6MP and Pregnancy

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WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/2/2009 2:23 PM (GMT -6)   
Ladies,

I am on the verge of going on 6MP. I have been in a flare for basically a year with my proctitis. I have been hospitalized, been on steriods, enemas, asacol, colazal, cortifoam and now I have been on sulfasalzine for week. My new GI told me to ween off the hydrocort enemas since i have been on them since July. He said that was a terrible recommendation from my old GI.  He bsically wanted to start me on 6MP but I convinced him to give the sulfasalzine a try first. Since 12/24 I would say I am definitely getting worse. Whether it is the tapering of the steriod enema or the sulfa...nothing is helping and nothing has ever helped.
 
 
For those out there that are on 6MP.....can you let me know the following?
 
How did you decided to go on it/ or stay on it when trying to get pregnant?
 
Is it safe during pregnancy?
 
How long does it take to put you in remission?
 
Whats the difference between 6MP and Imuran?
 
I have an appt with a high risk OB in a few weeks and a follow up with my GI on the 20th. I feel like I need to raise the white flag and surrender to 6MP. I have been bleeding since Jan 08.
 
Any advice would be appreciated. I did search the forum for old posts and that did help.
ulcerative proctitis - march 05 diagnosed
current status - trying to see what works - still bleeding!!!!!
hospitalized - 3/08 for 6 days of IV steriods
colazal - 9 pills  asacol - 12 pills, canasa 2x per day, nightly hydrocortisone enemas
VSL#3 Primal Defense Ultra Probiotic (2x per day)
fish oil, flaxseed oil, calcium w/ vitamin d 2x a day, prenatal vitamin plus extra vitamin c and b12 complex
 
 


jblue65
Regular Member


Date Joined Jan 2008
Total Posts : 381
   Posted 1/2/2009 2:39 PM (GMT -6)   

According to several articles I have read, there is contradicting opinions on this. It is considered a category D drug. I read an article which said that it should not be taken by pregnant women unless the "benefits outweigh the risks". Then, I read another article which said that 6mp is safe for pregnant women. I had this issue when I was pregnant and taking another non UC related drug  which was a category C. I decided to take it since the benefits outweighed the risks. I did decide not to breastfeed while taking the drug, though.

 

Here are some links to the articles: http://www.doctorslounge.com/gastroenterology/forums/backup/topic-12274.html

http://gastroenterology.jwatch.org/cgi/content/full/2003/325/1

Best of luck-


Jackie, 43

Pancolitis, DX October 06

Lexapro, colazal 3x3, Sythroid, Protonix, Flagyl

10 infusions of Remicade- doesn't work
Severely anemic-

back up to 30 mg of pred
Added 6MP- November 25th
 
Surgery almost certain


shannon1
Regular Member


Date Joined Feb 2005
Total Posts : 369
   Posted 1/2/2009 5:41 PM (GMT -6)   
Hi, im sorry you are being faced with this decision. A high risk ob will be able to help you make the decision.

I can only offer you my story, but i have no real advice to you as this must be a personal decision.

1. I decided to go on 6mp when all else failed.
2. I made the decision to stay on it during my PREpregnancy consult w/ both my Perinatologist (high risk pregnancy doctor) and my GI. BOTH counceled me to remain on it, as my disease was consider more threatening to a pregnancy than the drug itself. I was told that bad flares in early pregnancy "can" cause miscarrage (did not ask stats on that), that that there were a whole other host of issues that could arise as a result of flare during pregnancy (including premature birth).

3. It takes the med about 3mo or longer to get a theraputic dose. I was put on 60mg pred and 6mp at the same time, i tapered the pred, and went into remission and stayed there for a yr, and that is when i got pregnant. I did flare tho, right when i got pg, (tho we think it was more related to the stress of using injectable fertility meds). And i flared through the entire pregnancy, despite my 6mp. I was told 1/3 get better w/ UC, 1/3 stay the same as when they concieve, and 1/3 get worse.

