Cannot tolerate Imuran - what can I use instead?

Hi guys,
I would really appreciate your help with possible treatment options. I'm in the unfortunate situation that I am only really able to tolerate mesalazine tablets fine, but after that my options seems to run out which leaves me in a predicament when I start to flare.
I suffer from painful bladder/recurrent UTIs which seems closely linked with my UC but my bladder never feels great. If I take prednisone I am in excruciating bladder pain that can last for weeks/months, so much so that I'd rather do without the steroids and take my chances with UC which is saying something!
I tried Imuran years ago and within 45 mins of taking my first tablet, I was vomiting uncontrollably and couldn't stop for 6 hours and have never felt more sick in my life. My gastroenterologist wanted to try it again a year or so ago and I began vomiting uncontrollably again and nearly wound up in the ER. Does this mean I wouldn't be able to take 6-MP as well?
I currently manage it with mesalazine, probiotics and fish oil but it's not always enough. I have tried enemas before but if I have a formed stool but start going downhill with blood and mucus, the enema tends to add diarrhea into the mix.
I had some success with tacrolimus but it interferes with my warfarin therapy (which I take for another condition) so I feel quite stuck. I see my main options as being 6-MP or some suppository treatment but just wanted to see whether I've missed anything that may work for me?

The first time I ever took it, I took it without food. So, remembering that terrible vomiting, I took it the second time with food. But to be honest the vomiting was so severe/hospital worthy (for awhile I was worried I'd keep vomiting so severely I'd haemorrhage) that it wouldn't have made a difference. And then the full body pain which prevented me from getting out of bed the entire day. And I NEVER respond like that to anything, no more nauseous than the next person.
For the UTIs I have quite a bit of success with D-mannose, can't take cranberry because I'm on warfarin and it interacts but used to take it, and have tried uro-vaxom with variable success. There's also a vaccine called Strovac (from Germany) that I'm considering trying. I read somewhere that in people with recurrent UTIs, the E. coli remains in the cells of the bladder wall dormant and then come out and that's what mine feels like, it's always "there", like my UC, sometimes it's quiet but I know if I do the wrong thing it'll show its face again

I would assume your reaction to Imuran and 6MP would be the same.

I'd say biologics are next (remicade, humira, simponi, or entyvio). I'd certainly discuss the reoccurring UTI with your gastroenterologist before starting biologics as these medications increase the odds of getting those types of infections, and make them more severe. Having a current infection might mean not taking or delaying the biologic dose. Entyvio is the only gut-specific biologic, so it might be better and perhaps not impact UTI's? I've read entyvio has less odds of systematic infections than everything else.

The thing that puts me off is that I have relatively mild disease which I manage with mesalazine and probiotics. Going to biologics next seems extreme based on this. I feel that there are rectal meds etc that I could explore first, and not only that but if these medications affect my bladder then I may as well use the prednisone. I also disagree fundamentally with taking a disease that doesn't have a mortality and giving it one so I am quite against biologics and the pharmaceutical industry's obsession with only investing in biologics because they can charge a fortune (despite numerous studies showing patients and doctors alike don't want them).

if you don't feel like your disease is severe enough to warrant biologics, or you're not interested in taking them, perhaps you can get by without doing anything. if you're not going A LOT, and you're getting regular preventative scopes, you may be able to stay ahead of things. If my situation was mild, I wouldn't have moved up the ladder, I would have monitored, and dealt with an extra BM or two a day. The problem was that I was going 20x+.Definitely add the rectals when needed - it sounds like those alone could keep you in good shape. From what you've explained, it doesn't sound like it's necessary for you to do much. Why change things if you're not experiencing symptoms? Uceris may be an option if you need it.

I think it would be worth trying uceris, but only if you're in a real bind and nothing else was working for you. it sounds like you don't do great with steroids. I noticed, for me, that Uceris has WAY less side effects compared to pred, so it may be a good option, but i wouldn't bother trying it until you try some of the rectals. I think it's normal to have some looseness the first BM after a liquid enema, but it shouldn't go on like that for a long period. After you've healed, it should be more normal. I feel like after I healed I passed the contents more like little pebbles the following morning. When things were bad for me, there was no way I could use liquid anyway, I couldn't retain anything for even a moment. You should see about foam enemas. They have both steroid and mesalamine (in some places, not in the US unfortunately I don't think). There are even Uceris foam enemas - which might be great for you to try. Suppositories are good too for treating the way end, often the enemas miss that area. I used to use the foam and then follow with a suppository when things were rough (you can do this morning and night). If you're not really struggling, and you react badly to the majority of the medication, it's probably a good idea to try to get it under control with the rectals, probiotics and diet. If all that fails, then you worry about the next steps. I don't think you're there yet.

Thanks so much for your advice NotSoSicklyGirl, that was exactly the type of info that I was after. I will definitely try the Uceris foam and think I will do better with that than liquid, it's weird but the morning after I have a liquid enema, I am going to the bathroom about 10-15 times and just passing liquid, which then seems to damage my intestinal lining and make my UC worse until I am no longer able to pass any stool (even if I'd previously only had a little bit of blood and mucus and formed stool) so I don't know what that's about. I've also ordered some nopal leaves and kefir grains and am going to try those in a bid to pull me out of this flare.

In response to DB and iPoop, there is a paper by Khan et al. 2012 which discusses patients attitudes to FMT and their dislike of biologics. I have also met a number of people with different conditions including IBD at support groups who feel the same way about biologics, that they would like less 'severe' medications. But I thought all that was generally known, which is why a step-wise approach is used for IBD treatment (and many others, including RA) with biologics at about the third step instead of first-line.
DB you are right that there is a difference between research medicine and a for-profit patented medicine production industry, I should know having worked as a researcher in the former and now working in the latter. My problem is that when you look at the funding disclosures of many of these "independent researchers", there's no such thing.
There was an extremely interesting article about three or so years ago that looked at pharmaceutical-related deaths, and there were the biologics in the top ten behind morphine - I'll try and find it. And while the risk of 2-4% for infections (yearly I would imagine), 0.04% for lymphoma etc, that all adds up, particularly when you aren't actually taking away the UC entirely which I am aware does also have an increased risk of thrombosis events. You are all entitled to your opinion and if you've had success with biologics then I wish you nothing but the best, but I was just talking about my personal preference and my reason for it. I'm sure if I get desperate enough I will use them, but like NotSoSicklyGirl said, I just don't feel there yet.

UCTUCTone one I can certainly sympathize with you, I was diagnosed at age 13 and have been living with this dreaded disease for 20 years, it gave me such a shock the other night when I realised it had been that long! Although in many ways it definitely feels that long! I'm so glad remicade has worked for you and I like to have it in my back pocket, but I don't want to go straight from mesalazine tablets to remicade, I feel there are hopefully some things in between for me, starting with rectal meds.