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Imuran (Azathioprine) Question

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Posted 2/16/2017 10:27 PM (GMT 0)
Hello all I hope your all doing well.. I was wondering if anyone had any bad experiences with imuran?

I started Imuran (Azathioprine) about a month ago and at first it started giving me very violent nausea.. waking up and not even being able to make it to the bathroom. After vomiting I would feel better again,
then it would start all over again, for about an hour. (Was told to take before bed with food, zofran, nothing helped)

After a few days the nausea became milder but my stomach and back starting getting extremely tight and bad constipation. The tightness started getting worse and worse so I tried contacting my doctor and the nurse said to stop it because of the reactions.

I stopped Imuran and after 3 days I was symptom free. I finally talked to my doctor and he said he is worried
about me flaring and that I should continue taking it and that the symptoms could be something else and not Imuran.

I am currently on Remicade every 6 weeks (Been on remicade almost 3 years) and he added Imuran recently
because I guess i'm starting to get antibodies.. Anyone have any ideas? I don't want to go to the hospital everytime i go there i feel like im in prison and they never let me leave.
Posted 2/17/2017 12:33 AM (GMT 0)
Ask to switch to 6MP, 'cos you might tolerate that better than azathioprine. It's basically the same drug, just a slightly purer version of it. Start on the lowest possible dose - cut a 50mg pill in half. Move up to 50mg once the nausea goes away.

If that doesn't work, then consider methotrexate. It seems to be as effective as aza in helping to prevent antibody formation. Dunno how much difference either will make after 3 years of being on Remicade though.

www.jwatch.org/jg200710190000004/2007/10/19/effect-immunosuppressants-antibodies-infliximab
Posted 2/17/2017 2:10 AM (GMT 0)
Actually, I am a bit worried about it hurting into your back - imuran gave me pancreatitis. That should have been something your GI thought of right away. If you do start it again, you should keep an eye out and if those symptoms start again, ask for a blood test for lipase and amylase levels.
Posted 2/17/2017 5:49 AM (GMT 0)
You started it about a month ago - how long did you last before stopping? 2 weeks? 3 weeks?

Did you have any blood tests done during that time?

It's not uncommon at all for it to cause a lot of nausea. It's estimated that about 1 out of 4 or 1 out of 5 people with Crohn's can't tolerate it for that very reason. It gave me pretty bad nausea (not throwing up but wishing I could!).

But scifigal2k is right, that the back pain could indicate pancreatitis.

If you try it again, be wary of the symptoms for that and get in to see your doctor if you're having problems tolerating it.

If you find you can't tolerate imurant, NCOT is right that you can try 6mp. Some people tolerate one better than the other.
Posted 2/18/2017 12:10 AM (GMT 0)
Only a month and you already gave up on it? Nausea is a very common side effect especially in the beginning of the treatment. Zofran didn't help me either. My relief was and is ginger. I still take it to this day whenever the nausea hits me. I can tell you it does get better.
Posted 2/18/2017 12:55 AM (GMT 0)
I gave up on it after about a month. Tried it again a few months later and lasted about a month again. Tried 6mp and lasted about a month again. I tried my best to tough it out, but that nausea kept getting worse, not better. I could barely eat, was losing weight (which I couldn't afford to lose) and felt awful overall.

My brother started 200mg/day of imuran around the same time and had no nausea whatsoever. So weird how it can affect people differently.
Posted 2/18/2017 1:47 AM (GMT 0)

Andrina said...
Only a month and you already gave up on it? Nausea is a very common side effect especially in the beginning of the treatment. Zofran didn't help me either. My relief was and is ginger. I still take it to this day whenever the nausea hits me. I can tell you it does get better.

Have you ever been sick as a dog 24/7?

I have and I can tell you I would not spend a month on a med which made me feel like that. The nausea from new meds usually disappears after a week or two. If it's still there a month later, then it's probably not going to get any better.
Posted 2/18/2017 4:41 PM (GMT 0)
My son (20) is on remade every 8 weeks and initially was on Azathioprine. Although he tolerated it well there is a slight risk (according to his GI) of a rare cancer (not sure of name) that is linked to Azathioprine, especially in young men. He was given a choice to stay on Azathioprine or switch to Methotrexate (7.5mg per week). He finds it easier (and more of a relief) to be on Methotrexate with no cancer fears. He was told that both needed to be done at once to prevent antibodies. Hope you can switch to something as effective with minimal or no side effects!

