Imuran vs Prednisone vs Methodrexate

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FW
Regular Member


Date Joined May 2007
Total Posts : 477
   Posted 12/28/2007 9:06 PM (GMT -7)   
Hello to everyone. I don't post often but I am a frequent lurker. I have been in a rather bad flare, lately. My rheumy is fantastic, and says that I have to consider a more aggressive treatment, but, as always, it is my call. Right now I am on 30 mg of pred with a plan to taper back off. I have been resistant to a daily pred dose (long term). So, rheumy suggested Imuran or Methodrexate (long term). Does anyone know of long term effects of one drug vs another? He would like to prescribe Imuran, but had to do a blood test to make sure that I have the proper enzyme to metabolize the drug properly. I know that everyone says to avoid pred if at all possible but what about the other two? They all sound frightening!
Thanks in advance!
Take care,
Fran

Dx: Lupus, sjogren's, celiac, severe allergies.
Meds: Plaquenil, Zyrtec, Prilosec, Nasacort, Prednisone, Prozac daily.
Meds: Epinephrine, Benadryl, albuterol (as needed).


Bsime
Veteran Member


Date Joined Apr 2006
Total Posts : 1299
   Posted 12/28/2007 9:25 PM (GMT -7)   
Both meds are old drugs and doctors have a lot of experience with them.  If you have pulmonary problems methotrexate is not a good choice.
 
Imuran can be taken by most indefinitely but some people have problems immediately.  I have been on imuran for over 2 years and at 18 months it started to lower my RBC, WBC and platelets.  My doctor has reduced my dosage from 150mg to only 50mg which is as low as you can go and still get a benefit.  Other than that I have not had a single side effect from imuran. 
 
I had kidney and liver problems at the time the decision was made to start imuran and I don't remember the rationale for taking it instead of meth. 
 
Prednisone is a far scarier med than either meth or imuran but all can have serious side effects for some individuals.
 
Regardless you should have blood work done every 2 months and not ignore any new symptoms.  I would use imuran again even though I have had some problems with it.  It has helped to control my immune system and also taper me off prednisone.
 
Bill
Mixed connective tissue disease (systemic lupus, scleroderma, polymyositis), Raynauds phenomena, Hypertension, Barrett's esophagus.
 
Meds: prednisone 5mg, 50mg imuran, Lotrel 40/5mg, maxide 37.5/25mg, folic acid, potassium, aciphex 20mg, multi vitamins.
 
Maintain your optimism and you can beat the odds.
 
"Although the world is full of suffering, it is also full of the overcoming of it."  Helen Keller
 
 


FW
Regular Member


Date Joined May 2007
Total Posts : 477
   Posted 12/28/2007 9:41 PM (GMT -7)   
Bill,
Thank you so much for your answer! The Imuran appears to be the best choice for me at this time. I should have the blood work back in about two weeks which will be right about the time the pred taper is done. Don't worry - I will definitely stay up do date with any blood work.
Take care,
Fran

Dx: Lupus, sjogren's, celiac, severe allergies.
Meds: Plaquenil, Zyrtec, Prilosec, Nasacort, Prednisone, Prozac daily.
Meds: Epinephrine, Benadryl, albuterol (as needed).


redrose77
Veteran Member


Date Joined Sep 2005
Total Posts : 2573
   Posted 12/28/2007 10:02 PM (GMT -7)   
I am on Imuran and it is wonderful. I had elivated liver levels but Imuran brings them right back down.
Dx:fibromyalgia 2002, systematic lupus 2005, rheumatoid arthritis 2006, PTSD 2007, multiple allergies 2005, migraine, compression fractures T11 & T12, Sjögren's, pregnant due May 2008
Tx: plaquenil, Enbrel, Darvocet, Singulair, Flexeril, Baby Asprin,Prednisone


mom46
Veteran Member


Date Joined Dec 2004
Total Posts : 8198
   Posted 12/28/2007 10:03 PM (GMT -7)   

Hi Fran,

   I'm glad you are researching both meds before making a decision. We all act different to this type of treatment. Imuran works well for some and not for others. I did take it for 2 years and had bad side effects, but others do very well with it.

   Methotrexate worked well for me and I really felt good while taking it, but it raised my liver enzymes and the doctor took me off it.

   I wish you the best with the one you decide to try. Hopefully, it work well for you and your symptoms will get much better. Please keep us updated and take care. You will be in my thoughts and prayers.