4. I have never taken Imuran, so can't comment on that.

I think seeing a high risk doc is a great idea ahead of time, and they will have better knowledge of how these meds will affect your pregnancy. GL
2003, dx moderate UC
2000, dx selective IGA deficiency w/ anti IGA antibodies
2000, dx Antipholipid Antibody Syndrome
1999-current, chronic hemmoragic ovarian cysts, w/ partial ovary removal
1977, complete reconstruction of foot after lawnmower accident (chronic pain)
 
Meds
6mp 75mg, prednisone 40mg (just starting meds again)
percocet 5mg 3x day
potassium 3x day
 


LWW1993
Regular Member


Date Joined Oct 2006
Total Posts : 90
   Posted 1/2/2009 7:27 PM (GMT -6)   
Hi Wishful. I'm sorry to hear you struggle and face difficult decisions. I can relate because I was in your shoes not too long ago before ultimately deciding to take the leap to 6MP.

I had my worst flare 8 weeks postpartum with my first daughter. The flare probably started because of various reasons, but I struggled for two years to get it under control. During those 2 years, I was on and off high doses of prednisone, Asacol, enemas, suppositories, and hospitalized twice. Prior to having my daughter, my UC had always been maintained with very little if any medication and controlled with diet and exercise. I had NO idea UC could be so debilitating.

After about a year of struggling with the flare the idea of 6MP was presented to me by a new GI doctor I started seeing. I was scared to death of the idea and put it off primarily because I knew I wanted to get pregnant again. Finally after my second hospitalization and dealing with the nasty side effects of prednisone I threw in the towel and decided to give 6MP a chance. This was after many many consultations with my GI, other GI docs, my OB, other OBs, a perinatologist, and lots of research. They all agreed that in my case the benefit of me being healthy and flare free before getting pregnant HIGHLY outweighed the risks of being on 6MP. I decided to trust their advice and started 6MP this past May. My GI didn't want me to get pregnant until I had been off the prednisone for a few months and had a few months of blood tests back.

The first two months of being on 6MP, while tapering off of prednisone, it was very difficult to tell what was working and what drug was causing what side effect. I was tired, but couldn't tell if it was more so than normal. I just felt a little off at first (hard to describe), but couldn't really complain because it was better than a bad flare. Then all of a sudden one day (about 2 months), I felt GREAT! I mean AWESOME. I was having one formed BM a day and couldn't remember the last time in my life what that was like. It hit me like a ton of bricks that this is what most people without UC must feel like. My energy got better and I just felt like a normal healthy person. This was back in July and my DH and I accidentally got pregnant. We were planning on trying, but not for a few more months until I got the go ahead from my GI.

When I told my GI, he was happy since I was doing so well and was flare free and my bloodwork numbers had been looking good. I went back to my OB and perinatologist and have been seeing all doctors on a regular basis during the pregnancy. The first trimester I continued to feel great. Not a single blip or problem. Didn't even realize I was pregnant. Of course I was nervous about being on the medication, but it was hard to argue with feeling so great and I saw the baby during an ultrasound at 7 weeks.

My second trimester has been a little bit different. Pregnancy wise, I feel great and no issues or discomfort. However, my UC started flaring back in October. I am convinced it was brought on my the stress of my job (work in the financial industry). Since then, I have had some bleeding, mucus, and a little diarrhea, but still some formed stools. I finally saw my GI doctor again and we are hoping a month of Colocort enemas will help get the flare under control.

Anyway, sorry for the long winded answer, but your situation sounds so similar. I got to the point where I was ready to try anything. I remember coming home from being in the hospital for the second time knowing I was going to see my GI and go on 6MP and just crying for a week. I felt so beaten down and had lost hope, but over time it's possible to get your hope and life back. Hang in there and good luck.

