White blood count and Azathioprine

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Regular Member

Date Joined Jul 2006
Total Posts : 58
   Posted 3/4/2008 9:40 AM (GMT -6)   
I was wondering if anyone could help with a bit of a hic-up i am having with my medication. I recently had my quarterly check up, which includes a blood test to check that the Azathioprine is not causing any problems. However the WBC came back with a low Neutrophil count of 1.6 (i was told the lowest you should be is 1.7, so was not too bad). My Dr suggested taking the azathioprine every other day until our next appointment, to help raise the neutrophil count. However, 2-3 weeks in to this i begin to go in to a flare, urgent need for loo, and then eventually the signs of bleeding. Obviously this was really annoying as had been doing well for almost a year!! So eventually called the Dr again to say that i was now in a minor flare and was concerned about the lack of medication. His response was to get another blood test done and to start back on taking the Azathioprine every day. Last wednesday i had a blood test and asked for the results today. The Neutrophil count is now a healthier 2.4, which means the lack of medication helped raise this. My worry is the day of the test was the day that i had to start back on the full medication!!

Now my worry is a catch situation, the Azathioprine stops me from flaring and makes the world a better place, however it obviously lowers a very important part of my WBC!!! But if i dont take the Azathioprine i end up flaring.......

Has anyone experienced similar problems, or know of what i can do to help keep the Neutrophils higher? I have another blood test booked for 2 weeks from the last one, so will be keeping my fingers crossed that they dont drop back down!!

At the moment things are random internally, have not seen to much blood in the last few days, but know that the azathioprine takes a while to kick back in.

Any advice/help/cures would be gratefully recieved.

Dx : Sept 2005 UC entire colon
Meds:Finally off the pred = 125mg imuran a day Azacol 800mg 3xDaily
Supp's: 1 sachet of VSL 3

Regular Member

Date Joined May 2003
Total Posts : 297
   Posted 3/4/2008 11:33 AM (GMT -6)   
Sorry I can't advise you, for my situation is different. I take Azathioprine, but it has not interfered with my blood cell count. I take 100 mg a day too.
Age: 30
Location: Missouri
Diagnosed with UC in 1997.
Medications: 100 mg Azathioprine a day
Supplements: 2 Omega 3s, b-6, calcium, and multivitamin
No. of colonoscopies: I lost count at 6...LOL!
Last scope: 10/9/05-everything looked ok.

Veteran Member

Date Joined Jul 2007
Total Posts : 2148
   Posted 3/4/2008 11:58 AM (GMT -6)   
my only thought would be to lower your aza by 25mg instead of cutting it in half by taking it every other day since you were so close to the line, if you wbc goes to low again. Sorry I am too new w/the aza to be of much help.

I wish you all the best.
Beth, 32
Major Flare Sept/Oct 07 ~ almost in remission
UC dx'd March 2000 (30 cenitmeters as of 2005-proctosigmoiditis)
Azathioprine 200mg 1xday nightly; Calcium and Vit D 500mg 3xday, Multi Vit, Folic Acid 400mg 2xday, Prilosec, Probiotics.
Minimal Change Disease (Kidney Disorder) dx'd Sept 2007
Prednisone 40mg 1xday, Simvastatin 20mg 1xday, Diovan 160mg 2xday. Tekturna 150mg 1xday, Fursomide 20mg 1xday, Fosomax 70mg 1xweek. MCD may be from hypersensitivty to 5ASA drugs.
Pre-Diabetic from Prednisone use - Low carb/sugar diet & exercise.

New Member

Date Joined Feb 2008
Total Posts : 6
   Posted 3/4/2008 4:43 PM (GMT -6)   

Hi, I had the same problem with my Azathioprine and the doctor's plan was to cut the dose from 175mg to 50mg and put me on Allopurinol 200mg. He said that the Allopurinol reacts with the Aza and makes it work more efficiently at a lower dose therefore not affecting liver function or blood count. I have been trying it now for the past two weeks, I am also tapering on prednisolone from 60mg down 10mg every two weeks to eventually none at all (yeah!) have to have bllod taken next week and have an appointment at the hospital on the 14th to see if his plan is working and I can stay on the Aza. Don't know if this will help you but maybe you could mention the combination of drugs to your GI. 

Medications so far: Feb '07:Prednisolone 5mg (1 week), Prednisolone Foam Enema,
Mar '07 Pentasa tabs 200mg x2 daily, 
Apr '07 Colazide caps 750mg x9 daily,
May '07 Omeprazole 20mg, Prednisolone 30mg taper to 0mg (6 week taper) Colifoam enema, Nystatin (oral thrush),
June '07 Pentasa retention enema,
July'07 Pentasa suppositories,
Sept '07 Salofalk foam enema, Prednisolone (6week taper) 30mg to 0mg,
Nov '07 Azathioprine 12mg, Prednisolone (6 week taper) 30 to 0mg,
Jan '08 Prednisolone 15mg two weeks, 10mg two weeks. Up dose of Azathiporine to 175mg
Jan'08 Prednisolone up to 60mg  

Regular Member

Date Joined Jul 2006
Total Posts : 58
   Posted 3/5/2008 6:46 AM (GMT -6)   
Hi. Thanks for the response's, will mention the combination of drugs tomy Dr next time I see him. Though have not heard of it before so hoefully we have the drug here in the UK.

I will battle on with the meds for now, wait to see my blood results next week.

I think the fact that i am under a bit of stress at the moment as well probably dosent help, so fingers crossed it will all settle down again.

Dx : Sept 2005 UC entire colon
Meds:Finally off the pred = 125mg imuran a day Azacol 800mg 3xDaily
Supp's: 1 sachet of VSL 3

Elite Member

Date Joined Mar 2003
Total Posts : 10407
   Posted 3/5/2008 8:26 AM (GMT -6)   
Artz, the most common use of allopurinol is in treating gout, and it's been around for decades. I feel sure you will have access to it, ask your doc.
Moderate to severe left-sided UC (21 cm) diagnosed 2001.
Asacol, Rowasa, Pentasa, Prednisone, Entocort, Azathioprine
Colazal,  Remicade, Nature's Way Primadophilus Reuteri.
In remission since April, 2006. Remicade has been my wonder drug.
Co-Moderator UC Forum

Veteran Member

Date Joined Feb 2007
Total Posts : 640
   Posted 3/5/2008 9:01 AM (GMT -6)   
I agree about cutting your medication in half being too strong a measure. If you're taking 125, I'd try dropping that to perhaps 75 daily and see if you start to flare or your blood gets out of whack again. If you start flaring again but your blood is fine, up it to 100 daily.

It's been such a great med for keeping my UC in check, I want it to work as well for everyone else as it does for me. Don't give up!

Sporadic proctitis since about 1985. Mother had J-pouch surgery 1983.
DX'd with clostridium difficile in 2000. Pred, two courses of Flagyl, then Vancomycin finally got rid of it. 2001 colonoscopy dx'd left-sided UC. . Treated with prednisone, Rowasa, Asacol. Asacol not working, switched to Imuran. Three small flares since in 2002, 2005, and 2007, brought under control with steroid and Rowasa enemas. Lap Chole performed October 26, 2007, after gall bladder attack in June, '07.
Daily meds: 100 mg Azathioprine and 225 mg Effexor XR (for chronic, longstanding depression), many vitamins and Primadophilus Reuteri

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