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Imuran / Azathioprine and fatigue

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Ulcerative Colitis
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Posted 4/26/2010 7:42 PM (GMT 0)
Hi all, I hope you are all well!

I have a question for everyone on Imuran / Azathioprine. I have been on 100 mgs for about a year. I have been technically in remission since July 2009 when I last tapered off Prednisone.

I have complained of fatigue since this time last year when I got off Remicade and onto Apriso and Imuran. It was there but life was manageable. The last 3 weeks or so, my fatigue has gotten MUCH worse. I am really so tired that I am barely making it through my work-day (I work from 8:00 - 2:00 only). I am home sitting on the couch, I should be out playing with my 6 year old. Instead, I am letting her play on the computer and watch TV, something that I rarely allow her to do when the weather is nice. I wake up in the morning feeling so tired that it doesn't even seem like I rested. This is after going to bed last night at 9:00 but I slept essentially from 7:00 pm when I fell asleep on the couch to 6:00 am this am when I got up to get ready for work. I really could go to bed right now, but we've got homework and stuff to work on.

Since I had been complaining about my fatigue, my endocrinologist (too many "ologists" on my list the last couple of years) tested my thyroid levels mid February and all was well. I get my CBC and CMP tested every 3 months now on the Imuran and all has been well there, too.

Do you guys think that this is something to worry about? I have a check up with my primary care doctor next Monday, but I am wondering if I should wait that long? I know you guys on here have complained about fatigue and lots have taken yourselves off Imuran, but my colon has been so good! I am stuck!

Thanks for your help guys,
Jen
Posted 4/26/2010 8:01 PM (GMT 0)
Jen O:

I too am on Imuran and it has put my colon into remission with a solid BM once a day.  I was started on 200 mg and have dropped it to 150 mg.  I also get my cbc and liver function tests taken every 3 months.  I take it at night.  So, I was wondering if you take yours at night or first thing in the morning?  Also what is CMP?  I am not familiar with that test?  I am assuming you get your liver tested.  Also has your doctor considered lowering your dosage?  When I got my colon under control I requested I drop my level from 200 to 150 mg just to see if I could not take as much.  He stated that there have been documented studies which show that UCer's can drop thier Imuran usage once in remission and still stay in remission.

As far as myself is concerned I don't feel any side effects.  I think checking your thyroid out was very good.  How is your iron level and Hemoglobin level? 

MyUC

Posted 4/26/2010 8:16 PM (GMT 0)
MyUC,

CMP is a "Complete Metabolic Panel." In it is the liver function tests. Everything there has been good. My Hemaglobin was 13.3 last time, which is in the middle range of normal. I just looked on my test results page and I don't see iron there...

I talked to my GI in the fall. He said that actually I am on a low dose of Imuran. (100 mgs and I weight about 120#). At that time he said to keep it at 100 mgs, but I wasn't as drastically tired as I am now.

I take the Imuran in the am...never thought to take it at night. Buy I am wondering why it would be kind of OK for so many months and now become so bad so fast...could I have an infection somewhere?

Jen
Posted 4/26/2010 9:11 PM (GMT 0)
Could it be depression?
Posted 4/26/2010 9:18 PM (GMT 0)
Jen O:

Sorry about that goof, of course CMP is complete metabolic panel.  I knew that.  Anyways thanks for reminding me.  Could you have an infection?  Of course I guess one could but it would show up on your blood work.  Your wbc would be increased as a result, you would eventually run a fever, etc...  So, unless your blood tests come back out of whack I doubt you have an infection. 

Taking Imuran at night is Huge!  Many people feel tired and slightyly out of it when taking it for a chronic illness like ours.  So much so that on my Rx bottle it says to take it at night.  People just sleep off any side effects.  I would definitely try it at night.  I am surprised that your doc didn't even suggest it. 

As far as dosage is concerned I think 100 mg for a 120 lb person is medium.  I believe the dosage for Imuran is 1-2.5 mg/kg.  So if you weigh 120 lbs make that 60 kgms for simplicity.  So you could receive a dose of 60 mg to 150 mg per day.  I guess you could ask your doc to consider reducing it to 75 mg etc... 

Try it at night, see if it helps.

MyUC

 

Posted 4/26/2010 9:37 PM (GMT 0)
MyUC,

Thanks for the advice. I will for sure try it at night, if it is just that simple it would be wonderful!

Stupid question, then...I already took my usual 6:30 am dose today. Do I wait all the way until tomorrow night to take it again? It seems so long inbetween doses!

Durango: Nothing to be depressed about, so I don't think it's that! Thanks for the advice, though.

Jen
Posted 4/26/2010 10:13 PM (GMT 0)
Jen, could you maybe split your dose tomorrow, and take half in the AM and half in the PM? Just a thought.

Good luck!
Posted 4/26/2010 10:41 PM (GMT 0)
Jen O:

I would definitely take it tomorrow pm and not worry about the space in between doses.  There are plenty of people who miss a dose and just  take the dose the next.  So don't worry about taking it tomorrow pm.  I have gone a day or two without taking it with no difference. 

MyUC

Posted 4/26/2010 10:44 PM (GMT 0)
i agree w/my uc...i used to take it in the am and it was fatigue city for me!  then i read on here about taking it at night, and it has made a difference for me.  i take it at bedtime and crash out!  good luck - i hope that resolves it for you.
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