Oh, I'm sure someone else can answer the Imuran question better, but I believe both 6MP and Imuran are almost the same, but one (can't remember which) is already broken down a little more.
Diagnosed UC - 1993
33 year old female
27 weeks pregnant with second child

Current Meds:
6-MP - 50 mg one night 75 Mgs the next
Colazal (3 pills three times a day)
Folic Acid, Omega 3 Fatty Acid (2 capsules)
Colocort Enemas (been taking for 2 weeks to control a flare)


WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/6/2009 12:29 PM (GMT -6)   
Ladies,
Thank you very much for your responses. I am still sitting here completely scared and lost. I have an appt with a high risk OB next wednesday so i guess I should not make any decisions until I hear from her. I also called the crohns and colitis foundation and they are emailing me articles on 6MP and remicade during pregnancy.

Did any of you consider remicade as an option instead of 6MP?

Wishful
sever ulcerative proctitis - march 05 diagnosed
current status - trying to see what works - still bleeding!!!!!
hospitalized - 3/08 for 6 days of IV steriods
colazal - 9 pills  asacol - 12 pills, 4 pills 2x a day - sulfasalazine (started 12/24/08)
canasa 2x per day, nightly hydrocortisone enemas - tapering
VSL#3 Primal Defense Ultra Probiotic (2x per day)
fish oil, calcium w/ vitamin d 2x a day, curcumin, prenatal vitamin & extra vitamin c and b12
 


JM21204
Regular Member


Date Joined Dec 2008
Total Posts : 254
   Posted 1/6/2009 1:29 PM (GMT -6)   
I was on 6 MP prior to becoming pregnant, and my GI doctor happened to be at a conference where an expert spoke of this exact topic. I apologize for not knowing names and facts, but my doctor spoke to the speaker after the session because she knew I was interested in getting pregnant. The gist of the conversation was 6MP was fine in his/her opinion in small doses and the other uses for 6 MP and high doses given for those reasons, non UC, were the primary basis behind it being class D. Again, sorry for the vagueness, but the outcome was low doeses (50 mg and below) is not considered enough to be impactful. I ended up being on 25 mg a day my first trimester (as well as prednisone on and off) and Asacol. I finally quit taking the 6 MP around month 4 because I flared again and my dr. and I never saw any benefit of 6 MP helping me, so why take it in the first place.

I'm 30 weeks now and just got over my second flare - back on prednisone :( . I mentioned in another thread that I started that my GI doctor is suggesting a scheduled C Section - a lot of people incorporated their feedback into that thread too if haven't seen that yet. I think it's titled UC and Pregnancy.

Good luck!
33 yr old female
Diagnosed with Pancolitis in 1/2007
Baby due 3/2009
 
1600 mg Asacol a day
Ferrex
Pre-Natal Vitamins
Lovenox
On and off Prednisone, 40 mg then taper
 


LWW1993
Regular Member


Date Joined Oct 2006
Total Posts : 90
   Posted 1/7/2009 11:56 PM (GMT -6)   
Wishful - I always got the impression from my recently retired GI and new GI that they prefer to try 6MP first before trying Remicade because 6MP (or Imuran) has been around a lot longer than Remicade. My GI suggested we try 6MP before getting pregnant to see if I could control the flare. Once he found out I was pregnant (and fortunately flare free) he also wanted me to be tested to see if I could even have Remicade infusions in case I did need them during pregnancy. I haven't gotten to that point and hopefully my current flare will go away that we won't need to consider Remicade.

My understanding of Remicade has also been that once you start receiving infusions you don't want to start/stop them, because when you start them up again your body could possibly have developed antibodies (not sure if that is the correct term) against the Remicade and it's no longer effective. So in other words it's not something you want to just do once or twice. I'm sure someone else can answer/explain that better.

Good luck meeting the high risk OB next week. You are doing all the right things to get the information ahead of time. It will help you be at peace with your decisions once you do get pregnant. Plus, you'll have all the right people lined up to take care of you and your baby when you are pregnant.

