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Azathioprine and prednisone question...

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Ulcerative Colitis
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Posted 6/3/2015 4:17 PM (GMT 0)
Hi all,

I am currently taking 4 Lialda/day (2 morning/2 evening), 30mg Prednisone (morning) and I recently started taking 100mg Azathioprine (50mg morning/50mg evening).

I’ve been on Prednisone for 5 months and Azathioprine for 5 weeks. The goal is to get off of Prednisone ASAP as soon as the Azathioprine starts to kick in as Lialda alone was not working for me.

Overall I feel ok, but there are some days that I feel nauseas (stomach ache, feeling crappy) and it’s not clear whether it’s due to when I am taking the medications.

I do take vitamins (multivitamin, fish oil, glucosamine) in the morning, but recently switched to take these at lunch since the pharmacist said taking the meds and vitamins at the same time could cause an upset stomach. This doesn't seem to have made much of an impact.

Some questions:

- My GI recommends that I start tapering off of Prednisone when I hit week #6 of Azathioprine if I’m not having any side effects. I have heard that Azathioprine takes ~3 months to kick in. Does this seem too early to taper? GI recommends taper 5mg/week. I really want to get off of Pred but I am concerned my symptoms will return if I taper too soon.

- Would it be better to take all 100mg Azathioprine at night vs. splitting this between morning and evening? I am wondering if this would help to decrease some of the nausea I am encountering during the day but taking it all at once might be too harsh on my system?

Thanks in advance.
Posted 6/3/2015 4:34 PM (GMT 0)
I take 6mp which is similar to Azathioprine.

If you feel ok then I beleive you should taper. It does take long time for 6mp to kick in. If you need to bridge, try to use Uceris. It is different kind of steroid and supposed to be less harmful. Also try to get blood work that checks the level of 6mp in your system. If it is low, you can increase dose too and that might help too.

For nausea, take it at night after dinner and before you go to bed. It helps. With time it should get better too.

If your CBC and LFT are fine, don't give up. Wish you long remission.
Posted 6/3/2015 6:27 PM (GMT 0)
You may experience stomach/intestinal symptoms such as nausea, vomiting, diarrhea, or loss of appetite. If these effects persist or worsen, notify your doctor immediately. These symptoms may be reduced by taking the medication after meals. Talk to your doctor or pharmacist about other dosing advice that may also help with these symptoms.

This is what I found on Azathioprine.
Posted 6/3/2015 6:43 PM (GMT 0)
Sorry to hijack your thread a little bit but I'm in the same boat just a week behind. In the middle of the night or early mornings I always have diarrhea pretty consistently but I take it RIGHT before I go to bed, usually about 1-2 hours after I eat. Would it help to take it with my food instead? MikezUC have you seen anything similar?
Posted 6/3/2015 6:49 PM (GMT 0)
Take your Azathioprine just before you fall asleep and with food to reduce the odds of nausea. It doesn't have to be a meal, a snack will do.
Posted 6/3/2015 7:10 PM (GMT 0)
I do take Azathioprine with food (along with my other meds). It says that right on my prescription.

I feel the best in the morning when I wake up, but after I take Lialda/Pred/Aza (~5am), I have a stomach ache about 5 hours later in the late morning. It's not unbearable and doesn't happen every day, but when it happens, I feel blah...

The worst I feel is a stomach ache, but no D. The Pred makes me feel very anxious so I know that's not helping things either so that might be part of the problem.

I will try taking this in the evening. My concern was whether taking it all at once might be too harsh, but I can space it out between dinner and bedtime.
Posted 6/3/2015 8:19 PM (GMT 0)
Definitely split your aza if you're feelin nauseated or headachy. Half in the morning half at night. Your GI can also give you an anti nausea medication. The nausea does go away in my experience, but tell you GI if it gets worse. I was on a slow taper from 6 weeks on aza. Worked well. Hang in there.
Posted 6/3/2015 9:53 PM (GMT 0)
I am also on both of these drugs at the moment, although on slightly higher doses. You do not need to split your aza. Take it all at night, before bed, and that's that. 100mg all at once is not a "shock" on your system, many take double that. Give the aza some more time to settle with your system and the nausea should decrease hopefully. I had the same problems when I first started on it 5 years ago.
Posted 6/3/2015 10:10 PM (GMT 0)
Maybe the combo of both the Aza and Pred are causing a bit if stomach acid type discomfort or general discomfort. Perhaps try as iPoop suggests and try taking the Aza at night separate with some food and see if that helps or makes a difference.

I'm sorry I cannot recall if Pred and Aza bothered me when taken together. Thinking back I don't think I took them at the same time anyway. I always take my Imuran around dinner time or mid evening.
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