Prednisone tapering on Azathioprine...

Hi all,

There's been several questions on prednisone and I wanted to throw another out there to see if anyone has had similar issues as me. Currently, I am on 4x Lialda and 100mg Azathioprine (week #8) as well as prednisone (down to 17.5mg, tapering 2.5mg/week).

It's really hard to tell if Azathioprine is "working" since I need to fully get off pred first. I am noticing that once I recently hit 20mg of pred, I started to feel "sick". I wouldn't classify this as a flare (BMs are ok) but dull pain in the stomach, more gassy and much more sensitive to foods (especially diary). I recently started Prozac as my anxiety was amped up as I feel very jittery (I do drink a couple cups of coffee a day).

My question...is this just what to expect when tapering off of pred or is the Azathioprine not fully kicking in yet? I have read where Azathioprine takes ~3 months to work but I am confused if a lot of what I am feeling is due to my tapering so I am hoping there are others that have a similar experience?

Thanks in advance.

Yeah. I'm guessing the AZA hasn't kicked in yet and that's why you feel that way when getting down to the lower doses. What you describe are not typical prednisone withdrawal symptoms. It sounds more like your flare returning because the AZA is not working yet.

I'm in a similar boat.

Started 25mg aza/Imuran about 6 weeks ago, just last week upped it to 50mg a day.

My GI says it takes about 3 to 4 weeks to start working but I constantly read on here 2 to 4 months. Whenever I get below 15mgs of pred, I get sick. I'm scheduled to see my GI again in about 2 weeks and if I'm not good by then, then we are going to possibly switch me to remicade. I'm just wondering if, by then, we have even given the Imuran enough time to start working.

I'm supposed to taper down to 10mgs of pred later this week. Every time I have done that in the past 6 months, I have gotten sick again within a few days. Just hoping this time will be different and the imuran is working and I can finally get off pred.

If Azathioprine isn't fully kicked in yet, then you'll see a steady increase of uc symptoms as you reduce/ taper prednisone. If you start regressing then hault the prednisone taper, and contact your gastroenterologist for instructions. He/she will likely have you wait longer before dropping your pred dose again.

100 mgs of aza isn't much, unless you're light, what do you weigh? It's usually around 150mgs...

man, since I've joined this site about a week ago I feel like my GI has no clue what he is doing.

Read my signature below.

So many people have mentioned rectal meds, which I never even knew existed, before introducing aza. Also seen people saying to up the Asacol doses before that too. I keep telling my doc that whenever I fall below 15mgs of pred then I get sick and even last week he told me I should go down to 10mgs this week. This week is about my 5th or 6th week on aza so I figure once I drop to 10mgs of pred I will get sick again. I mentioned this to him and asked if I should just up back to 15mgs if it happens and he told me to call his office. Now it looks like I'm not even taking much aza to begin with and for the first month he had me only taking 25mgs of it a day.

The standard azathioprine dosage ranges are based on weight and can be googled. I'm only 119lbs and take 150mg - over dosing based on norms but it is what works for me... And has for many many (14) years.

Re comment about time to kick in - as others said it is a few months. Somewhat taken aback by speed some docs appear to what to move up a level. Not giving drug time to work let alone get the dose right.

As for pred issues: I struggled off pred a number if times. The last time I kept sticking at 10 - and flares restarting and back in hospital I went. What worked for me was a very slow taper ... Dropping 1mg/2mg per month. Yes that slow! But it worked.