Imuran not dosed to weight

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UCinNC
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Date Joined May 2007
Total Posts : 528
   Posted 8/25/2007 5:42 AM (GMT -7)   
Hi. I just saw my GI Thursday, and I fully expected him to up my imuran dose, as I weigh about 140 and am only on 100mg Imuran. I figured my therapeutic dose would be 125 or 150. But, much to my surprise, he said he would prefer to see if I can get by on 100mg, but that he will up it if it turns out I need more. I am a bit surprised/confused because he acknowledged that Imuran is usually dosed 2 - 2.5mg per kilogram, which is about 1mg per pound. he said he doesn't like to dose at 2.5mg, and I definitely trust him (he is a great GI) and appreciate his conservative tendency, as I want to be on as little medicine as necessary. But, nonetheless am a bit surprised. For those of you on Imuran, does this make sense to you? Thanks.
29/Female/NC
Pancolitis dx 3/07.
Currently on 12 Asacol a day.
*100mg Imuran b/c steroid dependent. (will dose up to 125 or 150 eventually)
*back on prednisone while Imuran kicks in. Down to 5 mg on 8/13.
Various vitamins, probiotics, fish oil.
Engaged: June 1, 2007


MitzMN
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Date Joined Feb 2007
Total Posts : 622
   Posted 8/25/2007 7:16 AM (GMT -7)   
I'm on 100 mgs of Imuran and I weigh a lot more than you.

I think there's fudge room and more factors than weight alone for dosing on Imuran.

How's it workin' for you so far?

Mitz
Sporadic proctitis since 1985. Mother had UC, then J-pouch surgery 1983.
DX'd with clostridium difficile in 2000. Prednisone, two courses of Flagyl, then Vancomycin -- symptomatic with UC after that.
Colonoscopy in 2001 dx'd left-sided UC. Treated with prednisone, Rowasa, Asacol. Switched to Imuran. Two small flares, 2002 and 2005, and 2007.
Gall bladder attack 6/13; ultrasound showed stones; surgery soon.
100 mg Azathioprine, Rowasa retention enema (nightly) and 225 mg Effexor XR.


Another UC wife
Veteran Member


Date Joined Jun 2007
Total Posts : 2111
   Posted 8/25/2007 10:00 AM (GMT 0)   
As some of you know from another thread.............my husband is about 190 and on 75 mg. imuran. We see the Dr on Monday and get the results of the Prometheus test (3 boxes were checked on the lab slip and 3 vials of blood taken).

I am super anxious to see what the consensus is with what I have read on this forum.

And whatever she decides we will need to follow but we go to the Mayo Clinic on October 1st and that will definitely be the 2nd opinion. I will politely ask why the dose is continuing to appear to be so low for his weight though if that is the case.

Honestly he has been on the Imuran now for close to 3 1/2 months -- we have tapered the prednisone down to 20 mg from 40. We check with her also on Monday if we continue to taper every 10 days or hang in at the 20 for awhile and maybe reduce by 2 1/2 mg and not the 5 mg levels??? At least the BMs are somewhat predictable and manageable with the flare under somewhat control. The pain, gas and cramps are not constant - certainly uncomfortable when they are though. Sometimes I can tell it really gets to him or hear him swearing in the bathroom :-) But he needs to vent too...better there than at me...lol.

So far he is not in trouble as he used to be when he got low on the prednisone - or at least not yet. From what she said the prednisone was prescribed along with the imuran to "jump start" it so to speak with the plan of tapering and hopefully eliminating as the imuran would stand on its own.

Since that hospital admission with terrible out of his mind flaring, back on prednisone and starting the imuran things have improved a lot. There is still much room for improvement but in comparison when you have been to hell and back you can measure and appreciate a somewhat functional day here and there.

The fatigue factor is there every moment - he is on the iron 3 times a day - just started monthly B12 shots. When those start to help and the prednisone is gone maybe that will help lessen the fatigue. The asacol and imuran unfortunately also have a fatigue factor with them from what I read here so it looks like those meds plus the UC itself is going to keep him from regaining his normal energy.

Maybe the Mayo Clinic can better educate us with all the different meds he is on better things to incorporate. Maybe change the Centrum multi vitamin for a liquid type I read about here for better absorption, maybe the B100 complex vitamin referred to in addition to other things I have written down from this board. Change the pro biotics to something different. After awhile I feel like I am constantly at him to try this and try that. I'm very interested in seeing their take and spin on things. We are going there fairly well prepared I think with all the records and testing that has been done here so far to assist them.

