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I might try Imuran instead of Remicade- need advice asap

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Ulcerative Colitis
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Posted 7/8/2016 1:46 PM (GMT 0)
I am scheduled 7/13/16 for my 1st Remicade infusion. I am on Asacol & Prednisone 20 mg taper & VSL #3 DS. I have had UC for 7 yrs (I'm 26 yrs old).I need to go to the next med level.I am having second thoughts. I might try Imuran. I really don't know what to do- I am hoping to have a baby in next couple years & thought Imuran was not an option for pregnancy. I'm scared of side effects- fatigue & nausea. I am a very busy teacher & can't deal with the possibility of side effects- that is why I was leaning towards Remicade. Help !! I'm so confused- should I try Imuran before Remicade??
Posted 7/8/2016 2:03 PM (GMT 0)
Neither medication is known for it's side effects. I never experienced any side effects on 6mp or on remicade.

How bad are your symptoms right now?

I ask because Imuran is a very slow working medication. If things aren't bad, then it's worth consideration. However, if you're flaring badly and miserable then I'd likely go the biologic route. Imuran would take a minimum of 2-3 months to show an improvement within your symptoms and during that interim you'd likely stay on prednisone. Although realistically, they start you at a low dose and up the Imuran after a few months. So, it might be 4 months total to really know for certain. Imuran can be used while in pregnancy but it it's one of the more risky uc medications. There's been moms with now happy and healthy babies who took Imuran during there pregnancies but comparatively risk is higher.

Biologics often show improvements within the loading doses (6 weeks or less), much quicker in comparison. You'd get off of prednisone quicker. Biologics are also considered safer for pregnancy than Imuran is.

Can Imuran sustain your symptoms in place of biologics? Possibly, but expect a much longer wait and dance with pred. Know also that Imuran requires routine blood monitoring. Biologics do not.
Posted 7/8/2016 2:22 PM (GMT 0)
Thanks iPoop- I always value your advice.Well, right now I'm doing well while on Prednisone. I had a bad flare that started abruptly the week of 5/9/16 & had a sigmoid 5/19/16 which my Dr said was "cruddy" & highest inflammation markers I have ever had :0( I was on Uceris with a bit of improvement & max dose of Asacol & VSL#3DS, but not good enough for my Dr. - bm's were less (still had am urgency & stools were like thick mud). He put me on Prednisone 30 mg taper &I am scheduled 7/13/16 for my 1st Remicade infusion. My GI wanted me to decide my next med (with his guidance). He's ok with me on Remicade only- no Imuran (my request). Hopefully I won't regret that decision.
Posted 7/8/2016 2:44 PM (GMT 0)
Remicade with low dose Imuran is the emerging standard of care.
Posted 7/8/2016 2:45 PM (GMT 0)
With scope results that bad, a biologic might be the better choice. Prednisone masks a lot. You might have cold feet, but the infusion process itself is pretty boring and uneventful. Other than a quick needle prick (when they set the IV), there's no sensation or discomfort at all. Plan on being there 2-3 hours, so bring entertainment (a book, iPad or whatever).

Some get antibodies despite following all of the rules. Who knows if you'll get them. Certainly there's increased risk without imuran.
Posted 7/8/2016 6:50 PM (GMT 0)
I think remicade and imuran is your best bet. Imuran can be used safely in pregnancy.
Posted 7/9/2016 5:58 PM (GMT 0)
I agree with the rest of posters. Remicade and Imuran are a good combo. It's been the best for me so far. I have had very few side effects...just a loss of appetite for a few weeks with Imuran at my highest dose. And I get sleepy after remicade but nothing that interferes with my life.

You can always back off Imuran when you are ready to get pregnant.
Posted 7/9/2016 7:21 PM (GMT 0)
I've been on Imuran since 2006 and I haven't had any notice side effects.
Posted 7/9/2016 7:53 PM (GMT 0)
I'd try the imuran first without the Remicade. Imuran changed my life, got me into remission after being on prednisone for 3/12 years. it's not perfect, no drug is, but if you're vigilant with blood work, especially at the beginning, it can be a great tool with little or no side effects. Remade on the other hand has not been that effective, it's an infusion and as I understand it -you can't go off it once you've started on it.
Posted 7/11/2016 11:18 AM (GMT 0)
I second beatUC's opinion. I had pancolitis back in 2013 when I was on Uceris and started my Imuran. I worked my way up to 150 mg within 3 months and I was able to get off the steroids and stay in remission.

I would also maybe consider to do the 23andme test and have your results evaluated by promethease. I found out that I would have been a higher risk for cancer on Remicade but my system tolerates Azathioprine very well. FYI I have been on Remicade before and did a "back step". Doing fine :-)

Nausea can be treated with ginger or other medications. Ginger is my best friend. The nausea will lessen over time.
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