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Sulfasalazine or Imuran?

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Ulcerative Colitis
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Posted 5/16/2013 12:37 PM (GMT -7)
Sigh. So here I am at this place I have dreaded. Although I had a good run with the natural treatments they aren't cutting it anymore. Lialda and Rowasa have not been helpful either, in fact I'm pretty sure the Lialda made me worse while the Rowasa just didn't quite do enough to keep me from flaring.

So I finally went to see my GI and my options right now are sulfasalazine and Imuran. I much prefer the safety profile of sulfasalazine, but if the other mesalamines didn't help me, will it make any difference??? I asked my GI that and he didn't really give me an answer.

I really don't want to take an immunosuppressant like Imuran but I am also fed up with this disease and could use a break. Hopefully Imuran would do that....is it worth the risk of side effects?

So I guess I need help deciding whether to potentially waste time with the sulfasalazine, or should I head straight to Imuran?

Posted 5/16/2013 12:44 PM (GMT -7)
How bad are your symptoms? If they are tolerable (meaning you have a decent quality of life), then you could experiment with sulfasalazine before moving to Imuran. It is possible it could work when Liada hasn't, though I would not bet on it. Imuran has a pretty good safety profile despite what you hear on the internet. Don't be afraid to take it if you are not doing well. It has helped a lot of chronies and UC folks.
Posted 5/16/2013 12:58 PM (GMT -7)
You can do both at once, if you want. I think there is no harm in switching from one meslamine based med to another. The Imuran would take a couple months to fully kick in, the sulfa you would notice a difference in a few weeks, if it is any better or worse for you (I am skeptical but hey it can't hurt to try).

I have been on 6mp (very similar to imuran just metabolized a bit differently in the body) since Jan 2013 and I have had no side effects from it, I survived cold and flu season without getting sick, and it for the most part pulled me out of a nasty flare. Yeah there is a statistically small chance of getting major side effects like lymphoma from it, but the odds are better of you dying in a car crash yet we all get in cars daily without thinking about it. Specifically, those who got lymphoma where several adolescent boys, so it was certainly age and gender dependent if you look into it further. Your blood is regularly monitored on Imuran, so I feel it is quite safe.
Posted 5/16/2013 12:58 PM (GMT -7)
I recently started azathioprine (imuran).

Obviously, it is a serious decision to start on stronger medication potentially long term.

So far I have been on it for 4 weeks (50mg for the first two weeks and now 100mg). I was very worried about the side effects but so far all my bloods have come back ok and I have not felt any side effects at all. It's been no problem.

While the side effects are obviously an important consideration, its also worthwhile keeping in mind that while they can be serious they are also rare. For example I read recently that only between 2-3% of those on aza get pancreatitis.

Your doctor will keep a good eye on your bloods in the beginning to make sure you are tolerating the aza ok. I will be getting bloods every week for at least the first 6 weeks then every second week and eventually once a month.

The test will come once I get off the pred to see if I stay in remission but so far so good!
Posted 5/16/2013 2:17 PM (GMT -7)
Try the sulfasalazine first!!

I tried Colazal, Asacol, and Pentasa with no significant improvement, but I have done well with sulfasalazine for years. You need to get your urine checked regularly, especially in the beginning, but it is the oldest UC drug, which makes me feel better about being on it long term because many people already have been.

My pharmacist friend told me the sulfa component may act as an immunosuppressor and it also may inhibit bacterial growth in the gut flora, BUT my GI had no idea what I was taking about when I raised these points and he's been prescribing it forever.

I hope you feel better, whatever you choose.

Jane
Posted 5/16/2013 2:25 PM (GMT -7)
Didn't realize my signature from a long time ago would come up - I updated it to reflect my current state of affairs :)
Posted 5/16/2013 2:27 PM (GMT -7)
Still didn't work. I give up. Sorry for multiple posts...
Posted 5/19/2013 6:04 AM (GMT -7)
Go for Sulfasalazine, ramp up the dose very slowly. If you have issues with headaches, it will make it worse.

Ask the GI about the side effects as well.
Posted 5/19/2013 6:24 AM (GMT -7)
If you have luck with sulfasalazine, that's great, but I would imagine since you haven't had too much luck with Lialda and Asacol, you may experience the same results with sulfasalazine. Regardless, it may be worth a try. Imuran may work wonders for you but it takes a while to get into remission and it requires frequent monitoring. I started 6mp a couple years ago and it has changed my condition for the better. If you're intolerant to mesalamine and sulfasalazine doesn't help you, Imuran may be a good next step.
Posted 5/19/2013 11:39 AM (GMT -7)
I couldn't tolerate Asacol, Lialda, or Rowasa; apparently, mesalamines and I don't get along. However, sulfasalazine worked well for many years for me, and it has a better success profile than mesalamines.

Start slowly and work up in dosage. I did get headaches at first, but they went away after a week or so, especially as I learned to drink more water while taking it. You should also wear sunscreen.

I'd say it's a better start than Imuran. Personally, I wouldn't try them both at the same time because you won't know which side effect is coming from which drug. Too, there's some research to indicate that they shouldn't be taken together.

I tried Imuran for five or six months and it was awful. I tried all the tips, tricks, and suggestions, but I just couldn't tolerate it and spent many days just wanting to barf, barf, barf. It was the most intense nausea I have ever had.

 

Posted 5/19/2013 11:40 AM (GMT -7)
Oh, and Jane123, one of my GIs said the same thing about the sulfa component of sulfasalazine.
Posted 5/19/2013 11:44 AM (GMT -7)
Start with sulfasalizine then move to imuran. I'm starting sulfasalizine again after stopping it five years ago. Lialda just doesn't work for me at all, neither did asacol
Posted 5/19/2013 6:41 PM (GMT -7)
I don't believe Sulfasalazine is actually a mesalamine although it serves the same function. I would definitely try that before Imuran.
Posted 5/21/2013 2:01 AM (GMT -7)
People are way too afraid of Imuran, just stay on top of your bloodwork and even if things go poorly, they're pretty much all reversible and you can quit the drug cold turkey.
Posted 5/21/2013 12:08 PM (GMT -7)
Agree with Jane. It's actually the sulfa component that's credited with helping a lot of people who don't respond to other mesalamines. Asacol never helped me, but sulfasalazine did and I've been on a maintenance dose for years.
Posted 5/21/2013 3:47 PM (GMT -7)
Sulfazine is more antibiotic/microbial then mesalamine. I'd definitely try it first.
Posted 5/21/2013 4:16 PM (GMT -7)
Sulfa is supposedly great for those who have joint pain associated with UC, unfortunately I'm allergic to it or I would have tried it before Imuran.
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