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Azathioprine stopped working?

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Ulcerative Colitis
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Posted 7/22/2014 9:24 AM (GMT 0)
Hi all,

Not been here for some time, thankfully i've been in remission from UC for several years (albeit with the odd mild flare that a short course of steroids sorted out). However lately I haven't been so good, recently all the symptoms of a flare are coming back, at first this was put down to me missing a couple of doses of Azathioprine and I was given a short course of pred to help (20mg and instantly taper) this took the edge off the symptoms but they didn't disappear, I don't feel 20mg was high enough tbh.

Since coming off the pred i've not forgotten anymore Aza doses for 2-3 months now but my flare seems to be getting worse to the point it's actually waking me up at night now too. Could it be that the Azathioprine has become ineffective for me? I've been on it coming up to 5 years now. Does anyone know what the options are after Aza? I can't take meselazine as I reacted badly to it.

Thanks in advance :-)

Post Edited (flufumps) : 7/22/2014 3:56:38 AM (GMT-6)

Posted 7/22/2014 9:45 AM (GMT 0)
So let me clarify this. You pointed out that you took Aza daily for 2-3 months. Does that mean the first 5 years you didn't? Honestly, then it's no wonder you're flaring again. Aza takes a while to kick in and not being on it regularly doesn't help. I know the doctors say that it is built up in your body. I can only tell from my experience: I miss a dose, I see slight symptoms. If I miss more, I risk flaring.

I was on Azathioprine before from 2005 - 2007. I started flaring after a couple of missed doses. The GI I had back then thought it was ineffective and took me off of it. When I got to the US, he even gave me a letter stating it was not effective enough.

My new GI didn't think much of it and started me on Aza again. Three months later I was in remission with the help of 60 mg pred (I was still bleeding on it) then switched to Uceris. Uceris took of the edge of my symptoms and when I finally reached the 8 week mark, I could stop it and stay in remission.

I agree that 20 mg pred isn't very much. Please do yourself a favor and take your meds regulary. I made that mistake of not doing it and it caused me a bad flare I couldn't handle for another three years. It doesn't necessarily mean your drugs stopped working.

Talk to your GI asap and stay on Aza as long as your liver is ok with it because it has helped you before.

I hope you get better soon.
Posted 7/22/2014 9:50 AM (GMT 0)
Hi,

No not at all, I've taken it solidly since 2009 but missed about 3 doses in a row one week (I was working nights and totally forgot!) what I meant by 2-3 months is I haven't forgotten a dose at all in that long so even if the missed doses affected things i'd have thought it should be working as it was again now. Sorry edited original post, I can see why it didn't make sense lol!

Thanks
Posted 7/22/2014 9:52 AM (GMT 0)
As I said you might need to talk to your GI about increasing the pred but stay on Aza as long as your liver is fine. Good luck
Posted 7/22/2014 9:54 AM (GMT 0)
Thanks Andrina, I haven't got an appointment with him until November now but I can see my GP and see if they can put me back on Pred and see how I get on.
Posted 7/22/2014 12:54 PM (GMT 0)
What dose of AZA do you take? What dose of prednisone did you take in the past?
Posted 7/22/2014 2:25 PM (GMT 0)
November is far too long but I think you know that. If you can't get with him, see if you can get with an assistant or another GI doc.
Posted 7/22/2014 3:21 PM (GMT 0)
I doubt Missing a few days made it ineffective, however, it seems like over time, everything I've tried has become ineffective, including 6mp... I am currently fighting to get back into remission and all the meds that helped me in the past are not working. Very frustrating. I think it's just how it goes unfortunately. Have you had the test yo see whether you're in the therapeutic range? I have and I am and still no luck... It happens
Posted 7/22/2014 3:28 PM (GMT 0)
Missing Aza for 3 doses in a week would not cause any complications, or trigger a uc flareup as Aza takes quite a long while to build up in your body. Missing a few dosages would not be something to worry about.

Could it be that the Azathioprine has become ineffective for me? Uc has a nasty tendency of getting worse in extent or severity over time. When uc simmers with small amounts of inflammation (not taken care of by your maintenance medication) then it can spread and get worse over time eventually causing a uc flareup. Either you might need a stronger dosage of Aza (if you haven't reached the maximum dosage yet) or you might need to add in an additional stronger uc drug to your prescription. Another similar medication 6mp, is prescribed in the 1.0-1.5mg per kg range (I am not as familiar with aza). I weigh 65kgs and take 75mgs of 6mp a day, so that is 1.15mgs per kg. I could be bumped to 100mgs of 6mp a day, should I get worse.

I've been on it coming up to 5 years now. Does anyone know what the options are after Aza? I can't take meselazine as I reacted badly to it. Generally, biologic medications (e.g., entyvio, remicade, simponi, humira) are taken in addition to immunosuppressive meds if immunosuppressive meds (e.g., Aza, 6mp, Imuran) are no longer enough by themselves. Either that or surgery are your conventional treatment options.
Posted 7/22/2014 3:33 PM (GMT 0)

iPoop said...
Missing Aza for 3 doses in a week would not cause any complications, or trigger a uc flareup as Aza takes quite a long while to build up in your body. Missing a few dosages would not be something to worry about.


I'm only saying how it is for me. Nobody ever believes it but if I even miss one day, I have mucus the next day. I don't know if I have a particularly quick metabolism or what. I have perfect poops otherwise so I'm sure my inflammation doesn't simmer (confirmed by blood work and recent scope). As I said it may be different for others.
Posted 7/22/2014 4:30 PM (GMT 0)
I definitely believe it Andrina, I just don't think that someone's overall condition would suffer for the long-term because of missing a few doses. I would think if you were to continue taking the doses after the missed days, things would get back to normal over time? If you miss doses, are you doomed to flare or can you get things back under control by not missing any more doses? I have missed doses here and there and haven't suffered any setbacks. Now I haven't missed any doses and I am not improving regardless shakehead

I am happy you're doing so well. smilewinkgrin
Posted 7/22/2014 8:43 PM (GMT 0)
Thanks for the replies everyone,

I'm on 150mg Aza which I believe is maximum dose for my weight now? Previously that dose has kept me very well generally aside from the odd very mild flare. Pred in the past was 40mg to start with I think so maybe that's what I need to see if it helps things. I can try to get seen sooner than November but he can be difficult to get hold of and I used to have an IBD nurse but she seems to have disappeared without a trace, that's why I may be better through my GP initially. It's becoming very frustrating, it's good to know there are other options for me if the Aza is the problem though!
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