Azathioprine side effects

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alltheway
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Date Joined Jan 2018
Total Posts : 26
   Posted 3/6/2018 3:43 AM (GMT -6)   
I have been taking 150mg/day of azathioprine for around two months now, whilst also remaining on 8mg/day of methylprednisolone, which I am due to start tapering shortly. I have been in remission since beginning this medication, and have not had any major effects other than fatigue.

However, this week I have started feeling quite nauseous a lot of the time. My question is, is it possible for azathioprine side effects to be this delayed (2 months since I began taking them), or could this problem be unrelated?

Thanks!

iPoop
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Date Joined Aug 2012
Total Posts : 13215
   Posted 3/6/2018 8:20 AM (GMT -6)   
It's most common to get nausea when 1st taking azathioprine and that to last less than a month. Maybe try taking Imuran at bedtime with a snack and see if that helps?
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

UC experience: wakeup with noisy bowels so no lingering in bed, soon after poop with discomfort/pain/mild-nausea, eat something, poop, get dressed, poop, leave in car and worry whole drive about more...

Dana37
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Date Joined Mar 2018
Total Posts : 13
   Posted 3/6/2018 10:32 AM (GMT -6)   
My nausea was horrific with azathioprine at first. Also taking 150mg.

I had to go back down to 50mg and gradually build up to 150mg. I also asked for anti sickness medication which really helped.

Also splitting the dose throughout the day was really helpful as well as so 75mg morning 75mg at night. I think I may have also done 50mg 3x a day. Try asking your GI for ways in which they're ok with you taking it so you're not taking 150 at once. Which by the way is the max dose you are able to take for UC so it is a lot for your body to cope with when you're new to it.

After a few months it totally stopped and I have been fine ever since.

I am not sure if it's normal for it to start after a few months however I would imagine so as it does take a few months for it to build up in your body and reach therapeutic levels. So I would imagine that's happened for you and now you're feeling the effects. But I'm not a Dr so that's just my guess!

alltheway
Regular Member


Date Joined Jan 2018
Total Posts : 26
   Posted 3/6/2018 11:52 AM (GMT -6)   
Thanks for the responses. Dana37, did your nausea eventually go away to the point where you have had success with azathioprine? I'm hoping to be able to stay on it as my symptoms have been managed very well since my last flare up over christmas. What was the anti-sickness medication you took? And was the nausea bad from the very first time you took azathioprine?

Sorry for all the questions, and thanks!

Dana37
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Date Joined Mar 2018
Total Posts : 13
   Posted 3/6/2018 1:43 PM (GMT -6)   
Oh yes it totally went and I was fine on it. I've been taking it for 6+ years now. It doesn't actually work for my UC anymore unfortunately but i got a good few years of remission out of it. I now take it to prevent antibodies to humira from forming. But I was absolutely fine on it for a long while. I think I did feel sick straight off although it was a long while ago j can't remember but I think I did.
But drugs are weird. Some weeks I take humira I feel absolutely fine no side effects, some I'm sick as anything ! So i wouldn't be surprised if it took a few months for you to feel sick as as k said it does have a cumulative effect. Again no medical knowledge here so I'd ask your GI.
Ummmm anti sickness stuff I do not know what I took. Although I'm allergic to some so what I took may not have been the first line choice for someone who wasn't. However I had great success with that to help. I'd definitely recommend asking for some for sure it made a massive difference to me .

Dana37
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Date Joined Mar 2018
Total Posts : 13
   Posted 3/6/2018 1:45 PM (GMT -6)   
Sorry didn't mean to be negative saying it doesn't work anymore for me - it's just I'd said I've been taking it for 6 years with no issues and since you asked about successfully taking it I wouldn't want to be misleading about how long it worked for. It actually stopped working when I got pregnant as that causes me to flare (doesn't for everyone for sure !) So there's a good chance it would have continued working otherwise. So good luck and I hope you have success with it !

alltheway
Regular Member


Date Joined Jan 2018
Total Posts : 26
   Posted 3/6/2018 3:24 PM (GMT -6)   
Thanks a lot for your thoughts/ experiences- I really appreciate it as I often feel a bit worn out with all the trial and error of sorting out UC.

I've just been vomiting quite badly after a day of feeling ill. This may just be a sickness bug- I had gone for two months on the Azathioprine without any noticeable effects other than tiredness. Everything I've heard suggests people who have a bad response get it very quickly so I'm just hoping it's not that which is causing me trouble!

Dana37
New Member


Date Joined Mar 2018
Total Posts : 13
   Posted 3/6/2018 4:10 PM (GMT -6)   
Maybe so , I mean sickness for me is always pretty much straight away with meds.
I've had some UC meds which have given me some funky liver issues (but I have liver issues anyway ) and that's taken a while. But side effects like sickness / headache / feeling unwell have always been from the start.

If you have had a bug and just started azathioprine you could well be taking a while to get over it - since it is an immunosuppressant. Your white blood count and your neutrophils would show if you are actually being immunosuppressed by it. That said, my blood results are always fine and it generally doesn't affect my immunity (nor does humira ) but I do find I take a lot longer than the rest of my family to get rid of bugs that we all get..... So it could well be that.