                                                          Babs


 
Dx: Lupus,RLS,RA,Asthma,Fibro,Sjogren's,Raynaud's,Divertic, Stroke,Atherosclerosis,Seizures,Neuropathy,CAD
Meds:arava,prednisone,plavix,aspirin,protonix,,zanaflex,xanax,
mirapex,advair,foxamax,Vytorin,folicacid,lunesta,Tramadol
 
JOB 5:18 For he wounds, but he also binds up; he injures, but his hands also heal.


Lynnwood
Forum Moderator


Date Joined May 2005
Total Posts : 7019
   Posted 12/28/2007 11:05 PM (GMT -7)   
I guess each doctor has their own rating for these drugs -- my dr uses prednisone (low dose) first, then Imuran. The Imuran did nothing for me (18 mths - nothing good, nothing bad), so we tried Cellcept, which has helped a lot.

Your mileage may vary!!

Lynnwood, Co-Moderator: Lupus Forum
SLE(’00), Sjogren's Syndrome, SAD, Depression, Herpes Simplex 1
Piroxicam, Plaquenil, Cellcept, Prednisone, Trazodone, Fosamax, Wellbrutrin SR, Valtrex
Links: DIAGNOSING LUPUS(4of11), LUPUS INFORMATION, LUPUS RESOURCES, Donate to HealingWell, Drug Interactions


BumbleBee1
Regular Member


Date Joined Oct 2005
Total Posts : 130
   Posted 12/29/2007 8:45 AM (GMT -7)   
 I would be far more scared of being on long term Pred than taking either of the others. They are used in lower doses for lupus than for transplants or cancer. You will get frequent checks for any invisible side effects.
If you start the Imuran, start very slowly indeed and build up to avoid any nausea.
 
Cellcept might be suitable for you depending how lupus affects you.
If your problems are mainly joints  fatigue and the usual 'mild' lupus symptoms Quinacrine can be added to Plaquenil to great affect, or used as an excellent alternative to Plaquenil if that's not tolerated.
 
You will have to wean very gradually off the Prednisone if you have been on it for more than a few weeks.
 
Bee

Ginny
Veteran Member


Date Joined Feb 2003
Total Posts : 5514
   Posted 12/29/2007 11:40 AM (GMT -7)   

I'm on both Imuran and Prednisone.  They've both been life-savers for me.  The Imuran has been fantastic.  No side effects except slightly elevated liver enzymes.  Imuran is metabolized through the liver.  Other than that, I've had absolutely no problems with it.  I'll take it forever!

Yeah, prednisone is a catch 22.  It works great to bring me out of a flare.  I've been on it for 7 years now.  Mostly at a low dose - under 10mg. 

It really depends on the person, and how your lupus is acting.  Lynnwood suggested CellCept, and it is the newest and most talked about treatment.  Lots of people have great success on it.  I'm curious about it for myself actually. 

Talk about ALL the options with your rheumatologist.  There might be more out there for you than you think!

Good luck,

Ginny


I can do anything through Jesus Christ who strengthens me. I have learned in whatever state I am in,to be content. Phillipians 4:11-13

33 years old. Diagnosed with lupus in 2000. Fibromyalgia, anti-phospholipid syndrome(APS)(stroke),Sjogren's, Raynaud's, seizure disorder-(miraclulously disappeared!), Libman Sach's Endocarditis, vasculitis, sacroiliitis, arthritis (neck) . Prednisone, Imuran, Coumadin, Clobazam, Amitriptyline, didrocal, monopril, calcium, Cykolokapron, multi-vitamin, vitamin D, Magnesium, vitamin B6, Acidophilus


BlessedBe
Regular Member


Date Joined Dec 2007
Total Posts : 24
   Posted 12/29/2007 11:43 AM (GMT -7)   
Why does it seem that prednisone is most often prescribed? Is it the best for all over tx. or just the most familiar?
Wife, Mother, Nurse
SLE with all the additives, sjorgens, raynauds, RA etc.
Plaquenil, Effexor, serequel for sleep.
Refusing Steroids


BumbleBee1
Regular Member


Date Joined Oct 2005
Total Posts : 130
   Posted 12/29/2007 4:00 PM (GMT -7)   

 

 

Prednisone is invaluable for quickly bringing down inflammation so is often used as a stop gap while other medicines are taking effect, or to quickly dampen a flare or because it is essential as  for example if there are signs of serious organ damage occuring or sometimes to counteract certain effects of other drugs.

It's also used if for some reason steroid sparing drugs can't be used or after surgery to prevent a flare. Each drug works slightly differently and thus has different benefits and side effects. Every effort is made these days to have people on Prednisone for a short a time at the lowest dose possible because of the very serious side effects. It sometimes happens that people need to keep taking a low dose because they have lost the ability to produce it naturally.