JM21204 - Good luck with the rest of your pregnancy. I am also due at the end of March. My GI also just suggested a possible scheduled c-section if I'm still flaring. He said that if I was flaring badly then a vaginal birth, and if I tear (which I did a little with my first DD), could make the healing process even longer. Right now, I think I would be okay to still have a vaginal birth, but if my flare were to get much worse or if I got significantly weak from the flare, I suppose I wouldn't want nor have the energy for a vaginal birth.
Diagnosed UC - 1993
33 year old female
28 weeks pregnant with second child

Current Meds:
6-MP - 50 mg one night 75 Mgs the next
Colazal (3 pills three times a day)
Folic Acid, Omega 3 Fatty Acid (2 capsules)
Colocort Enemas (been taking for 2 weeks to control a flare)


WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/8/2009 7:47 AM (GMT -6)   
LWW1993 - thank you!! so you are currently taking 6-MP and you are pregnant? how bad of a flare were you when you went on the 6Mp and how long did it take to work?
sever ulcerative proctitis - march 05 diagnosed
current status - trying to see what works - still bleeding!!!!!
hospitalized - 3/08 for 6 days of IV steriods
colazal - 9 pills  asacol - 12 pills, 4 pills 3x a day - sulfasalazine (started 12/24/08)
canasa 2x per day, nightly hydrocortisone enemas - tapering
VSL#3 Primal Defense Ultra Probiotic (2x per day)
fish oil, calcium w/ vitamin d 2x a day, prenatal vitamin & extra vitamin c and b12
 


WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/11/2009 1:18 AM (GMT -6)   
bump...
sever ulcerative proctitis - march 05 diagnosed
current status - trying to see what works - still bleeding!!!!!
hospitalized - 3/08 for 6 days of IV steriods
colazal - 9 pills  asacol - 12 pills, 4 pills 3x a day - sulfasalazine (started 12/24/08)
canasa 2x per day, nightly hydrocortisone enemas - tapering
VSL#3 Primal Defense Ultra Probiotic (2x per day)
fish oil, calcium w/ vitamin d 2x a day, prenatal vitamin & extra vitamin c and b12
 


LWW1993
Regular Member


Date Joined Oct 2006
Total Posts : 90
   Posted 1/11/2009 11:15 PM (GMT -6)   
Wishful - Yes, I am currently on 6MP and will be 29 weeks pregnant tomorrow. I take 50 mgs one night and 75 mgs the next night. I started taking 6MP back in March of 2008 (I believe, I would have to check my calendar). I conceived in July of 2008. I was on 6MP prior to getting pregnant and have been on it the entire pregnancy.

When I started taking 6MP I was in a very bad flare and just was released from the hospital for the second time in less than a year and half. Since September of 2006, after the birth of my first daughter, I was 6-8 weeks postpartum and started flaring. Ever since then I have been struggling off and on to get the flare under control. I was hospitalized twice (prior to this I had NEVER been hopsitalized or so much incapacitated from my UC during the 13 years I had lived with UC) and finally my GI and decided that prednisone was not helping me and I was becoming dependent on it. It took a few months for the 6MP to start working for me which is why you generally take prednisone at the same time. So I was slowly tapering off prednisone while slowly increasing the 6MP to the right dose for me. By June/July of 2008 I was feeling better than I had in two years, and I have to believe it was largely due to the 6MP. Coincidentally, I also got pregnant and still continued to feel great (both pregnancy and UC wise) all through my first trimester. Unfortunately, starting in October I have been flaring. I'm not 100% sure what triggered my flare (hormones, food, etc...) but I strongly believe it had to do with the stress I was experiencing at work when the financial markets started to tank.

Good luck with your decision if you decide to go on 6MP. I think I resisted the drug longer than I should as it really scared me to take it. But after the second hospitalization, I felt so hopeless, defeated, and decided I needed to give it a try to see if it would help me get my life back. I also had to put my faith and trust in all the experts, doctors, I consulted before starting the drug and getting pregnant.

