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Imuran (Azathioprine) Question

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Ulcerative Colitis
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Posted 2/21/2020 1:19 PM (GMT -6)
Hi I’ve been fighting a debilitating flare for over 2 years now with little to no relief. My doc finally put me on azathioprine a month ago (50mg) and I tapered off the steroids and I was doing well for about 2 weeks then started flaring again. How long does it take to work? I know most people are successful on it but it seemed to work fast for those who had success with it. Thanks
Posted 2/21/2020 1:22 PM (GMT -6)
It typically takes 3 months to work. Also, you're on a super low dose. When I was on it, I took 150 mg.
Posted 2/21/2020 4:28 PM (GMT -6)
I’m taking it w Asacol which is supposed to make it work better. My GI said she never needed more than 50mg for UC. I’m back on the cortenemas as of today - I really want to stop the steroids
Posted 2/21/2020 5:29 PM (GMT -6)
Azathioprine/Imuran dosing is weight based. You should have 1.5 - 2.5 mg/kg of body weight. A 120 lb person would have a therapeutic dosage of 81 -135 mg or anywhere from 75 - 125 or 150 mg in the actual pills. The more you weigh the higher the dosage. I never heard of anyone here staying on only 50mg. Often times people start low to see if you can tolerate the medication and then move you up to the proper dosing.

Asacol is a completely separate medication and has no affect on the aza dosing. People often take both medications at the same time, but Asacol doesn't make aaza work better.

I am astounded that your GI said she never goes higher than 50 mg.... unless all her patients only weigh about 75 pounds. Is this an actual doctor or a physicians assistant/nurse practitioner?

It sounds to me like you are under medicated, but it does take about 3 months for it to kick in .

How much asacol are you taking? Are you also on rectal meds?
Posted 2/21/2020 5:32 PM (GMT -6)
Uh yeah, your GI doesn't know what she's talking about. I'd get on the max dose of Asacol and do mesalamine enemas and ask why your Imuran dose is so low. Or just seek a second opinion.
Posted 2/21/2020 6:07 PM (GMT -6)
Im a really tiny person so I weigh 109lbs now which makes sense for 1.5 mg/kg and I’m taking 2 tablets 3xs a day for asacol
Posted 2/21/2020 6:09 PM (GMT -6)
My doctor is a gastreontologist and she specifies w IBD patients but she works from the bottom up she doesn’t prescribe biologics or immunosuppressants unless she has to.
Posted 2/21/2020 6:44 PM (GMT -6)
That's a very low dose of Asacol. You should be on 8 or 12 a day if you're flaring. 12 is the max and I've been on it for 13 years. Well, I like her bottom up approach, but I would ask about upping your Asacol.
Posted 2/21/2020 8:41 PM (GMT -6)
I started Imuran just over a year ago. I took 50 mg for the first 3 weeks. Once my blood work came back ok after 3 weeks my dose was upped to 100mg. A 50 mg dose isn’t enough for UC unless you weigh under 75 pounds. It is doses by weight. If it helps, I also take 2-3 lialda (generic) a day and use sfRowasa 3 times a week and I weigh between 98-103 pounds. 1.5-2.5 mg per kg us standard for UC.
Posted 2/21/2020 10:10 PM (GMT -6)
Are you currently in remission? How is your WBC count on 100mg? And how long did it take for you to reach remission (if you’re there)

Anyone here have any success with only 50mg azathioprine along with a mesalamine.