 

Bee

 

 

 


FW
Regular Member


Date Joined May 2007
Total Posts : 477
   Posted 12/29/2007 7:56 PM (GMT -7)   
Thank you all so much for your responses! I've only been on the pred "burst" for three days and the difference is unbelievable! I had forgotten how "good" feels. It isn't completely helping with the breathing difficulties but the overall pain is so much more tolerable. I am allergic to most of the pain meds (aspirin, nsaids etc.) I know how bad pred is and I try to avoid it, but right now it's hard to remember why! Just kidding!
I, too, had heard of CellCept. I don't know why the doc didn't mention that one. He seemed to lean heavily toward the Imuran - said that if I could tolerate it he thought it would do the most good. We shall see.
Again, I appreciate your responses.
Happy (and pain free) New Year to everyone!
Fran
Take care,
Fran

Dx: Lupus, sjogren's, celiac, severe allergies.
Meds: Plaquenil, Zyrtec, Prilosec, Nasacort, Prednisone, Prozac daily.
Meds: Epinephrine, Benadryl, albuterol (as needed).


Ginny
Veteran Member


Date Joined Feb 2003
Total Posts : 5514
   Posted 12/31/2007 10:15 PM (GMT -7)   
Hey Fran!
 
Glad to hear that the prednisone is making such big improvement for you already!  It is a good drug.  Nothing else works quite like it.  Give that Imuran a good try.  It takes about a month for it to kick in, so you have to be patient.  But it is another "oldy, but a goody!"
 
Thanks for keeping us informed on how you're doing!
 
Ginny
I can do anything through Jesus Christ who strengthens me. I have learned in whatever state I am in,to be content. Phillipians 4:11-13

33 years old. Diagnosed with lupus in 2000. Fibromyalgia, anti-phospholipid syndrome(APS)(stroke),Sjogren's, Raynaud's, seizure disorder-(miraclulously disappeared!), Libman Sach's Endocarditis, vasculitis, sacroiliitis, arthritis (neck) . Prednisone, Imuran, Coumadin, Clobazam, Amitriptyline, didrocal, monopril, calcium, Cykolokapron, multi-vitamin, vitamin D, Magnesium, vitamin B6, Acidophilus


Bsime
Veteran Member


Date Joined Apr 2006
Total Posts : 1299
   Posted 1/1/2008 9:18 AM (GMT -7)   
Actually, imuran takes anywhere from 6-9 months to fully kick in.  It has some effect earlier but it takes quite a while for it to work fully which is why most docs will start it while someone is taking prednisone, taper the pred, and hope that imuran will work in its' place.
 
Most people who have problems will know right away and imuran can be stopped.  If you do take imuran you should get a blood test every 2-3 months to make sure it is not "working too well" and attacking your blood.  Long term users can have their RBC, WBC and platelets lowered in time.  It happened to me after 18 months and I am on a lower dose and doing OK.  Maybe I will be on nothing in a year????  I can only hope.
 
Bill
Mixed connective tissue disease (systemic lupus, scleroderma, polymyositis), Raynauds phenomena, Hypertension, Barrett's esophagus.
 
Meds: prednisone 5mg, 50mg imuran, Lotrel 40/5mg, maxide 37.5/25mg, folic acid, potassium, aciphex 20mg, multi vitamins.
 
Maintain your optimism and you can beat the odds.
 
"Although the world is full of suffering, it is also full of the overcoming of it."  Helen Keller
 
 


Audrey Ann
Veteran Member


Date Joined Jul 2005
Total Posts : 815
   Posted 1/1/2008 2:56 PM (GMT -7)   
The methotrexate takes time to "kick-in", also. The prednisone helps keep a flare issue under control while the target drug goes into effect. Sounds like your doc has a good plan in mind and it is sometimes best to just trust their judgement and see how it goes. My experience so far is that the meds work for awhile and then I seem to need something else because they kind of stop being effective. I think it will be a constant issue for us as the lupus decides, rather erratically, where to target it's next attack.

Good luck and my prayers are with you!
Prayers,
Audrey Ann
 
Lupus and RA and LOTS of Medications!
 


 


omega
Veteran Member


Date Joined Jan 2007
Total Posts : 607
   Posted 1/3/2008 5:18 AM (GMT -7)   
I cannot tolerate Imuran. My WBC will drop and hair loss and Platet drop and hospitalized. I did not take the Methx..., but Pred. is my life saver even though it is not good in the long term. I would say our drugs are not good for us, but we need to take it anyway in order to help us feel better.
DX SLE 1988; Pred 10mg, Cellcept 2500 mg, Verapmil 120 mg (for migraine headaches), Famotidine 20 mg BD, Volteran 150 mg (temporary), Calcium + Vitamin D 1200mg

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