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Imuran Question

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Ulcerative Colitis
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Posted 7/21/2010 8:21 PM (GMT 0)
I had my first colonoscopy in 7 years last Friday.  Over that time I have had maybe two flares and felt really good.  My GI doctor, who is one of the best in my area, said that my UC has gotten some worse, but not severe.  Before the colonoscopy, I was taking 8 asacol a day and that was all the meds.  My doctor wants to be proactive and get me into remission, which I felt I was already there.  I have about 3 BM's a day, sometimes less, with no blood and very minimal mucous if any.  He has upped my asacol to 12 a day and started me on one Canasa at bedtime.  He also did some bloodwork to see if I can take Imuran.  I feel like I dont need a drug that is that strong.  Plus, I do not like the possible side effects of this drug.  Can any of you give me some input on Imuran and why he would want me to take it at this point?  Thanks.
Posted 7/21/2010 10:09 PM (GMT 0)
Hey Volsfan,
Well I will act as "Mr. Negativity" toward Imuran (Azathioprine) as I had serious side effects to the drug - but many others do just fine. This is indeed a strong drug given the symptoms you have described - and the list of potential side effects are as long as your arm (just google it).

I guess I understand your docs desire to be proactive but one scope in 7 years to determine that the UC has become "somewhat worse but not severe"? Compared to what? I had a scope two weeks ago and the UC in my rectum was so bad my GI could not pass his scope past my recent surgical site (about 7 inches up the rectum). Yesterday, I went in for another and the UC is completely cleared.
So again, I would question how the Doc is making a determination about how much worse the UC has become based on the symptoms and the length of time between scopes?

In the end it is of course something you and your Dr. should determine together but I would proceed with caution (which it sounds like you are doing anyway).
Good luck,
Posted 7/21/2010 10:17 PM (GMT 0)
Some Docs seem pill happy. If I had your symptoms, I would consider myself in remission.

I had a bad reaction to imuran. My body just went crazy after taking it a few weeks and my liver labs were off the charts. The doc had me rechallenge and the only difference the second time was the allergic reaction was immediate instead of delayed.

My experience is that once you start a new drug, it is very hard to stop, so I prefer the minimalist route myself. 12 asacol/day seems reasonable. Why not see if that alone helps before moving on to the big guns?
Posted 7/21/2010 10:55 PM (GMT 0)
I recently started taking 6mp and I haven't had any adverse reactions to the drug. I don't think I would take it if I were in your shoes because your symptoms are so mild. While I do consider 3 movements a day to be more than "normal" and it sounds like you have visible inflammation, it is definitely something you can live with and as long as it doesn't progress, you shouldn't be required to be on stronger medication.

Have you noticed any changes in your symptoms since starting the Canasa and increasing your dose of Asacol? Maybe that will be enough to get you down to 1/2 stools a day? Did your doctor do basic blood work to see if your counts are elevated? Maybe he is worried about ongoing imflammation and the effect on your health? I started 6mp because I was in a massive flare, on prednisone and every time I tried to drop down to 0mg, I would have a relapse. I think this is why most people end up on the drug.
Posted 7/22/2010 1:54 AM (GMT 0)
This seems weird to me that your doc wants to put you on Imuran when nothing seems to really be 'wrong.'

When I went on Imuran, it was because the Lialda (higher dose Asacol) wasn't working, and I needed to get off the Entocort. This was in January of 2009. I began Imuran then, and I didn't have a problem until this month: a few weeks age actually. I got into a rash on my arms (from the Imuran, first side effect really, ever) and then I got a little flare that turned into a little bit bigger flare, and now I'm back on Entocort. =|

If you had to go on Imuran, if your body allowed it, it's not the end of the world. You'd just have to be careful around sick people, wash your hands often, and be careful out in the sun.

However, if you're feeling as well as you say you are, I don't think you'd have to take Imuran just yet. You're not on your last try of other drugs first...
Posted 7/22/2010 1:33 PM (GMT 0)

I can try to help clarify.  I too have used Asacol.  I used it for about 10 years.  My colitis spread and got worse even though I was taking 8-12 pills a day.  The enlightening part of that story was that overall I felt pretty good.  Meaning there were times I didn't even feel like I had colitis and then there were times I had really bad bleeding, diarrhea, etc...  During one of my good times (colitis was good) I had a colonscopy and biopsies taken.  The pathology reported moderate and chronic inflammation.  So, even though I felt good there was a lot of inflammation present.  Second the bloodwork that you have taken for taking Imuran is just blood work to see if you have the enzyme necessary to metabolize Imuran.  You may never have to take it but if you do you will know you can. 

Bottom line, there can a hugh discrepancy between how one feels and what is actually going on a microscopic level.  I am saying that is what is going on with you, but that may be what your doc is thinking.  Have you gotten your path reports back?  Or is this just your doc talking based on what he sees? 

Based on your description I would be in no rush to go on Imuran.  I however was in a totally different place.  I had rampant inflammation in my colon and prednisone and Asacol weren't even touching it.  Imuran got things in order for me. 

Hope this helps.

MyUC

Posted 7/22/2010 5:43 PM (GMT 0)
I have gotten by path reports back.  From the reports, my doc said that my uc in the rectum area was really inflamed.  However, my colon had some blotchy spots of uc here and there.  I have never taken any suppositories for my uc and he gave me Canasa.  I already feel better from using the suppositories.  Maybe using more of a dosage of Asacol and the Canasa will work.  I definitely want to give these drugs the ample amount of time to work before going on the Imuran.  Like I said, no blood, very little mucous, diarhea from time to time, no cramping, some gas.  My doc just tends to heir on the side of caution, which I like.
Posted 7/22/2010 6:14 PM (GMT 0)
Volsfan:

I am in total agreement with your last post.  I think at this point you have the right attitude and I would follow what your are already doing.  I feel bad that I wasn't of much help but good luck to you.

MyUC

Posted 7/23/2010 2:34 AM (GMT 0)
I personally wouldn't be satisfied with 3 BM's a day, but if Asacol gets you to that, then the upped dosage and supps may be helpful and get you further into remission. So I'd stick with that til your UC gets worse, if it does.
I'm on Imuran, works great for me with no side-effects.
Posted 7/23/2010 4:50 AM (GMT 0)
hello,

I've been on imuran for 4 yrs now. I have had wonderful results with it. However, I still get my flare ups but no blood or cramping in 4 yrs till the past week. the only problem I had with imuran is my leg muscles get weak. Other than that i've been fine.
I went on the imuran because my doctor didnt want me going on a steriod again.
Your doctor can start you out with a low dose of course of imuran and work it up if needed. But see how you do maybe with rowasa enema's or something along those lines first if you feel more comfortable.

Good luck with everything, Keep us posted
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