More Imuran or Back to Endocort?

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Regular Member

Date Joined Sep 2008
Total Posts : 211
   Posted 8/16/2009 10:29 AM (GMT -7)   
Hi everyone.  I  really need opinions on which option I should ask my GI for--more imuran or back to endocort.
I have been competely off edocort since mid july after beginning my taper the end of June.  I was taking 3mg two times a day. 
My SED rate is back up to 41 (not near the highest it has ever been) and my "D" and pain is worsening.  This has been happening over the last few weeks.
I am wondering if it would be better for me to try to stay off the endocot and ask about uping my imuran.  I know from reading this board and other sources that the "norm" is 100-150 mg.
I am really torn about this.  I am even thinking about just waiting it out a few more mo's to see if it gets any worse.  If it was not time for my kids to go back to school and my college kids to come back for the fall semester I probably would.
Thank you all in advance.

36/f   proud single mom of 2

Diagnosed with GERD/Acid Reflex 2002

Diagnosed with IBS 2007

Diagnosed with Arthritis 2007

Diagnosed with UC, then Crohn’s 2008, now the GI isn't sure which is it exactly...he calls me a strange case.

Diagnosed with Generalized Anxiety Disorder 2008

Current medications: Asacol 2 tablets 3X daily, Imuran 50 mg daily,Endcort 3mg 2X daily, Pentasa 2 500mg caps 2X daily, Prilosec 20 mg 2X daily (if needed), Cymbalta 60 mg daily. 05 mg Zanax (if needed) Probiotics, Calcuim/Mag/Vit.D. Flinstones multi with Iron and Vit. C 500mg daily

Veteran Member

Date Joined May 2009
Total Posts : 506
   Posted 8/16/2009 10:33 AM (GMT -7)   
It would probably best to see what your GI thinks. If Imuran dosage is too high, all you're going is making yourself more vulnerable for illness. If the levels of Imuran in your blood are within the maintenance range, I kinda doubt your doc will agree that more will be better.
Diagnosed with CD July 2007
Currently on Remicade, Imuran, probiotics, folic acid, multivitamin.

Veteran Member

Date Joined Feb 2009
Total Posts : 529
   Posted 8/16/2009 12:55 PM (GMT -7)   
If it were me, I'd go up to 9 mg/day of Entocort before increasing my dose of Imuran, but of course, you should consult your doctor.

Regular Member

Date Joined Jul 2006
Total Posts : 73
   Posted 8/16/2009 2:08 PM (GMT -7)   
Instead of 3mg twice a day you should take it once a day 6mg. Normally you take it together. Might make a difference. And if 6 mg is not enough then go upto 9 mg.
26 years old
CD for 20 years
Bowel resection in Dec. 2006
Pentasa 4000mg

Veteran Member

Date Joined Mar 2007
Total Posts : 1653
   Posted 8/17/2009 11:51 AM (GMT -7)   
Are you still on only 50mg of Imuran? If so, that's probably too low to do any good. For most people the effective dose ends up being fairly close to your weight (for example, 150 pound person would be on 150 mgs of Imuran).

Anyway, instead of thinking which one, why not do both? Ask to start back on the Entocort for short term, and also increase your Imuran dose to an effective level at the same time. After a couple months, the Entocort should have helped get you through, and the Imuran should have had enough time to kick in, and then you can taper off the Entocort again.

That would be my strategy in your situation.

Regular Member

Date Joined Aug 2007
Total Posts : 44
   Posted 8/17/2009 8:02 PM (GMT -7)   
I can't really speak to the entocort, but as for the Imuran, 50mgs is a VERY low dose. I'm only 115 lbs and my doc has me on 125mg (dosage is based on weight). I did start out on 50mgs, to make sure that I tolerated it okay and then increased by 25 mgs every other week. It wasn't till I got up to about 100mg that I started to notice a difference. Is there a reason that you're on such a low dose? Also, even at a therapeutic dose, which is I think about 2.5mg/kg, it can take months for Imuran to really take full effect, so it might make sense to go back on entocort at least for the short term.
21 years old, diagnosed with CD at age 18,
First major flare since diagnosis started in Nov. 08. Still recovering and mostly stable, but having trouble tapering Pred.

Current Meds:
Prednisone 12.5 mg, Azathioprine 100 mg (started 5/03/09, think it may be starting to kick in), Asacol, and Rowasa
Plus Vancomycin and Florastor for a recurring case of c diff.

Regular Member

Date Joined Sep 2004
Total Posts : 207
   Posted 8/17/2009 8:20 PM (GMT -7)   
To echo other replies, 50mg of Imuran is a really low dose. There is a blood test available to show whether or not you are in the therapeutic range for Imuran to work (it's from Prometheus labs, but it's pretty expensive -- I couldn't have afforded it if I weren't insured). I had been on 100mg for years, slightly underdosed according to weight calculations. My new gastro ran the test, and sure enough, I was underdosed (I'm now on 125mg).

Entocort never did all that much for me, but I would be a little leery of taking steroids long-term, even if their systemic absorption is supposed to be minimal. For long-term maintenance, I'd go with the Imuran. As someone else suggested, you could do both -- go on the entocort and raise your imuran dose...once you're stable, taper off the entocort and stay on the Imuran. Honestly, for me, Imuran has had the fewest side effects of any med I've taken (and I've been on a lot of them).
Diagnosed with Crohn's in April 2003 (first symptoms in 2001).
Current Medications: Imuran 125mg/day, Humira, Pred 2.5mg/day, Cortifoam, Phenergan as needed for nausea (have previously taken Asacol, Entocort, Flagyl, and Cipro)
Dietary Supplements: Flax seed oil, Folic Acid, B12, Culturelle, Glucosamine/Chondroitin, Calcium +D

Veteran Member

Date Joined Apr 2006
Total Posts : 1885
   Posted 8/18/2009 1:43 PM (GMT -7)   

The dose of Imuran you are on seems subtherapeutic - I think it needs to be at least 70 mg.

Since you are already on Imuran, you should probably try increasing the dose because Entocort is not a long term solution. Imuran can cause mucosal healing but I haven't seen any scientific evidence that Entocort can do this, too. 

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