Let us know how you appt with the high risk OB goes next week.
Diagnosed UC - 1993
33 year old female
28 weeks pregnant with second child

Current Meds:
6-MP - 50 mg one night 75 Mgs the next
Colazal (3 pills three times a day)
Folic Acid, Omega 3 Fatty Acid (2 capsules)
Colocort Enemas (been taking for 2 weeks to control a flare)


UCMommyof2
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 1/15/2009 9:48 AM (GMT -6)   
I cannot be much help, I am sorry as I would only take Prednisone during pregnancy, which I took from the day I was diagnosed until months after I delivered. It controlled my flareup from 40-50 times a day to 7 times a day and then after I delivered down to 3-4 times a day. After about 2 months when the pregnancy hormones started to leave my body, I went into remission. I remember the day I was daignosed and I was so incredibly scared, first of the condition and 2nd because I was going on meds. It took me a long time to accept that taking drugs was necessary and if I couldn't get this under control my baby was going to suffer. Luckily I didn't start until the 2nd trimester, the biggest risk of all meds is during the 1st trimester, specifically during the first 6 weeks. Increase risk of malformation (low risk) and miscarriage (a bit higher risk) but you need to do whats best for YOU. Unhealthy mommy = high risk baby. The best thing I could do is get everyone on the same page. MY GI and OBG were communicating with eachother and because I required a prednisone IV during delivery I set an induction date a week before I was due so that MY OBG was on call. You are not alone in this sweetie, and I know is's SO SCARY but if the 6MP is the only thing that will control your bleeding then you need to consider it even though it's a catagory D.

This last pregnancy the Prednisone made me blow up like a balloon, I was anemic, I was Hypertensive and had a severe calcium deficiency. I was a hot mess, but I have a beautiful baby girl to show for it and so will you :) Get that bleeding under control!!!
28 yr. old Mother of 2 in NY
Diagnosed in 2008. Family history: Mother with Active UC, 30+ years.
Flare-ups during pregnancies only (so far). Currently in remission.
Controlled: Prednisone, 40mg/ed. for 30 week @ time of diagnosis.
No maintenance drugs.
Supplements, Fiber, Probiotics


WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/15/2009 1:05 PM (GMT -6)   
Thank you again for all your replies....
Interesting tid bit of information. I was put on sulfasalzine fromt this new GI..what my original post said. I had a terrible reaction to it. ...on the verge of going on 6MP...

I got off the hydrocortisone enemas and replaced it with rowasa enema and back to my 12 asacol pills...and I have not had any bleeding since Saturday morning!!! Its a MIRACLE!! I am thinking I must of built up an immune to the steriods and the canasa suppository wasn't reaching the proctitis. I am in remission for the first time since fathers day 08. Fingers crossed of course.

I saw a high risk OB yesterday at Beth Israel and she basically said she would like to see me in remission for 3 months before doing another round of IVF. She said if I can continue to not have any blood...they keep on these meds. She did say if I had to go on 6MP that she has delivered many healthy babies and have many pregnant mothers on 6MP. she did say I would be closely monitored and would prob would want a c-section.
severe ulcerative proctitis - march 05 diagnosed
current status: In remission (first time no blood since June 08)!!!! -fingers crossed
hospitalized - 3/08 for 6 days of IV steriods
past meds: colozol, sulfasalzine, hydrocortisone enemas, canasa and prednisone 
current meds: asacol - 12 pills, 4 pills x3, nightly rowasa enema, Primal Defense Ultra Probiotic, fish oil, calcium w/ vitamin d 2x a day, prenatal vitamin & extra vitamin c and b12
if i can't stay in remission....next up 6MP


UCMommyof2
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 1/15/2009 2:52 PM (GMT -6)   
By reading your posts I had thought you were recently pregnant, please do not be upset at my post, I in no way wanted to offend or upset you. I know alot of women going through IVF and I wish you the very best of luck with that!!!!! Please keep us updated :D

YAY NO BLOOD thats wonderful!!!!!!!!!!!!!!!!!!
28 yr. old Mother of 2 in NY
Diagnosed in 2007. Currently in remission.
Family history: Mother with Active UC, 30+ years on Remicade treatment.
Flare-ups during pregnancies only (so far).
Controlled: Prednisone, 40mg/ed. for 30 week @ time of diagnosis.
No maintenance drugs.
Supplements, Fiber, Probiotics


WishfulMA
Regular Member


Date Joined Jul 2008
Total Posts : 197
   Posted 1/17/2009 9:19 PM (GMT -6)   

I was no offended at all. Even the High Risk OB said to get in remission before trying to conceive. I asked her what if I wasn't doing IVF...she said I would tell you to use protection. The GI at Beth Israel said the same thing.

