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Therapeutic level?

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Ulcerative Colitis
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Posted 9/1/2014 10:10 AM (GMT 0)
I have been on Azathioprine (Imuran) for approx. 2.5 months now. However my dose was increased about 1.5 weeks ago to 125mg as my doc told me I was not at the 'therapeutic level' for the drug, based on my blood test. He seems to think that is why I am not completely symptom free yet.

Well I am still having mild uc flare symptoms. I am only having 2 BM a day (normal for me), no blood or mucus really (the od time may have mucus). However stools are very soft and semi-formed and still get some mild cramping pain on the left side ( I have left sided colitis). However recent calprotectin test showed inflammation in gut was still high at >1800.

I have noticed the past two days that the pain has subsided slightly but still niggling a little. However my stool is still too soft and not as formed as it should be.

My question is, is everyone's therapeutic level different? I know the drug dose is calculated upon your weight but is that the case with the therapeutic level too. Does anyone have any experience of being in the same position with Imuran or 6MP? Did anyone have their dosage increased because they were not at therapeutic level and if so, did it help you eventually with your symptoms?
Posted 9/1/2014 10:48 AM (GMT 0)
I had the opposite happen to me - I was on 100mg of Imuran but after about six months had it decreased to 75mg because I was above the therapeutic level, and only 80% of the medicine was being metabolised.

So yes, everyone's levels are different depending on what their bodies can process, and it's not necessarily a weight thing. That was my understanding anyway. I hope the increase will help with your symptoms, I'm sure it'll do you some good.
Posted 9/2/2014 10:19 AM (GMT 0)
Has the Imuran worked for you Malaika? I can see from your signature you state that mothing has worked yet? That is a shame. I am still hoping that this drug will work.
Posted 9/2/2014 10:47 AM (GMT 0)

Happychick said...
Has the Imuran worked for you Malaika? I can see from your signature you state that mothing has worked yet? That is a shame. I am still hoping that this drug will work.

Thanks, no unfortunately I haven't been in remission yet. The Imuran did help a little bit in the beginning though, and it works for a lot of people, so have faith!
Posted 9/2/2014 4:57 PM (GMT 0)
Probably has to do with the varying bioavailability of the drug. Some people absorb 30% of what is ingested while others absorb 90%. That is likely why you needed to have your dosage tweeked.
Posted 9/3/2014 5:00 AM (GMT 0)
Therapeutic levels are usually a range, not a specific number. Like others have said, different people metabolize things differently so some may respond well at the very base level of what's considered therapeutic while others may need to go towards the higher end.

I've also been told by a dr at cedars whose main focus of research was in the imuran/azathiaprine area that studies seem to show that splitting up the dose can be beneficial as far as the metabolization of the medicine is concerned. I would usually take 75 mg in the morning and 75 mg at night. While it never actually helped me keep remission, splitting up the doses definitely helped me with the dizziness and nausea that could sometimes happen with the higher doses.
Posted 9/3/2014 5:01 AM (GMT 0)
Also wanted to add that azathiaprine can take up to three months to reach therapeutic levels and really start working.
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