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opinion needed on medication - azathioprine and prednisone

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Ulcerative Colitis
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Posted 9/26/2008 1:22 PM (GMT 0)
Hi there - I am relatively new to the world of medication when fighting UC - though not new to the disease. I was diagnosed in the summer of 2002 and have been relatively lucky with some flare ups that were usually helped with ASA 5 Saloflak enemas. However, I have really been struggling for the past year and a half and was finally able to get into my specialist in August for a colonscopy to re assess everything. Well now it seems to have gotten worse and I have developed an ulcer about 20cm up, had a few polyps removed and it is quite inflamed especially my rectum which makes it very difficult to have a BM with strain, mucus and blood - lots of gas and bloating but no action!! lol I tend to have constipation more than anything ... and then when I do go, accidents.

So to make a long story short, he prescribed azathioprine [50mg] and prednisone [5mg] to help reduce the inflammation - however I am terrified of taking either since I do not react well to prescription meds usually ... and I have heard and read so many horror stories about the two and their side effects. I just recently bought the book Breaking the Vicious Cycle and am hoping to give the SCD diet a chance before taking the meds. I don't mind the effort because I have always been a fitness and health person so the time and effort to make the food is no longer than before - it is just different using the almond flour - tasty though. I started the diet yesterday and also started juicing for energy.

Any comments or suggestions would be greatly appreciated.

Posted 9/26/2008 1:45 PM (GMT 0)
UC is a chronic illness which requires maintenance medication to stave off flares. You really need to give the drugs a fair try. I would caution you about eliminating drugs in favor of the SCD diet but it's your life and your choice. It's been proven that the immunosuppressants are safe however long term prednisone use (long term meaning more than 4 months) is not recommended. Try and work with your doctor and continue with the SCD diet. The critical factor for you right now is to prevent this flare from getting worse.

Sue
Posted 9/26/2008 1:58 PM (GMT 0)
Thanks Sue for your advice - I really appreciate it. I think that I will take the immunosuppressants but not the prednisone. I have never had to be on meds except for the enemas so it is all new to me. I have noticed a little reduction in the blood which is good thing ... now if I could just cure this constipation, things would be great :)
Posted 9/26/2008 8:35 PM (GMT 0)
Juniper girl, I have found Azathioprine very helpful (as long as it continues to work - sometimes the dose needs to be adjusted).  5ASAs did not do a lot for me on their own to maintain remission and steroids can help to induce remission but don't maintain it.  While on azathioprine, just make sure you have blood tests done periodically to monitor any unwanted side-effects.  As for the prednisone, I, along with practically everyone else here, hate the stuff.  However, it may take a few months before you feel the full effect / benefit of azathioprine so pred is sometimes prescribed to assist in the meantime.  But, there are alternatives steroid formulations - oral and rectal - that have a lower systemic effect.  I have taken entocort capsules and use proctofoam and both have helped to induce remission.  You may wish to investigate these alternatives to pred with your doctor while the azathiaprine kicks in.
Posted 9/26/2008 10:52 PM (GMT 0)
Perhaps ask your doc about steroid enemas if he continues to press for steroids while the azathioprine is building up in your system. Azathioprine usually takes 2-3 months to feel the full effects.
Posted 9/27/2008 12:08 AM (GMT 0)
I had been taking Aza since late June till day before yesterday when my GI doctor phoned me and asked me to stop. She said my last bloodwork shows that both my red blood cell and white blood cell counts are very low. She asked me to stop Aza for 1 week, then do the bloodwork again. If the result is okay, I can start Aza again with 25 mg and slowly go back to 75 mg.
It's interesting to note that I feel better after stopping Aza. I have also stopped Salofalk tablets. So now I'm only using Salofalk enema and suppository.
Posted 9/27/2008 1:53 AM (GMT 0)
azathioprine was helpful (a little tiny bit) when I took it a couple of years ago. However, when they upped the dose, I became so nauseous on it. I was dry heaving every morning. I started taking ginger tablets and that worked to settle me down. but, then eventually I had to come off of it due to blood issues.

Prednisone is my friend. It worked the best to allay my symptoms. HOwever, I didnt want to be on it long term due to side effects... for me it was the constant hunger and moon face. I looked like a freak. I wouldnt let anyone take my photo for over 6 weeks until I stopped the drug and thankfully went back to normal.
Posted 9/28/2008 3:37 PM (GMT 0)
Thanks for everyone's input ... it is so helpful to hear other people's experiences with both medictaions. I am not as severe as many people on here and am very thankful for that. I did a lot of thinking this weekend and will try to work things thru with my diet. I have realized that stress has caused a lot of the problems with the inflammation - stress over this! lol I had a good weekend with things calmed right down so I am hoping to stay medication free ... the side effects otherwise are too daunting.
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