How quickly did Azathioprine work for you?

Sorry, you're not going to feel any effect for at minimum 6-8 weeks with immunomodulatros like Azathoprine. To understand why, lets take a look at what Aza targets and how. When we're flaring we have sky-high White Blood Cells (WBC) totals within our body (above the normal range in tests), and you can see that in your recent Complete Blood Cell Count (CBC) blood test results, if you have one. WBCs are your immune system's attack dog, directly causing inflammation within your body, in this case our large intestine which we feel as the awful UC symptoms we all know and loathe. What Azathioprine does is it slows the rate in which your body can produce new WBCs. Aza cannot do anything about the WBCs that currently are present within your circulatory system and we must wait for our body's natural blood clearance process to get rid of the WBCs we currently have. When our old and formidable WBC forces are replenished with new, greatly smaller force is when our bodies can begin the actual healing process, and we feel better and notice less UC symptoms. And that's a process that can take at least a few months.

The reason the 3 month figure is often cited is due to nearly everyone being started at a very, very low dosage of Aza. It takes 6-8 weeks for that very low dose to have a tiny impact, and during that timeframe your dosage is increased again to an ideal therapeutic (healing) dose, which then takes another 6-8 weeks to be noticeable.

With low TPMT you are more likely to need a lower dose of Aza and are more prone to myelosuppression. It might be a little harder to get you into an ideal therapeutic range on Aza alone (redo the Thiopurine Metabolites test to see and ask about using Allopurinol in addition to it, if needed to get within an ideal therapeutic range). Your doctor should be keeping an eye on your CBC blood test results and see where the numbers move after a couple months and further down the line as well. You should see less WBC and that's what the treatment goal aterall. Myelosuppression means it may not be just WBC that drops, it could also be RBC, Platelets and/or other blood components might drop as well and that wouldn't be good. Nothing to worry about but just something to be aware of and dosing cane be adjusted should additional numbers fall.

Do ask about allopurinol. I dunno exactly how it works, but it somehow increases the potency of azathioprine (or 6MP), so that lower than normal doses are required for the same therapeutic effect. It also reduces liver-related side-effects, making it less toxic.

I personally wouldn't stop the rectal meds until azathioprine has had enough time to kick in - about 2-3 months from starting it. Also, there is no point in spending 8 weeks at a sub-therapeutic dose before increasing it. Maybe 1-2 weeks, while your body adjusts to the medication, then - once the nausea has passed - increase it. But yeah, definitely look into taking allopurinol, so you can actually get some benefit from that low 50mg dose.

Thanks NiceCup of Tea and ipoop. I suspected so about the rectal meds. Do people still use them to help maintain a remission when they are stable on stronger drugs?

Thanks both for explaining Allopurinol. I will definitely ask as I have been told I can not take any more than 50mg of Aza as for some reason my body holds on to meds for longer and so it would be dangerous.