If I don’t feel better by 3 months I’ll ask her to increase my dosage.
Posted 2/21/2020 10:32 PM (GMT -6)
Well everybody says it goes by weight. Here is my little anecdote. When I reached 60 - 65 kg, I upped to 150 mg. And flared. I lost my colon without knowing what's going on. After surgery I flared in different parts of my body and insisted to be put back on azathioprine. Well, I was on 100 mg and fine. Then I increased my dosage to 150 mg because according to my weight that's the dosage I should be on. Guess what. I flared again. My doctor called me to say I need to stop aza immediately and my white blood count was very low. I stayed off for 2 weeks. I was miserable. I again insisted I get back on it and stay on 100 mg indefinitely. So far so good. I currently weigh 54 kg. More is not always better.
Posted 2/21/2020 10:40 PM (GMT -6)
How long did it take to kick in? Yeah I agree more isn’t always better I want to wait and see if it’ll work
Posted 2/22/2020 2:19 AM (GMT -6)
I took 50mg azathioprine when I used it in combination with allopurinol, as the allopurinol makes it about 4x more potent. Perhaps that's what your doctor means? Prior to adding allopurinol I previously tried doses of 100mg and 150mg (for 3 months each) but we had to terminate that when my enzymes went dangerously high (you need to have the right "window" of 6mmp and 6tgn in your blood, unfortunately they can only meaningfully test this after 2-3 months on azathioprine as it takes time for the levels to adjust). Adding allopurinol is only recommended for ~11% of the population who otherwise metabolize the 6MMP into 6TGN (so the therapeutic level of 6MMP is not reached while 6TGN gets too high - allopurinol stops that reaction from happening). I had a partial response to azathioprine but not enough to get off prednisone
Posted 2/22/2020 8:05 AM (GMT -6)
Why are you against raising your Asacol dose to an actual therapeutic level and adding in mesalamine enemas? Your doctor didn't really do a bottom-up approach because she has you on almost no mesalamines... I was on mesalamines ONLY for 6 years, then mesalamines only with prednisone once or twice a year for another 6 years. I truly did a bottom-up approach...
Posted 2/22/2020 10:21 AM (GMT -6)
Are you on 800mg tablets of Asacol? If so, 6/day is max dose. If less than 800 mg tablets you are not on max dose. Max dose should total 4800 mg/day

Therapeutic dose of azathioprine for 109 lbs is 75 - 125 mg

I would add rectal meds at a minimum. If your inflammation is limited to your rectum, mesalamine suppositories may be enough. Otherwise, mesalimine enemas can work wonders. Some doctors don't prescribe rectals unless asked especially if you have pancolitis. But rectals can work wonders ... even if you have extensive inflammation.

What are you current symptoms? 3 months is a long time to wait to get more meds that will take another 3 months to kick in. You said you have been already fighting a "debilitating" flare for 2 years.

Hope you find relief.
Posted 2/22/2020 3:21 PM (GMT -6)
Yes Asacol HD 800mg tablets I take 6 a day at one point I was taking 8 a day but reduced it once I started the azathioprine.

I tried the mesalamine enemas but had a very bad reaction to it idk why my GI thinks it might an additive in it.
Posted 2/22/2020 6:31 PM (GMT -6)

HealingSarah123 said...
How long did it take to kick in? Yeah I agree more isn’t always better I want to wait and see if it’ll work


If you mean me. After 6 days my joints swelling went down and I was able to get off daily pain meds. I was diagnosed with "inflammatory arthritis"
Posted 2/23/2020 11:40 AM (GMT -6)
Ah, I thought you meant Asacol, not Asacol HD.
Posted 3/3/2020 2:31 PM (GMT -6)
I am on 6mp since 2013 75mg/day and mesalamine DR 1.2 mg 4 tablets. It started with 50mg and then increased to 75mg. You have to monitor your liver function and blood count. If they are good your doctor can increase dose.

Also it takes long time to get remission but you should start feeling better. I noticed in 3-4 weeks improvements and as months passed by, it got better. So if you are feeling better, give it a time. Even after 3 months you don't feel better than go for increased dose. Make sure you get complete blood count and liver function every 3 months initially. Wish you a long remssion
Posted 3/3/2020 2:34 PM (GMT -6)
My doctor had me doing blood counts every week for the first month, then it was going to be once a month for the first 3 months.
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