Starting Imuran with very small dose?

Hello to all. I'm 39 years old, from Romania.
Suffering for a long time. I weigh only 54 kilos at 1,78 m height.
I have been diagnosed with ulcerative colitis (although a second opinion I got was Indeterminate/Nonspecific colitis, but definitely IBD, since bowel mucosa is modified and calprotectin is around 2500).
Although I have 1 stool every 3-5 days, with only small traces of blood and insignificant/almost no anemia,
it seems I need to start Imuran (doctor's recommandation). Pentasa & co doesn't help (makes it worse) and I don't tolerate corticosteroids.
But since Imuran listed side effects seem dreadful, and I fear nausea, could I start it very gradually?
What negative effects should I expect from a small dose (12 mg)?
Thank you in advance for sharing opinions and experiences with Imuran.

For a 54 Kilogram patient, a 108mg to 135mg per day dose of Imuran would be typical (dependent on getting good bloodwork). I do not think 12mg daily would be any different than taking a sugar pill.

Nausea is experienced by 20% of UC patients, take it before bed with a snack to reduce the odds of it. I have never experienced nausea or any side effect from it, myself!

Seems overly cautious to me, especially with a medication that is incredibly slow working (3-months for a typical dosage schedule to reach ideal therapeutic/healing levels within the body). Internet horror stories are available for everything, and represent outliers (rare incidence/occurrences) that will only feed your anxieties.

Thank you, guys, for all the fast responses and encouragement.
Anyway, if things went well/acceptable, I intended to increase the dose fairly quickly (at least until 50 mgs), not stay weeks on just 12 mgs.
1-2 days at 12 mgs, next 2-3 days at 25 mgs, then 1 week at 50 mgs, something like this.
It's not just the Internet horror stories with Imuran that got me scared, it's also my own personal history with testing/introducing antidepressants - I've got many, many bad experiences with those drugs with terrible side-effects. Headaches, but especially nausea.
And since I already am very thin and every meal is a tedious chore (I have zero apetite), nausea is all that's missing right now...
I'm sorry I sound like such a kid, but it's difficult. Force eating.

FSLondon said...
As for the horror stories about Imuran, remember that what you read on the internet is often the worst of the worst. Very few people bother to take to the internet to announce that they started a new medication and had no side effects. Do remember if you do have unwanted side effects that's something you can discuss with your doctor and then can adjust your medication.

Truth! It's just like those comment cards available in most restaurants, hotels, etc. The only people who fill them out are those who had a horrible experience. Those who had a delightful meal or stay at a hotel don't bother.

The other thing is a that many of these horror stories are anonymous, unverified claims on the internet, and there's no guarantee that what they experienced was indeed due to the medication taken. If I took my morning medication and got mugged in the afternoon, was that mugging directly-related to me taking my medication that morning? Correlation does not necessarily equal causation. I would recommend carrying a healthy skepticism with such things.

Everything has risk, and side effects do occur. However, it is always a good idea to put the odds behind those side effects. The Crohn's and Colitis Foundation of America has a good presentation and transcript that talks about the odds of various side effects and the benefits of taking the medications. If you want to take a deeper dive into risks versus benefits then this is a good place to start:
Webcast: programs.rmei.com/CCFA139VL/presentation/player.html
Transcript: http://www.ccfa.org/assets/pdfs/risk-and-benefits-transcript.pdf