Posted 12/14/2010 12:47 PM (GMT -6)
Severe allergic type side effects usually seem to show up quickly.
Moderate side effects or major ones that take a while to show up (like bone marrow suppression) can take a week or much longer - say 3 months.
Typical mild side effects vary a lot in onset.
Here's a list of helpful information about administering Imuran/6-MP/AZA that I have put together over the past 2 years from various sources including articles, doctors, prescribing info and other parents. Hope you find it helpful.
Possible drug interactions include:
Mesalamine (Pentasa, Asacol, Rowasa)
Ideally give on empty stomach 1 hour before meal or 2 hours after meal however it may be taken with food if needed to avoid nausea. Give at bedtime to reduce mild nausea
Do not give with milk or milk based products; there’s an enzyme in milk products that breaks down 6-MP making it less effective
Ideally, give at same time each day
Missed dose: give within 12 hours otherwise wait for next regular dose
If the child vomits after taking it:
If it is within 15 minutes give a second dose
If it is more than 15 minutes wait for next regular dose
Call the doctor for fevers:
If 101.5 or higher twice within 12 hours
If 100.5 once within 12 hours
Call doctor and report:
Chicken pox exposure
Side effects may include nausea, hair loss, rashes, low blood counts, liver damage, pancreatitis
Expert recommendation (Dubinsky) regarding how often to monitor for low blood counts with CBC w/diff:
every 2 weeks x 2 then
every 4 weeks x 3 then
every 8 weeks x 4 then
every 3 months
Dubinsky recommends following the same schedule for liver panel (ALT, ALP, AST, Billirubin, Albumin, Total protein and possibly GGT); others check liver function less frequently once dose titration is finished but most watch liver function closely during dose titration.
Theraputic/toxic ranges of prometheus values for 6-TGN (therapeutic metabolite) and 6-MMP (potentially toxic metabolite) are generally quoted as:
6-TGN below therapeutic range <235
optimal range of 235 to 450
toxic range >450
6-MMP below 6000 generally believed to be OK
above 6000 generally viewed as potentially toxic levels
Not all doctors agree that Prometheus metabolite testing is needed and not all insurance companies approve this testing.
Some doctors use allopurinol in combination with Imuran to boost 6-TGN levels. Allopurinol blocks one of the pathways for inactivation of 6-TGN thus increasing the amount of circulating 6-TGN. When used in combination with Allopurinol, the Imuran dose must be reduced to 1/3 to 1/4 of usual prescribed
son now 14 1/2, dx CD age 10; current meds: MTX and omeprazole; previous tmts: pred, 6-MP, Humira, entocort, GMCS, exclusive enteral feeds, pentasa, mesalamine enemas, cipro, flagyl, many topical treatments for perianal disease