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Switching from 6mp to azathioprine

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Ulcerative Colitis
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Posted 3/19/2014 2:01 AM (GMT 0)
So, my 6mp hasn't reached a level of therapeutic benefit and my liver isn't tolerating it well. I'm slightly frustrated because my labs were taken 4 weeks ago and I'm just now finding this out. I've been really tired with dark circles under my eyes for the past week. My eye whites aren't quite yellow, but they aren't white either.

I'm atypical with my UC. I have full involvement in my colon, but I've never had urgency/blood/mucus. Constipation and throbbing pain throughout my colon is more my issue. I didn't feel like that was improving with the 6mp, but I knew it took time to work.

It looks like azathioprine has fewer side effects. Have those who have taken it found that to be true? With 6mp I dealt with nausea and headaches the first month. I'm curious what to expect with this new drug.

On a crazy side note, has anyone tried a nicotine patch for UC? My husband wants to me try it. I don't smoke, but he read smokers do better with UC.
Posted 3/19/2014 2:14 AM (GMT 0)
hey spartan.

i switched from 6mp to imuran. not sure if you will be able to tolerate it better though. i had high liver enzymes on 6mp and just got my blood work back on imuran. my liver enzymes are up again. i'm on the lowest dose possible so not sure what to do now. they really aren't that different in my opinion.

i use the nicotine patch, too. it has been the most helpful UC medicine i've tried since i was diagnosed. i get my patches at the pharmacy since i asked my GI for a script. they are really expensive but i get a month's supply for $20 now.
Posted 3/19/2014 2:22 AM (GMT 0)
Good to know about the nicotine patch. Bummer about the imuran. My doctor made it sound like the imuran didn't need to be metabolized the way 6mp does so it's less of a problem. Were you given any time off between drugs to let your liver find a happy place again? My doctor hasn't told me to take a break between the two, but I'm sorely tempted to do so. I don't have urgency issues, so giving myself two weeks to clear the 6mp out of my system is tempting. My doctor told me to finish taking what I have left of the 6mp (I have 20 more pills) and then roll to the imuran. If it's not a level of therapeutic benefit and my liver isn't handling it well, I don't see the point in taking more. I'm tempted to just not taking anything for the time I'd be taking the 6mp.

How do you feel when your liver enzymes are up? Are you a funny color at all? I have gigantic circles under my eyes. It's not normal for me.
Posted 3/19/2014 2:37 AM (GMT 0)
i honestly can't remember how much time it was between 6mp and imuran. i've had to stop them both a few times due to the liver enzyme problem and also neuropathy. i was on 50 mg of 6mp as my highest dose and now i take 50 mg of imuran (this is equal to 25 mg of 6mp). the imuran is easier to modify doses since it's half the strength as 6mp.

what's your dose now? i only take the imuran just because it helps biologics work better. i don't get any benefit from the imuran/6mp by itself.

i'm kind of used to not feeling "awesome" so i never know when my liver enzymes are up. i'm tired a lot but i figure that's just from all my meds. i'm not a weird color though.
Posted 3/19/2014 2:41 AM (GMT 0)
I've been taking 75mg of the 6mp and I think she said I'll be taking 125mg of imuran. I know I'll be taking 2 pills. versus 1 1/2 of the 6mp.

I was telling my doctor I wish I could sort out what I feel from UC and what's coming from the drugs. Thank you for your input!
Posted 3/19/2014 3:03 AM (GMT 0)
I was able to use allopurinol with 6mp to get my liver enzymes down and my therapeutic level up but it can cause other side effects. It could be worth mentioning to your GI to see if it's an option for you. Not sure how Imuran would work for you considering your history but it may be worth trying. It sound like your symptoms aren't that severe if you don't have blood/urgency. can you try rectal meds and 5ASAS?
Posted 3/19/2014 3:05 AM (GMT 0)
Yeah, I had to go to allopurinol too. I also take 25mg of Imuran on the weekends.

I felt totally normal when my liver tests were wonky. I don't mean healthy, but I sure could not tell any difference between the week of the weird test and the weeks 'resting' before restarting at he lower dosage.
Posted 3/19/2014 3:09 AM (GMT 0)
Spartan, I did the reverse of your situation. I took Imuran, which I couldn't tolerate, and switched to 6MP. I was told 6MP is the broken version of Imuran. I had the same dark circles and people told me I looked worn out and not myself. There was no lag time between the two drugs for me...however, I was curled up every day with a bowl by my side bc I was so nauseous on Imuran. I think I only last two or three weeks. Miraculously, I could tolerate the 6MP much better but I did deal with fatigue.
Posted 3/19/2014 10:18 AM (GMT 0)
NotSoSick, I'm already on the Canasa and 5ASAS. I neglected to mention that. It helps keep my swelling down and I'm looking pretty good on a macroscopic level. My pathology results continue to get worse from my biopsies, so my gastro is trying to find the right combination to stop that. Last Fall, my biopsies showed chronic disease in my descending and active acute in the remainder of the colon. After being on the rectals and 5ASAS, all of my ulcers cleared up on a macroscopic level, but my disease has continued to worsen to the point my biopsies on my right side are starting to take on a chronic presentation.

My situation is definitely unique. My UC causes me to lose motility. I didn't know I was even ill until last summer when I suddenly (probably not to suddenly if I'd known what to look for) I couldn't go to the bathroom...even after 3 weeks of bag enemas, laxatives, softeners, mag citrate, etc. My initial diagnosis came from an ER CT scan. With how sick my colon is and how few of the traditional symptoms I seem to show for it, it's hard to know without an actual scope if I'm improving. My platelet count is my only elevated inflammation marker. My WBCs and CRP were up early on, but they're great now.

This feedback about the Imuran is helpful. Madpotter, I need to circle back with my doctor because I feel she told me the Imuran is the broken version of 6mp. I'm so glad to have this forum to compare notes.

Tornado, I'll ask about allopurinol, too. All of these drug names are hard to keep track of. We'd all be great spelling bee contestants.
Posted 3/19/2014 4:38 PM (GMT 0)
i started out first with imuran but my enzyme went way high, i then switched to azathioprine and they added allopurinol to the mix and my liver enzyme level went back to normal.
Posted 3/19/2014 5:15 PM (GMT 0)
I don't have any side effects from the azathioprine. Been on it since September 2013.
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