6MP Labs- need advice please :)

[AverysMom]

Hey guys just having some abnormal labwork that I wanted someone with some background knowledge to review. My daughter was started on 6MP back in March. First labs showed she was sub therapeutic so we increased her dose to 75mg. She is 48kg, btw.

Labs from 4/15: 6-TGN 97, 6-MMPN 5691, ALT 39, AST 24 (50mg)

Labs from 6/26: 5-TGN 227, 6-MMPN 16,961, ALT 57, AST 35 (75mg)

We are in our last couple of weeks of Prednisone taper; we attempted to wean off a month ago but she started having symptoms so we had to extend the regimen. Obviously my concern is that she is barely therapeutic and her liver enzymes are through the roof and we aren't in solid remission. Given the knowledge here, what would you guys think in our situation? Thanks in advance for the advice and insight!

Mandi

 

[my little penguin]

We had a similar situation for DS.
Gi lowered 6-mp dose and then added allopurinol for a while to try and get things under control .
Hope your Gi has answers and a good plan

 

[DustyKat]

Hi Mandi,

My two are on Imuran but have not had the issues you are facing. As mlp has said, it is not uncommon to add Allopurinol as it interferes with the metabolism and therefore the breakdown and excretion of the thiopurines. This then results in a dose reduction of Imuran/6mp of approximately 50% and therefore, hopefully, a decrease in pressure on the liver.

Good luck!

Dusty. xxx