6MP - Mercaptopurine -Puri-Nethol

[soupdragon69]

Hi Folks,

As many of you know I had to stop Azathioprine aka Imuran before Xmas 07 because my it impacted on my liver.

I started 6MP in January and got to my target dose tues of last week. Had to contact gastro yesterday and they have told me to stop the 6MP now because it also is impacting on my liver. :voodoo:

With both drugs have been very very tired and just ached deeply in all muscles and joints with stiffness coming more to the fore as the weeks went by. Seems like this drug group is just not for me eh?

Have my next remicade 11th March roll on that day!

Hope everyone is doing ok.

 

[Shoeless]

Good to hear your doing better. It can mess with your liver. I hear good things about remmicade. and how it works

 

[drew_wymore]

That sucks to hear it was hurting you =( I echo Shoeless, I've heard nothing but good things about Remicade.

 

[DarrylP_Ajax]

I dont mean to hijack this thread, but i am currently on 250mg/day of Imuran and it seems to have stopped working, did the doctor tell you what the advantages of taking 6MP over Imuran was supposed to be? I know Imuran is a prodrug of 6MP but i am wondering how 6MP would work any differently if Imuran didnt work for you if they are the same drug???

 

[soupdragon69]

Hi Darryl,
Azathioprine (Imuran) is converted to 6MP by the body. The team I am under thought if I just took the 6MP the fact my body didnt have to convert it may mean my liver function tests stayed normal once they had settled down after the Aza.
I told them I wasnt convinced but agreed to give it a go as my gastro cons felt I still needed something else on top of the remicade/infliximab with my crohns not settling down as much as he thinks is possible.
The team also told me that in the U.S (I know you are in Canada) they tend to go straight for 6MP whereas here in the UK they opt for the Imuran first. They dont have a reason for this - its just general preference and also means they find one drug works for one patient and the other better for others but like me neither work for some of us too!

These are all the reasons the gastro team did what they did with me.

Hope this helps. And no you havent hijacked the thread you are more than welcome!



Hope this helps.

 

[Kev]

well, after my issues with Imuran/Azathioprine, my GI wouldn't recommend 6MP... even as a limited trial/option. And, tho neighbours, the health care system in Canada is probably closer to the UK counterpart than the US one.
you have the NHS (right?).. whereas we have a number of independant provincial services.. (really odd... federal govt' says we have to offer free health coverage, but each provincial jurisdiction set's their own rules/regs)
A real bureaucratic mess if one moves from one province to another, even for just a visit..

so, can I ask a really 'tawdry' question? does the Health Service pay for your remicade, or do you have private coverage for it thru your work?

 

[DarrylP_Ajax]

Hi Darryl,
Azathioprine (Imuran) is converted to 6MP by the body. The team I am under thought if I just took the 6MP the fact my body didnt have to convert it may mean my liver function tests stayed normal once they had settled down after the Aza.
I told them I wasnt convinced but agreed to give it a go as my gastro cons felt I still needed something else on top of the remicade/infliximab with my crohns not settling down as much as he thinks is possible.
The team also told me that in the U.S (I know you are in Canada) they tend to go straight for 6MP whereas here in the UK they opt for the Imuran first. They dont have a reason for this - its just general preference and also means they find one drug works for one patient and the other better for others but like me neither work for some of us too!

These are all the reasons the gastro team did what they did with me.

Hope this helps. And no you havent hijacked the thread you are more than welcome!



Hope this helps.

Interesting, i have the opposite problem to you, i am on the max dose of Imuran and i get nothing from it lately, no side effects nor any results. I was talking to some people before and they had mentioned in the states they have a Thiuprine Metabolite test from a company premetheous Inc that showed how your body was metabolizing Imuran. Convienently Canada is always 3 years behind the states in everything and that test is not available here. I think in my situation i am not metabolizing enough of the drug to do anything, my body is just flushing it out before it can be utilized, which is why i am leaning towards asking my GI to put me on 6MP since that metabolizing step is elinated, right now i am on 250mg/day and am getting no negative reactions to being on the Maximum recommended theraputic dose for CD. If my RBC and Hemoglobin is normal, and my WBC is still above normal (high) obviosuly there is no toxicity occuring whatsoever, so i feel i need to be on a higher dose of imuran or switch to 6mp which elimates my body from having to metabolize stuff to get it to work.

