Not metabolizing Imuran well

Apparently I'm not metabolizing Imuran very well anymore. I was on 150 mg and I had to go down to 125 mg. My nurse threw a few numbers at me and I didn't understand what they meant. She said before my count was 16k, now it was 8k which was better but still not good. Whatever value that was...

So she had me go down to 100 mg and I told her I'm going to flare on this dosage. She suggested to do a 100 mg one day, then 125 mg next day and 100 mg after that and so forth. I find myself going to the bathroom more frequently again but thankfully no symptoms (yet). I'll be crying if I find mucus!

My weight was 129 lbs when I last checked (my scale broke) and I don't know if that's the correct therapeutic dosage for my weight. I'm really afraid to flare because Imuran is the only thing which helps me at the moment. I have been on Remicade a few years back however I cannot afford it since I'm in the USA and I don't even know if I have antibodies or not. Humira didn't do anything for me.

When I began with 150 mg my weight was around 130 lbs (58 kg) and I think that was a good dosage for my weight. After a flu in December 2013 I dropped 5 lbs and couldn't gain that weight back. I was around 123 - 125 the whole time up until recently when I ditched my Nuvaring and got my appetite back. My point is, to me it seems like since I lost weight, my metabolism didn't work well with Imuran anymore and I was hoping I'd tolerate it better again when I gained the weight back.

We're going to do another Prometheus test in 5 weeks. I told my nurse that I cannot keep doing them (we did 2 already) because I cannot afford them. They're $270 per test. I tried to correct my blood work with vitamin B12 which seemed to help at first but it really didn't. My blood cells are too big which could mean that Imuran is causing this. My liver is OK at the moment but my GI really doesn't want to take any risks.

I'm not sure what do think about all that and I don't understand most if it either. I just really want to keep my Imuran and stay in remission

I am sorry to hear you are struggling. I really don't have experience with Imuran so I can't offer any help there. Have you tried rectal mesalamines in the past? Also what about Entyvio as a biologic option?

I was going to suggest that allopurinol could be an option to help you metabolise the imuran.

Allopurinol,would be able to help. I don't think you half the dose necessarily but you lower it a lot. You would probably go to100 and see who your labs look. You can get much more therapeutic benefit from a much lower dose with allo and it alleviates negative impact to the liver. I think I would get a second opinion. It sounds like a perfect solution for you, at least worth a try if you get frequent monitoring. My therapeutic level went from very low to very high when I added allo and my toxicity went way down

I could not tolerate Imuran. Surprisingly, I could take 6MP much easier. I would switch to 6MP.

I'm usually able to tolerate Imuran. Sure, I'm tired but I'm also working night shifts.

I went on 150 mg the first time because I still had symptoms on 100 mg. That was back in Germany. 150 mg did the trick. Now my liver doesn't like it anymore and I'm scared to go down. Not to mention that I weigh more now.

I finally reached my goal weight of 130 lbs and I couldn't be happier.

We'll redo the tests in December and go from there. I just hope it comes back good. I do seem to have bowel problems however. I go more often and I'm cramping. I hope it resolves soon.