(My son is sure methotrexate is making his hair fall out but I think he is imagining it - apparently a side effect but at a higher dose)!
Posted 2/18/2017 6:23 PM (GMT 0)
Betty Sue, he's not imagining anything. It does happen even at the lower doses. Maybe not going completely bald like a full dose of chemo. But I started losing a lot more hair after being on methotrexate for a while. A good handful in the shower. My brush was full after a short time using it. Things like that. I've added taking biotin in the morning as a lot of methotrexate users suggested and I've seen it slow down a lot.

As far as giving up on Azathioprine only after a month. I think I'd be dead if I pushed it much longer then the 10 days I was on it. Pay attention to severe nausea as that IS a sign of pancreatitis. Keep up on that blood work. However I give up pretty quickly if a drug makes me feel like death. It's supposed to help, not make things worse.
Posted 2/18/2017 6:32 PM (GMT 0)
One thing to make sure is that you've had your TPMT level checked. A small subset of the population (myself included) have a low level, which makes you way more sensitive to the enzymes in Imuran, 6MP, etc. I've decided not to take these medications because of an increased risk of myelosuppresion.

See www.crohnsforum.com/wiki/TPMT
Posted 2/18/2017 11:54 PM (GMT 0)
I think I will let my son know about the biotin. He is on folic acid which is also supposed to prevent that... (but to me his hair still looks very thick!). Thanks for the information - I will pass it on to him!
Posted 2/19/2017 5:01 PM (GMT 0)
Thank you all for your replies! way better info than the doctors/nurses have given me..
I really wish healthcare would wake up and stop being all about $$$

I stopped the imuran and i am back to normal no symptoms nothing!!

I am going to talk to him about everything you guys suggested! THANK YOU SO MUCH!! Hope you
all have a great weekend!
Posted 3/12/2017 10:17 AM (GMT 0)

NiceCupOfTea said...

Andrina said...
Only a month and you already gave up on it? Nausea is a very common side effect especially in the beginning of the treatment. Zofran didn't help me either. My relief was and is ginger. I still take it to this day whenever the nausea hits me. I can tell you it does get better.

Have you ever been sick as a dog 24/7?

Yes I have. Being left from my then husband in a hotel not being able to eat anything. I'm surprised I survived. I stayed on imuran because I knew it helps me. Ginger is my instant relief.

My nausea hit in month 3 and lasted about a month. Everyone is different I guess. I know for me it got better. I took 50 mg in the first month, 100 mg in the second and 150 mg in the third. Since it's common to build up the dosis I'm surprised to feel sick already in the first month.

I was on Azathioprine in 2005 through 2007 and in remission so I started being on it again in 2013 and I'm still taking it.
Posted 3/12/2017 1:08 PM (GMT 0)

Andrina said...
Yes I have. Being left from my then husband in a hotel not being able to eat anything. I'm surprised I survived. I stayed on imuran because I knew it helps me. Ginger is my instant relief.

My nausea hit in month 3 and lasted about a month. Everyone is different I guess. I know for me it got better. I took 50 mg in the first month, 100 mg in the second and 150 mg in the third. Since it's common to build up the dosis I'm surprised to feel sick already in the first month.

If you can find something to relieve the nausea, that's different. Ginger wouldn't have helped me; nothing would have made my constant nausea any better. (This was when I developed an ileus after surgery and it lasted for over a week.)

A small minority of people just cannot tolerate azathioprine or 6MP. They will never stop feeling sick, no matter how long they stay on it for. For the majority the nausea will last 1-2 weeks and then go away.
Posted 3/15/2017 6:54 AM (GMT 0)
You should have had the TPMT test before you started. I completely lack TPMT and I became seriously ill after just 5 days of taking 6MP. The lab test came in right around the time I called in to tell the GI was very sick. They had me come in for STAT lab work (the people in the long line at the lab were miffed). I went back to his office to wait and he (GI) came out less than 15 minutes later and gave me a face mask and said almost all of my white cells had been destroyed and the paramedics were on the way to take me to the hospital.

I now list an allergy to thiopurines anytime any asks. He said if I continued to take them the reaction could be fatal.

The chances of lacking this enzyme are low but it happens.
Posted Today 4:49 PM (GMT 0)
azathioprine actually has caused me to gain weight. After researching on the internet, I came only across a few ppl it's affected like this, one woman saying she went up three dress sizes. All I know is, while it's helped some symptoms for the severe U.C. I endure daily (blood/mucus/sense of urgency), it almost had the reverse effect in that after feeling nauseous, I also become constipated ! And bloated.., so I went from an inflammatory bloat to a constipated bloat. I talked to my MD, & am cutting my dose in half. If that doesn't resolve my concerns, I will cut my dose even further. Weight gain is not what I need, nor appreciate.
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