The 1 month imuran effect(worse than colitis)

Hi folks,

This is my story with imuran(Love and hate it)

First try:100 mg
No issues till about a month. Symptoms improved considerably. Calprotectin labs came almost normal. At exactly one month into it, BAMM. Horrible horrible nausea. Was so sick i took 2 weeks off from work and gave up all medicines. The nausea was wayy worse than colitis. At this point i didn't really know it was the imuran which caused this because i was expecting imuran side-effects in days or weeks and didn't see any.

Second try:100mg
As i recovered from being very sick/nauseous. I started all my meds again. Things were all good again. I thought 'wow'. And BAMM the same horrible nausea at one month AGAIN. Ok now i understood that it's the imuran. Stopped imuran and in a few days got better(and colitis got worse)

Third try: 50mg
As expected, in a few weeks my symptoms came back and mesalamine was just not cutting it. I had to do something and started imuran again with 50mg. Symptoms improved(but not enough) with occasional spike in problems especially when take spicy stuff. Light nausea and some weird feeling in upper chest sometimes. but overall it was alright. This went on for many months. The improvement plateaued. I was almost happy overall but doc is not happy with Calprotectin levels and the inflammation being there which i know is bad.

Fourth try: 100mg
I wanted to get better and hoping for a miracle started 100mg again. Things got better. At 1 month i was feeling alright. I thought maybe because of the many supplements that i started lately(D, B12, Boswellia/curcumin/bromelain etc) i wouldn't crash again because of the imuran. But again At 1 month and a week the same old crash :'(. This was 3 days back and i stopped imuran completely. Now i feel better and planning to start 50mg again tonight.

Any of you guys experience this 1 month affect? Could it be because of the decreasing WBC? Any thoughts/help would be great.

Initial nausea is reported with imuran, about 20 percent get it. It's typically temporary and goes away within a few weeks. However, some do have an allergic reaction that presents the same but is much more severe in nature and those folks discontinue this med and try something else. So it really depends on severity, if it's bad then tell your gasteroenterologist you believe you're having an intolerance/allergic reaction with the nausea and see what he/she says. Some try prescription zofran and see if the nausea go away. Some have severe vomiting and clearly the allergy, and cease it.

Next would be biologics like humira or remicade if you pass on the imuran.

I definitely had some serious nausea for the first 8 weeks on Imuran and I have the odd day here or there when I take it without a proper meal. I take mine at night with dinner, it seems to work well for me now. It could be an allergy or sensitivity if your liver and kidney functions are all good or it could just need more time. It takes a while to reach a therapeutic level of the drug, so perhaps you are experience issues once your body has more in your system. Theoretically you don't need a thiopurine if you are on Humira although some folks do better with both.

Azathiopurine/imuran is metabolized by your body into 6-mercaptopurine which is what actually acts on your body. So taking 6mp directly, saves a step, and is half the dose.

Nausea could kick in later on. As it's typical to start at a lower dosage and increase dose over time.

I'd take all of the imuran just before falling asleep, with a light snack. I'd take them with food in your stomach for now, as it eases the nausea. Don't believe splitting dose helps at all. I hope zofran makes it stable. If the nausea gets worse, I would discontinue imuran and go for a biologic of your choice.

Biologics can be taken with or without imuran/6mp. Old school approach was take them with it to reduce the odds of your immune system creating antibodies against remicade/humira. Although the whole antibody thing is poorly understood and not predictable. See a lot more going straight to biologics and never trying imuran/6mp at all, these days.

I had bad nausea each time I started azathioprine. Each time it passed and it got me into remission. I was living on ginger for a while