 

[Brando]

might want to ask about methotrexate as an alternative. get it through IM injection because the pill form gets absorbed in the terminal ileum where most people with Crohn's have their inflammation problems and it doesnt absorb well in pill form. it's a once a week injection.

 

[katiesue1506]

Well I know it sounds like defeat when you exhaust another drug therapy... but Imuran sucks anyways Now you don't have to lose your hair or be tired all the time. And your liver is happy

-- Just looking for the brightside

 

[Digits]

When i was first on 6mp (which half the docs i see have no clue what the heck it is) my GI did it in conjuction with Prograf, he said they kinda "cancel" each other out for the harshness it does in your body.

my 6mp was just raised, and now i get a poke once a week for 6mp metabolites.

maybe you should ask about Prograf.

 

[soupdragon69]

Kev, Yes we have the NHS and I am very very fortunate it pays for my remicade! They have me on 6wkly infusions down from 8wkly and werent sure how long they could keep me at 6wkly due to the cost for the hospital in general. The initial plan is for 3 sessions of it the last of which is 11th March but am really hoping they continue at 6wkly for a while at least.

Darryl, Neither the aza or the 6MP made any changes to my white cell count and my gastro cons wanted it down to 2-3 whereas normal here is 4-11. I dipped below 4 twice on seperate occasions and only for a few days. Yet both still affected my liver! Keep good watch is all I think..

Brando, The gastro nurses mentioned metho before to me and am waiting to hear what the team think now about it and whether they need to add it in.

Hi KatieSue, I agree it does suck! However, I cant take any of the 5-Asa's either now like pentasa as they trigger my asthma really nicely lol So its more than one drug being kicked out for me. I am going down the foods route big time though as you will have maybe seen from my other posts as am dealing with more than just Crohn's - oh joy. Time will tell eh? Thanks for your kind thoughts though I do appreciate it!

Hi Digits, have never heard of Prograf. Will look into it... Welcome by the way, its good to see you posting!

 

[DarrylP_Ajax]

Darryl, Neither the aza or the 6MP made any changes to my white cell count and my gastro cons wanted it down to 2-3 whereas normal here is 4-11. I dipped below 4 twice on seperate occasions and only for a few days. Yet both still affected my liver! Keep good watch is all I think..

Ya, that range is almost the same in Canada, ours is 4.5-11, seems that a lot of things are common between UK and Canada. I am on the opposite scale, while i was in remission my WBC hovered around 9-9.5, while i was on Pred to get my current flare under control my WBC spiked to 17, now its holding steady at 13 and wont budge, i have my CD under control, but my WBC is still high so i am reluctant to taper to fast off the Pred as i dont want it going out of control. I was maybe hoping that with 6MP more of the drug would get into my body and do a better job controlling the WBC, seems that once i get it down to around 10-11 or lower i feel awesome....8.0 is the lowest i have ever had it on 250mg/day of Imuran.....btw do you have that Thiuprine Metabolite test to see how well you are absorbing Imuran? Did they ever give that to you?

 

[Kev]

Well, I'd suggest anyone considering metho as a next step look at all of the risk factors, then the typical success rates... then examine any other options and do a little comparison. If my LDN doesn't work for me, metho is likely the next step... (barring a freebie give-away by either the Remicade or Humira suppliers)

 

[soupdragon69]

Hi Darryl,

My gastro team have always told me that pred increases your white cell count anyway - cant remember why... Knowing how much it affects me when I come off it (usually for my unstable asthma) they tell me if you have been on it longer than a couple of weeks you need to wean down as it can impact on your adrenals. They basically go to sleep and need to register the drop in steroid to begin making cortisol again if you have been on a higer dose. So keep in mind your white cells will drop a bit still once off the pred would be my thought based on the above.

If the test mentioned is the TMPT test that my derms asked me had gastro done to check about imuran and 6MP which sounds like it is then the answer is no. She was surprised. My GP had never heard of the test. But gastro told me they dont use it where I am. To me it would have made sense surely so I wouldnt have gone through all I did? Maybe its not financially viable in relation to the number of folk that it shows up as no point in taking it? Just thinking out loud here..

Hi Kev, sometimes we are really caught between the devil and the blue sea eh? Hope the LDN really does the trick for you!!