maintenance low dose prednisone/Azathioprine - harmful long term?

Hello.  I've had U.C. for about 4 yrs now.  All of the normal meds(colozal, asacol, and now lialda), seem to make my symptoms worse.  The only thing that has ever worked for me is Azathioprine(imuran) at 50 mg, and a maintenance low dose of prednisone where I take 10 mg per day.  Even with this, I still have problems in the middle of the night and the morning, but the 50 mg imuran and 10mg pred with breakfast gets me through the whole day 99% of the time without a problem.  My concern though is what preds and Imuran might do to me long term.  My doc thinks I should not really take either medication long term.  I do the blood tests, which so far have come back fine every time.  I don't want to be doing long term damage to my health, but...it took me forever to find a combination that gets me through the day...and it's so frustrating that the normal medications just don't work.  If I go off preds, the symptoms come back within a week, even when i tired to up the dosage of Imuran to 100mg.  It seems i'm stuck right now with low dose prednisone.  No crazy side effects yet, but I'm worried about my future health.  Just thought i'd get some thoughts from others that might have had some similar issues.  Thanks for any responses. 

Hi John,

I am like you, i have UC and i do my best when i am on prednisone.  However as we all know it is not good to be on it for a long time.  I have a hard time tapering past 10mg myself without starting up a flare.  Asacol only made things worse for me as well.  My doctor recently took me off the Asacol and is having me try to taper down from 20mg of pred while also taking 9mg daily of Entocort.  Each week he is having me taper the pred 5mg until i am off of it and just taking the Entocort daily.  He said that you can be on Entocort for a lot longer as it is safer than the prednisone, yet also a steroid.  If this doesnt work he is going to look into either 6-MP or Remicade. 

Thanks. I think what i may try to do is up my Azathioprine from 50 mg to 100 mg, and try my best to rid myself of the prednisone. I'm not sure if that will happen, but...this Lialda is giving me horrible abdominal pains and nausea and I often feel like I want to vomit. Especially when my stomach is empty in the morning. Gosh mornings are rough on this stuff. I may post a separate thread on the side effects of lialda, cuz my doc seems to think that the side effects i'm experiencing with Lialda are actually being caused by being in a bad flair-up. I don't agree with him, cuz I felt worse within a few days after taking that stuff. Yea, maybe I need to get a second opinion from another doctor. I hate to give up on it so quickly, but I feel horrible. His intentions are good in trying to get me off the preds...but none of these 5-asa meds are working for me at all, and I actually end up having to increase my pred. dosage every time I try one. Kinda counter-productive.

Hi.  I'm 32 yrs old.  Unfortunately Imuran was about the last of the meds(along with prednisone) that worked.  None of them ever did. I tried all the mesalmine drugs, as well as all the sulfasalizine drugs over the past 4 and a half years since i was first diagnosed with U.C. in 2004. 6MP didn't do it for me either.  Finally Imuran along with low dose preds got me mostly into remission.  Only problem now is..if I cut off the preds..i'm back in a flair up within a week.  I only take 50 mg imuran and I am probably going to incease that to 100 mg and then try to completely ween myself off the preds.  I am just very frustrated that the typical medication has NEVER worked for me.  Everyone one of those 5-asa drugs put me into one hell of a flair up.  So, i guess i'll put up with the blood tests every  3 months on the Imuran and pray that nothing horrilbe happens.

Thanks for the reply. Yea, I am only on 50 mg Azathioprine, but i'm going to start 100mg soon. Maybe that will allow me to totally kick the preds. At least for awhile. I can get to where I only take 5mg preds. Such a low dose! and it makes such a difference! Hopefully a dose that low isn't going to create too many issues down the road, cuz...with nothing else working, I feel like i'm stuck with this combo of meds. What kind of prednisone enemas do you use? Entocort? I'm going to create a separeate thread..but anyone who reads this..let me know what vitamins you take, or supplements that might help to counter act the side effects of low dose prednisone. I'm just nervous that even 5mg of preds long term is going to do some horrible damage. I guess the good thing for now is...when i'm just taking those meds, I have no side effects, pass all my blood tests, and I feel pretty good.

the enemas i've had are called predsol

A condition where one's cortisol is very low.

www.nlm.nih.gov/medlineplus/ency/article/000357.htm