Unfortunately (today is day 7)...I saw traces of blood.....

I am BEYOND SAD. Looks like 6MP for me.


severe ulcerative proctitis - march 05 diagnosed
current status: In remission (first time no blood since June 08)!!!! -fingers crossed
hospitalized - 3/08 for 6 days of IV steriods
past meds: colozol, sulfasalzine, hydrocortisone enemas, canasa and prednisone 
current meds: asacol - 12 pills, 4 pills x3, nightly rowasa enema, Primal Defense Ultra Probiotic, fish oil, calcium w/ vitamin d 2x a day, prenatal vitamin & extra vitamin c and b12
if i can't stay in remission....next up 6MP


Mommy pooh
Regular Member


Date Joined Apr 2008
Total Posts : 131
   Posted 1/18/2009 1:30 PM (GMT -6)   
I too am torn with the decision to take the leap for another baby on 6MP or wait in hopes that I can remain in remission and come off of it to get pregnant. My GI and OBGYN seem divided just like a lot of the reseach is. I feel that both of my flares were hormone related because both stated shortly after starting birth control pills. I would like another baby and then have my tubes tied and never have to take the pill again. My daughter was breech so I had to have a C-section so I know I would have to have another C-section with a second child. I was worried about the C-section because I thought 6MP effected the way your blood clots and was worried about excessive bleeding. It made me feel better seeing that most of you have had C-sections recommemded. I could not breast feed the first time due to medications and if we do have a baby on 6MP I would probably feel safer not breast feeding. I don't know how we'll ever be able to decide when or if we add to our family. At some point we'll put it in God's hands and what is meant to be will be I guess. Good luck to all you pregnant and trying Mommies!! Thanks for giving me the confidence to at least think about pregnancy and 6MP because it was always out of the question to me.
  • 25 years old, married, Mommy to 22 mo. old 
  • Ulcerative Colitis since Sept. 2004
    • 1st flare Sept-Nov 2004
    • 2nd flare Aug. 2007-July 08 
  • Currently taking:75mg 6MP, 4 Lialda, Digestive Advantage Chrons/Colitis, Loestrin 24, and allergy shots once a month 
  • Past meds: Pred., Entocort, Dipentum, Asacol, and Canassa
  • 10/6/08 Found a 1cm kidney stone in right kidney.  Had the stone blasted and passed the fragments.

 


UCMommyof2
New Member


Date Joined Mar 2008
Total Posts : 19
   Posted 1/19/2009 12:33 PM (GMT -6)   
Well if it makes any of you ladies feel better I was in remission, got pregnant, had a flare that continued throughout both pregnancies. One not controlled with medication, one controlled with medication and both of my babies went to full term, one delivered vaginaly, one delivered c-section, both 9 1.2 lbs, full bill of health. If I was in a full-on nasty flare I probably would avoid trying to conceive but in my opinion, a small amount of symptoms or a mild flare wouldn't stop me. Neither of my kiddos were breastfed, the first for personal problems and the 2nd for medical, I just wasn't comfortable being on Pred. and BFing.
28 yr. old Mother of 2 in NY
Diagnosed in 2007. Currently in remission.
Family history: Mother with Active UC, 30+ years on Remicade treatment.
Flare-ups during pregnancies only (so far).
Controlled: Prednisone, 40mg/ed. for 30 week @ time of diagnosis.
No maintenance drugs.
Supplements, Fiber, Probiotics

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