach down to rectum.
Current Medications for the Crohns:  Humera 40mg injections every other week, Imuran 150mg, Levsin, Welchol 625mg, Prednisone 10mg(started weaning off, now going back up in dosing).Canesa suppositories, Calcium, Acidophilus & Potassium
Misc:  I recently joined a local crohns disease support group that meets monthly.  It has been great talking to and meeting other people who share the same disease.  I hope to continue gaining insight through this forum as well.


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 6/24/2009 5:16 PM (GMT -7)   
Thanks Beave!

You are right!! I was mixing up the two related drugs. I am on 100 mgs/day of 6MP and the typical dose is 1.5/mg/kg/day. My doc expected that I would need more, but the blood work says 100 is fine.

Did I get the rest of it right?


Diagnosed with Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.

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