GI wants me to lower imuran

My Prometheus test didn't come back well. I am on 150 mg and he wants me to lower on 100 mg and that was a dose in the past I flared on. I am NOT happy.

I asked if I can go on 125 mg but apparently there are no 25 mg pills.

I'm waiting for his call back. I had asked him if I can do that. I just had in mind it was harmful to break or cut them. If that's an option I'll surely do it.

Are you in remmission? Are your CBC and LFT good? I am asking because my prometheus test shows high level of TGN and MNGA level but I am not completely in clinical remmision and my CBC and LFT are fine so my GI is not reducing my dose. I take 75mg of 6mp.

May be imuran works little than 6mp so you may not be able to break but your GI should be able to tell you.

I have been taking Imuran since 2010, with a brief period of being off of it, now I am currently back on it and I have never heard of this Prometheus test. Nor have I ever heard my GI bring it up. Should I be asking about this test or is this something that is contained in the monthly blood work I get done?

I only ask this because I was on 150mg/day and now he wants me to be on just 100mg/day.

Yes you should be able to split your imuran in half by just snapping it with your fingers, it should be slightly scored in the middle. Aza the same.

That's great. I hope the 125mg/day is your magic number, good luck.

What did the test show? Toxicity? I used allopurinol for a while to combat toxicity. I would think you are either over the therapeutic range or you have toxicity for the gi to want to lower the dose. I have done half pills of 6mp and it worked well.

My insurance covered the tests.

@Cavalier9, If you are in remmision then you don't need this test. Normally if GI thinks you r not in remmision because of not enough medicine, then they ask for PROMETHEUS® Thiopurine Metabolites test. If those levels are low they may increase the dose.

If you are in remmision and if your regular CBC and LFT tests are fine than they may not order test.

In my case I am not 100% in clinical remmision so he thought if he can increase the dose and he ordered one but mine came back high so he is not increasing it but he is not reducing either. but he is watching my CBC and LFT more closely. Basically that blood test suggest that you might get toxicity but if there CBC and LFT don't show toxicity then you are fine. Here is the details about that test.Basically it checks TGN levels for blood toxicity and MMPN for liver toxicity.

PROMETHEUS® Thiopurine Metabolites testing assists physicians in optimizing ongoing dosing of thiopurine immunosuppressant therapy to reach and maintain therapeutic goal. Thiopurine metabolite testing also helps to identify drug metabolite levels that may lead to toxicity and some of the reasons for treatment failure.
• A quantitative evaluation of 6-TGN (thioguanine nucleotide) and 6-MMPN (methyl mercaptopurine nucleotide)
• PROMETHEUS Thiopurine Metabolites is only offered at Prometheus.
• Patent protected.
• Specimen Requirements - Whole blood, 5.0 mL; EDTA / Lavender Top Tube.
• Shipping and Handling - Refrigerate; Ship with cold pack (DO NOT FREEZE).
• Storage Conditions/Stability - 8 days refrigerated; 24 hours ambient.
• Turn Around Time - 3 business days from date of receipt.
• Therapeutic Range - 6-TGN: 235-400 pmole/8X108 RBC; 6-MMPN: <5,700 pmole/8X108 RBC.