60 yr old male~Colitis 1st diagnosed Jan '05-cleared up within a few wks. Flared again in May '06 ... left sided UC now, fully involved and trying to get in remission. Acute inflammation-pancolitis-tenesmus rectal pain-granulation is showing some healing started. Osteopena of spine from prednisone DX 8/07  July 07 starting to feel somewhat normal 75mg Imuran 40  mg prednisone (tapering 8/07) 12 Asacol, Lidocaine Hydrochloride Jelly 2%,multi vitamin, iron 3X day, DanActive, chewable calcium, Prilosec 20mg, enalapril 10mg, glipizide 5 mg, zocor 20 mg, baby aspirin, (Fentanyl pain patch 50mg 72 hrs  Morphine Sulf 15 mg twice daily)Colocourt enemas at night. Fosamax and mthly B12 shots.


UCinNC
Veteran Member


Date Joined May 2007
Total Posts : 528
   Posted 8/25/2007 12:32 PM (GMT -7)   
MitzMN - Hi! It's been awhile since we ended up on the same post..... You know, for some reason I thought you were on a higher dose. i feel much better after reading your post, so thanks for replying. As for Imuran, I don't yet know how it is yet because I haven't been on imuran without pred. I do really well on Pred, so I have actually been feeling totally fine since getting on Pred 8 weeks ago. I do notice more hair coming out in the shower, and I do get a bit more tired, but on the whole I feel totally fine, knock wood. I have been down to 5mg of pred for about 2 weeks, and because we are getting ready to leave the country for 2 weeks next weekend, my GI wants to wait until we get back to get off pred. at that point Imuran will have had 12 weeks to kick in, so i will get off pred, keep my fingers crossed, and see how it goes..... thanks for asking. how are you?

Another UC Wife - did you see my last post on the other thread we corresponded on, the one I wrote about fatigue? If not, the main point was just to let you know that though I take Imuran, fatigue is not too much of a problem for me and that your husband may regain energy with time. I think the illness can be very draining, and pred definitely can be exhausting on the body, so don't yet worry that he will always be so tired from imuran. Give it some time, wait until he is off pred and in remission to determine the effect of imuran on him. I do get tired more easily - don't get me wrong - but i also still go for 45-minute runs, work all day, etc.... so try to be patient, though I know that's hard. he may regain some energy once off pred and once his illness is calmer.
29/Female/NC
Pancolitis dx 3/07.
Currently on 12 Asacol a day.
*100mg Imuran b/c steroid dependent.
*back on prednisone while Imuran kicks in. Down to 5 mg on 8/13.
Various vitamins, probiotics, fish oil.
Engaged: June 1, 2007


MitzMN
Veteran Member


Date Joined Feb 2007
Total Posts : 622
   Posted 8/25/2007 2:58 PM (GMT -7)   
Going out of the country. On a holiday? FABULOUS! Yes, I'd hang on to that pred for this event. What a tragedy it would be to go on a vacation and be sick.

I don't know what I attribute my lack of energy to, I just remember I used to be an energetic person and now I definitely am not. It'd be easy to say it was X, Y or Z, but I don't really know that.

I don't remember how long it took for me to get better on the Imuran, but it seems to me that it was pretty quick, relatively speaking. I do notice after getting out of the shower and combing my hair, I have a bit to throw into the trash/toilet, and I never connected that to Imuran but it could be, I suppose. Otherwise, I really have no side effects that I can detect from the Imuran. It certainly is better tolerated than pred and I'm sure you're looking forward to the day when you can say you are no longer on that nasty medicine.

Have a fabulous time on your trip out of the country!

Mitz
Sporadic proctitis since 1985. Mother had UC, then J-pouch surgery 1983.
DX'd with clostridium difficile in 2000. Prednisone, two courses of Flagyl, then Vancomycin -- symptomatic with UC after that.
Colonoscopy in 2001 dx'd left-sided UC. Treated with prednisone, Rowasa, Asacol. Switched to Imuran. Two small flares, 2002 and 2005, and 2007.
Gall bladder attack 6/13; ultrasound showed stones; surgery soon.
100 mg Azathioprine, Rowasa retention enema (nightly) and 225 mg Effexor XR.


