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Blood counts high on Imuran - questions for doctor?

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Ulcerative Colitis
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Posted 11/19/2009 5:32 PM (GMT 0)
Hello all,

I've been on Azathioprine/Imuran 150 mg. about 3 weeks now and my UC has been definitely improving.  But, I just got the results from my blood test Mon. 11/16 and my liver counts are pretty high:  Alk Phos 7 times higher than normal, ALT 128, two and half times higher than normal, and AST 277, 7 times higher than normal.  I researched sites last night looking for numbers related to Imuran, but couldn't find any.   

While I'm having some upper digestive pains, I honestly feel so much better, I think I would put up with the liver problems if I could continue to feel this good. 

I'm seeing my NP this afternoon and wonder if anyone could suggest questions I might ask her.  Has anyone had numbers like these on Imuran?  Is it just a dosage problem?  Were you able to continue to remission on lower dosages?  What would you ask your doctor?

I'm also still on prednisone 10 mg, tapering to 1/2 next week.  I think the prednisone has helped only a little getting me out of this flare. 

Thanks for any suggestions you might have.     

Posted 11/19/2009 7:25 PM (GMT 0)
I'm not familiar with the numbers that come from the testing but I do know that you do NOT want to put up with liver issues to feel better from Uc. You can live without a colon but you can not live without your liver. You can always see if you can lower your Imuran dose and see if that helps but it may be that you aren't meant to take this med. But it's good that you are going to the docs office so you can talk to the NP about this.
Posted 11/19/2009 7:31 PM (GMT 0)

Thanks, Red.

I'm off in a bit and I definitely hope it's just a matter of changing dosage. 

I'm amazed at what I could be willing to accept to get away from the symptoms of this disease, sometimes.  I definitely don't want more issues but the relief I've had this past week has been like a vacation. 

Thanks again for responding. 

Posted 11/19/2009 7:41 PM (GMT 0)
Ugh, that's exactly what I'm afraid of with Imuran. I got my first blood labs back yesterday and they're normal but I do not want to tax my liver. I think red's right, there are other ways to stay in remission via other drugs, dosages, or just quitting it all together. But doing damage on top of damage, I'm not a fan of. I'm attributing all my upper gastro funk to Imuran because I never used to have it, now I kinda do. Let us know what the doc has to say, please. I'd like to hear about it...
Posted 11/19/2009 11:25 PM (GMT 0)
100 mg of imuran put me into remission 3 yrs ago. I reduced to 50 mg after being in full remission (entirely clean colon). I'm now in flare again but the three yrs was, as you said, a vacation. I'm back up to 100 mg and am hoping it worked as before but am more prepared, mentally, in case it doesn't. Don't throw good organs after bad.
Posted 11/21/2009 1:53 AM (GMT 0)
i was on imuran for about 4 weeks and my liver counts were through the roof.
i had to stop. it means you are intolerant of it.
can't take it anymore. dr should take you off it with counts like that.

also, i had upper digestive pains too and it mimicked or was gallstones.
went to hospital in ambulence, was there for a few days.
had the pain for about a week tho.
very intense horrific pain that you cant get away from. it sucked.

dr said i had to stop imuran and the next day all pain was gone and hasnt been back.
liver function tests returned to normal quite quick.

but yeah, you cant take imuran. thats why they do the tests in the first place to see if that happens.
and it did.
Posted 11/21/2009 4:03 AM (GMT 0)

Thanks for the replies.

I met with my NP yesterday and surprisingly, she was not so alarmed that the numbers were so high.  I'm getting blood tests again next week, including another prometheus test, but for now I'm staying on the same dosage.  Her thinking is that the Imuran is working faster on me, not the 2 to 3 months that's expected, which may be affecting my liver function blood tests.  My white cells counts, etc., were much better than 2 weeks ago.  Although it turns out my GI is on vacation, she forwarded the results to him.

I'm ok with this approach, although the numbers initially set off a bit of anxiety!  But I really am feeling so well, I'd almost say remission, and I have no signs of jaundice or any other symptoms of liver problems, and I had no liver swelling.  So I'm being patient and hoping the numbers come down.

Kazygirl, have you considered the gall bladder area pains might be PSC related?  Or could you have had pancreatitis?  That's honestly one of my big fears, which I shared with the NP.       

I hear you, bebushka...  moving up to Imuran has been a bit frightening and I put off starting it waaayyyy too long.   I won't sacrifice my liver, but the complications from my UC and its drastic progression in 2 years was frightening.  It's time to stop it and for me to live again.

I wish the same for you,  Burli, and that the increase works.   

       

Posted 11/21/2009 4:46 AM (GMT 0)
High blood counts would trigger anxiety and it seems that this drug only puts people in remission for a few years and it stops working as in Burli's situation. In my case, I'd never get over the paranoia associated with UC flares even when on this drug. I've even checked out another website that people have blogged about the drug and they kinda say the same thing: remission only followed by a flare-up a couple years later. I'm just not a fan...
Posted 11/21/2009 10:56 AM (GMT 0)
yea i was checked for pancreatitis... thats what we originally thought, but all test showed negative for that.
the only thing they could think of (after 2 days, a million tests, mri, scans etc) was gallstones, that had already passed cuz they couldnt find those either.
then the pain stopped pretty much right when i stopped the imuran.
so it was definitely related.

and my liver function tests just kept getting higher and higher and higher.
so they made me stop it.

jsut as well, not too keen on being on a immunosuppresant really.
Posted 11/21/2009 10:25 PM (GMT 0)
     Last year when I was admitted to the hospital, my amylase and lipase levels were through the roof.  The doctor immediately took me off the 6MP, but placed me back on it when they returned to normal.  He did a CT scan of the pancreas, gall bladder and liver and all were fine.  My white count plummeted on the 6MP too...make sure he keeps close tabs on that.
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