How long on azathioprine until I stop feeling sick?

Hi all -

I'm new here - I have been reading for the last few weeks (just diagnosed in August), but this is my first post.

I started taking Azathioprine about 6 weeks ago. For the first 2, everything was pretty much fine. After that, I started feeling sick (no vomiting, but felt like just a step away) multiple times a day. I was taking it in the morning, and feeling sick with 2 hours. It kind of came and went in waves throughout the day, progressively getting worse over the 2nd/3rd week. I read some suggestions from these posts and switched to taking it at night. That helped for about a week, but then I just started feeling sick again throughout the day, and getting worse than before.

I had an appointment with my GI almost a week ago and told her about the nausea. She said that sometimes it just takes time for your body to adjust, and hopefully the sickness will just go away. She suggested I split the dose (200mg/day), so now I am taking 100mg at bed time and 100 at lunch, and if that doesn't work, "we will try something else...". Really not sure what that means - she seemed supportive though, and said I shouldn't feel sick all the time just to get the Crohn's in order, so that made me happy.

So now, a week later, I'm feeling just as sick or more. I'm just wondering if anyone here started Aza and had nausea, and it took more than 6 weeks for the nausea to go away, but ended up adjusting and being fine? I don't know whether to call the GI and ask for plan B or what. Also, did anyone take any kind of anti-nausea medicine? I am also on 20mg of Omeprazole, is that supposed to be helping with nausea?

Also, any idea what "trying something else" could be that is comparable to Aza? I don't think I'm at the stage where Remicade is necessary and 6-mp seems to essentially be the same as what I'm on, so will likely make me just as sick.

Any help would be great!!
Thanks in advance

What is your weight (in pounds)? In general, the dosing for azathioprine ends up being just a little over your weight (ie, if you weigh 180, 200mg/day would be about right; if you weigh 140, then 150mg/day would be about right).

Sometimes people start at a lower dose and then gradually work their way up.

I had similar problems. Tried starting slow and increasing the dose. Tried taking it mornings, tried taking it nights, tried taking it split doses, tried with food, without food, etc. Nothing helped. Toughed it out as long as I could (about two or three months) and then gave up. Felt better within a couple days of stopping it. Tried 6mp and went through all the same things again.

I heard a well-known IBD researcher say that about 1 in 4 or 1 in 5 Crohn's patients just won't be able to tolerate imuran or 6mp, with nausea being one of the top reasons why.

Thanks for all of your ideas. I eventually got in touch with my doctor's office to ask about an anti nausea medicine, and just heard back that she will prescribe Zofran. Hopefully I can pick that up today.

As for your question about weight and dosing, yes, 200mg is about right- (I'm female, weigh 180, 6'tall, the MRE tech was surprised I was there for Crohn's- he said I'm a large person all around than midst who come in...) I don't know why we didn't start with a lower dose and increase, but the only explanation I can come up with for that would be in order to get off the Budesonide more quickly.

I have to think you're probably right NiceCup, I don't think after this long the nausea will go away, but the doc said I should try to stick it out another week or two (@ which point I have another appointment anyway). If the Zofran works, then no big deal, I'll be happy to give it more time to potentially avoid stronger medicines.

Also Beave, thanks for the stats- I started feeling like I am being a wimp or that its all in my mind that I feel sick. Seemed like most people adjusted pretty quickly and those who had to stop did so because of bad bloods, so glad to hear I'm not the only one!

(Stef, glad to hear Zofran makes you less sleepy... Hopefully it will be the same for me!)