UCinNC
Veteran Member


Date Joined May 2007
Total Posts : 528
   Posted 8/25/2007 3:49 PM (GMT -7)   
yes, out of the country on holiday. my fiance is irish so we are going to ireland to see his family. he is just on a visa here in the states, and everyone but him lives in dublin, and this is our first time going back since getting engaged. should be interesting. the good thing is that one of his aunts will be gone so we can stay in her apartment while we're there, which means I will be able to cook and generally have a lot more control over my food. wish me luck!
29/Female/NC
Pancolitis dx 3/07.
Currently on 12 Asacol a day.
*100mg Imuran b/c steroid dependent.
*back on prednisone while Imuran kicks in. Down to 5 mg on 8/13.
Various vitamins, probiotics, fish oil.
Engaged: June 1, 2007


MitzMN
Veteran Member


Date Joined Feb 2007
Total Posts : 622
   Posted 8/25/2007 5:30 PM (GMT -7)   
Fabulous! You're marrying an Irishman. I fancied an Irishman once -- he even had a wee bit of red hair, as I recall. I thought he was sexy as hell. He wasn't a true Irishman in the sense that your honey is, but his name was Mc-something and he was pretty darned Irish.

It might be a little stressful meeting his family (and all of them at once!) so I'm glad to hear you'll have a place to stay and can get away a bit. It could be very overwhelming staying with his family at the same time. And, yes, cooking for yourselves will help, too, I am sure.

I hope you have a fabulous trip. I've heard Ireland is a fabulous place to visit and learn about. Everything in the states is so new in comparison. We think in terms of decades; they think in terms of centuries!

Mitz
Sporadic proctitis since about 1985. Mother had UC, then J-pouch surgery 1983.
DX'd with clostridium difficile in 2000. Prednisone, two courses of Flagyl, then Vancomycin finally got rid of it. Symptomatic with UC after that.
Colonoscopy in 2001 dx'd left-sided UC. Was pretty darn ill at that time. Treated with prednisone, Rowasa, Asacol. Asacol not working so switched to Imuran. Three small flares since in 2002, 2005, and 2007.
Gall bladder attack 6/13; ultrasound showed stones; surgery before end of 2007.
100 mg Azathioprine and 225 mg Effexor XR (for chronic, longstanding depression) daily.


Another UC wife
Veteran Member


Date Joined Jun 2007
Total Posts : 2111
   Posted 8/28/2007 1:14 PM (GMT -7)   
Hi There - saw the GI yesterday - the 3 results of the prometheus testing were very good and she was pleased. The 75 mg dose she explained to us she treats more conservatively initially and waits for these results - she does not feel an increase is in order. She is interested in what the Mayo Clinic thinks and sounds like she will defer to their opinion if they feel it should be higher.

Genetics-normal enzyme activity TPMT1*1 the other two tests had the symbol at the real low end way under the 6 TGN metabolite level & 6 MMPN metabolite levels which is a good thing. Not sure really what it all means other than he is metabolizing it fine and it appears a higher dose is not in order.

However it will be interesting to see if Mayo Clinic agrees with this. Will a higher dose bring remission faster??????????????? We'll know soon enough. Prednisone tapering seems to be going ok at the moment.

Plus another pill due to the B12 shots..........1mg folic acid to add to the signature

Went to the movies to see Hairspray Sunday night wasn't feeling all that great - last 10 minutes or so extreme discomfort (gas). Woke up Monday great day all day. Go Figure. It can make you crazy for sure. Today hanging out and resting. Like I say - take each day and be happy with the good ones.

60 yr old male~Colitis 1st diagnosed Jan '05-cleared up within a few wks. Flared again in May '06 ... left sided UC now, fully involved and trying to get in remission. Acute inflammation-pancolitis-tenesmus rectal pain-granulation is showing some healing started. Osteopena of spine from prednisone DX 8/07  July 07 starting to feel somewhat normal 75mg Imuran 40  mg prednisone (tapering 8/07) 12 Asacol, Lidocaine Hydrochloride Jelly 2%,multi vitamin, iron 3X day, DanActive, chewable calcium, Prilosec 20mg, enalapril 10mg, glipizide 5 mg, zocor 20 mg, baby aspirin, (Fentanyl pain patch 50mg 72 hrs  Morphine Sulf 15 mg twice daily)Colocourt enemas at night. Fosamax and mthly B12 shots.

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