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Increasing Azathioprine

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Ulcerative Colitis
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Posted 2/14/2019 12:18 PM (GMT 0)
I’ve been on 150 mg Azathioprine for around 6-7 months and I still have not achieved remission. My doc did a blood test that showed the levels in my blood were sub-therapeutic so he decided to increase my dose from 150mg to 200mg. Has anyone else had this experience? I’m nervous about upping the dose. I’m a 145 pound female so it seems to be on the high side.
Posted 2/14/2019 12:43 PM (GMT 0)
There are two enzyme levels they need to test - 6MMP is the azathioprine and then another one which the aza gets metabolised into whose name i forget. If the second one gets too high while trying to get a therapeutic level of 6MMP then it becomes dangerous for your liver and kidneys. That happened to me when i went from 100 to 150mg (not sure of my weight in pounds, maybe 130?). So then they can add a drug called allopurinol to prevent azathioprine being metabolised into the other enzyme. And then because the aza becomes more potent in this situation you can reduce the dose (i went down to 50mg).
Posted 2/14/2019 4:06 PM (GMT 0)
A typical UC dose of azathioprine is 2.0 to 2.5mgs per kilogram of body weight. You weigh 145-pounds or 67-kilograms. A typical UC dosage for you would therefore be 134-mgs per day (67-kg x 2-mg) at the low end, and 167.5-mgs (67-kg X 2.5-mg) at the high-end of that spectrum. You've been on 150-mgs, the high end, for 6 to 7 months without a response and being sub-therapeutic.

Hmmm, I'd consider a different medication. Considered biologics (remicade/humira)?

If you did decide to go forward with 200-mgs of aza, then I'd first get the Thiopurine Methyltransferase (TPMT) blood test, just to make sure you're not going to get any bad side effects (something more pronounced at higher dosages). It's not to say higher dosages cannot be used for UC, however, you're talking about an outlier, and far from the norm for us.
https://labtestsonline.org/tests/thiopurine-methyltransferase-tpmt
Posted 2/14/2019 5:42 PM (GMT 0)
Thank you for your responses! I looked back at my lab work and my doc did the TPMT test before I started the aza and my levels were normal. He said he would like to try this increase but if it doesn’t help or I develop side effects I will likely move on to Humira. I’ll try the increase in aza but I’ll be on the lookout for side effects. I’m having bloodwork done in a month so we will see.
Thanks again! I like to be informed about my meds but I get a bit overwhelmed trying to filter through all of the research and information I find online.
Posted 2/14/2019 7:13 PM (GMT 0)
I remembered now, the other enzyme is 6TGN. So for azathioprine to work the 6MMP needs to be in the therapeutic range without the TGN going too high. 11% of people produce too much TGN and when you're one of that 11% adding allopurinol can induce remission (in my case it reduced my symptoms within days but i still could not a remission)
Posted 2/15/2019 9:34 PM (GMT 0)
I was on 125mg AZA for years. I weigh 60kg. It didnt work. I was upped to 150mg and I got neutropaenia. And had to come back down. After initial success in early years, I never had any real improvement.
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