Good luck and hope you feel better soon!!!

alltheway
Regular Member


Date Joined Jan 2018
Total Posts : 26
   Posted 3/7/2018 10:05 AM (GMT -6)   
What sort of symptoms did you get to indicate liver issues?

iPoop
Forum Moderator


Date Joined Aug 2012
Total Posts : 13215
   Posted 3/7/2018 10:14 AM (GMT -6)   
One is NOT likely to feel a side effect as the test detects it early. While we're on azathioprine, you should be getting regular blood tests that include a Hepatic (Liver) Function Test which monitors your liver. If your liver enzymes skyrocket than that is a warning sign and the medication is either reduced in dosage until your numbers return to normal or discontinued. No actual damage is done at that point, it is just a warning sign.

Post Edited (iPoop) : 3/7/2018 8:36:50 AM (GMT-7)


Dana37
New Member


Date Joined Mar 2018
Total Posts : 13
   Posted 3/7/2018 12:01 PM (GMT -6)   
As above. There are no symptoms and I didn't get any liver issues with azathioprine - other drugs prior to that I did.
But you wouldn't know there are no symptoms and it will be found in blood tests for definite before any damage is done. Dont worry. As I said , I have liver issues anyway aside from UC. It was just an example of the sort of thing that would take a while to show potentially, rather than nausea etc which in my experience is more immediate.

alltheway
Regular Member


Date Joined Jan 2018
Total Posts : 26
   Posted 3/8/2018 9:36 AM (GMT -6)   
Thanks a lot for all this. This may sound like a stupid question but does anyone have any way of identifying when they are suffering a drug side effect vs. when they are just ill?

Sorry for all the questions, I was only diagnosed last summer so I'm trying to work all of this out for the first time!

doug9801
Regular Member


Date Joined Oct 2015
Total Posts : 20
   Posted 3/8/2018 11:33 AM (GMT -6)   
I have been on 150 of aza for over a year now and I still get nauseous sometimes. It'll usually be like an hour after I take my meds and last for another hour or so. Especially if I am hungover or take my meds on an empty stomach. What I've been doing for the past 6 months or so is taking my meds right before bed. This took care of my issue and works like a charm! Best of luck.
27 year old male
Moderate to severe UC, diagnosed 9/15

Lialda 4x daily
150mg Azathioprine daily
Tapered off of prednisone 2/16 and again 1/17
Men's daily multivitamin
Vitamin D and Calcium pill
Iron and Folic Acid when blood tests warrant them

"Comparison is the thief of joy"
-Teddy Roosevelt

iPoop
Forum Moderator


Date Joined Aug 2012
Total Posts : 13215
   Posted 3/8/2018 11:38 AM (GMT -6)   
"does anyone have any way of identifying when they are suffering a drug side effect vs. when they are just ill? " It can be tough to tell sometimes. If it is a flu symptom that goes away in less than a week then perhaps it was just a bug that was going around, when during cold/flu season.

Thinks like is it UC bleeding or a hemorrhoid? are equally tough...
Moderator Ulcerative Colitis
John
, 39, UC Proctosigmoiditis
Rx: Remicade @5mgs/kg/6wks; daily 75mgs 6MP, 4.8g generic-Lialda, and rowasa

UC experience: wakeup with noisy bowels so no lingering in bed, soon after poop with discomfort/pain/mild-nausea, eat something, poop, get dressed, poop, leave in car and worry whole drive about more...

beatUC
Veteran Member


Date Joined Mar 2010
Total Posts : 1441
   Posted 3/8/2018 12:58 PM (GMT -6)   
Azathioprine has helped me regain my life, it has worked extremely well for me. But I did have a nausea problem a few months in like you did. What I did was take it in the morning with oatmeal or toast. It seems best to surround the pills with food in your stomach. Take a few bites, then the pills and then a few more bites. I found this method to completely get rid of any nausea that I was having. Also remember to get your blood work on a regular basis, especially in the first 6 month or so. Best of luck & I hope you feel better!

Dana37
New Member


Date Joined Mar 2018
Total Posts : 13
   Posted 3/8/2018 1:44 PM (GMT -6)   
To be honest for me I think I've just become able to tell over time whether it's a side effect / a flare / or a bug or virus. Im very in tune with my body - I can't speak for anyone else but I have multiple chronic conditions and have had them for many many years. So I think the longer you have them the more able you are to work out how your body responds to the actual conditions you have , and the more meds you try and (hopefully don't!!) Have side effects to you recognise them as well. I'm pretty well able to distinguish between what's what. Maybe over time you'll work it out too but hopefully you find some meds that work for you with no side effects also!

alltheway
Regular Member


Date Joined Jan 2018
Total Posts : 26
   Posted 3/9/2018 10:42 AM (GMT -6)   
Thanks everyone, fingers crossed I have not been sick again since a few nights ago, and have continued taking azathioprine. I'm hoping this means I don't have a major issue with it.

I've also just been to have a blood test to check my liver function so hopefully all will be well!
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