Azathioprine..need some input

Five years ago, I tried azathioprine (generic) for 8 months but in vain. Then, I was switched to Imuran and it worsened my symptoms : fever, severe abdominal pain and d. GI thought it was just a new flare up. However, I insisted on quitting it and I did.

Three years ago, my GI convinced me to get back to Imuran and I have been on it for 3 years now.

As for the blood work check, it's every month at the beginning to check that it does not affect your liver or your blood components : WBCs, platelets and RBCs, negatively. Then, when Imuran kicks in after 4-6 months, the tests will be every 3 months.

The side effects I had at the beginning were nausea and at this forum I was advised to take the 3 tablets as a single dose before bedtime. This has really helped w the nausea. Every now and then, I get white scaly patches on my skin. These are said to be a fungal infection caused by Imuran. Any steroid cream can treat them.

Tbh, I don't see that Imuran is doing anything to my intestines; I haven't seen any remission yet. Still, my GI thinks that as long as it lowers my WBCs count and they are within the normal range, I should keep taking it. He's even paired it w Remicade.

Good luck :)

At the beginning, some docs do it weekly, some every other week, for the first couple of months. Then about once a month, then maybe every 3-4 months after you've settled in on it.

Imuran is just a brand name, while azathioprine is a generic/medical name. Same med, comes in the same strengths.

The most common side effect is the nausea & fatigue. Some people push through that and it goes away. For others it won't go away.

Some mild liver inflammation is somewhat common and a reason for all the blood tests (to make sure there is no inflammation of the liver or that it's very mild). If it gets bad you would need to stop the imuran.

Pancreatitis is less common (something like 1 in 30? I forget the number?), but it's serious and would require stopping the medication immediately. Pancreatitis is felt as pain in the upper abdomen that may radiate into the back.

I'm not particularly happy about it, but I'm thinking of asking to go on azathioprine or 6MP as well. I wish I had more optimism that these meds will help rather than hurt me, but I know from bitter experience just pretending my Crohn's isn't there won't work in the long term either. Also, I'm just plain miserable as I am anyway.

I had fevers on azathioprine. I remember that quite clearly because my GP got quite alarmed when I told him and insisted I have a blood test. But at that time I was having lots of fevers because of the Crohn's anyway, so it was almost certainly a Crohn's symptom rather than a side-effect. As for weight loss, that's not a direct side-effect, but you may lose your appetite through feeling sick.

Imuran is azathioprine; it's the brand name, while azathioprine is the generic name. As for 6MP, that's very similar but not identical: azathioprine breaks down into 6MP in the body. If you want to know which is 'better', there is no definite answer, but this article is pretty interesting. Well, would be if it wasn't denser than a thicket bush.

www.gastrohep.co.uk/ebooks/irving1.pdf

As best I can make out, AZA is theoretically the more effective drug but in practice 6MP is more effective for inducing remission in Crohn's disease. However, the business with odds ratios does my head in: I need to take a crash course in statistics.

Finally, as for pancreatitis, I read there was a 5% chance of that, but not sure if I can find the link again.

I seem to have had good success with Azathioprine over the last two+ years or so.

Today I had some very, very mild symptoms later in the day but when I came home I took my usual stuff which includes 150mg Aza and in an hour or two I felt great again. The symptoms (super mild IBS type) were due to the extra large coffee and muffin (wheat) that I indulged in for breakfast at 5am as I was in a hurry and starving with no other option at the store I was in and nothing else nearby...

Anyway it's worth a try. You never know. You might get lucky and find good results.

Incidentally I have been on it years ago with no results.

I had awful reactions to 6mp recently. I was fine for the first 2 weeks and then I ended up in ER with severe upper abdominal pain and vomiting. They said it was gastritis but I know it was 6mp. I continued to take it and was an absolute mess. Fever of almost 102, beyond extreme fatigue, anxiety, no appetite, extreme thirst increase, etc. I stopped taking it for 2 days several times to test it out and each time I stopped, the symptoms went away..started it and symptoms came back. My GI took me off it and added it to the long list of meds I can't take.
I have seen that a lot of people have had great success with it though. I wonder if I would react any differently to Imuran even though it's similar.. My GI hasn't mentioned trying me on Imuran after that reaction

Lipase aren't usually tested routinely. There's a difference between a bit elevated (maybe you just ate) and pancreatitis. Trust me, when you have it, you'll know. The pain is incredible.

Dorri, keep us updated. I'm interested to see if you have reactions to it again. I recently had horrible reactions too and wouldn't want to try it again right now,,, but maybe in the future..I took it about 10 years ago and I was fine with it, and this time it was no good for me. Hope it works for you and you have no or minimal side effects!

Question Everything, you do have me worried but I asked?     By your explanation 1/3rd or less of the responders got pancreatitis, but 2/3 rds didn't, so I hope I am in the 2/3rds that didn't. Just curious, how much did you start out at, another question, can they tell by your blood work that it's coming, that is before the pain comes? Do your liver enzymes go up or something, so they can take you off in time? The last time I took it, I was able to go a month without developing it. I did get weight loss, fevers and fatigue that I remember and then went off because of that, not anything else??

Post Edited (dorri) : 2/27/2016 5:13:43 PM (GMT-7)

  He started you off with a lot to begin with?   I wonder if it would have made a difference, if you would have been started at a lower dose?  I'm not sure if the approach I will soon be taking, will make a difference, that is to start low and get my body use to the medication, and then increase?  I'm small to begin with,  and don't weigh very much, so I wouldn't want to end up on the same amount of medication a larger person would normally take?