6MP vs. Imuran

[Maya142]

M has been on Imuran for 7 months now and her levels were checked a couple months ago. They are quite low and her GI and rheumatologist recently decided that increasing her dose from 75mg to 100mg might help with both joint and abdominal pain.

She started 100mg last weekend and within two days she was so nauseous she was up all night. We went back to 75mg for a few days and then tried 100mg again but this time splitting the dose (50mg in the morning and 50mg in the evening). It's been two days and she's up and nauseous and miserable tonight:voodoo:.

I was wondering if switching to 6MP might help with side effects. Is that possible?
Help!

 

[DustyKat]

Although it seems doubtful that a switch would make a difference, due to the close relationship they have, it is possible to switch between them and not suffer the same level side effects.

Dusty. xxx

 

[CrohnsKidMom]

Yes, I think it's possible, although maybe not likely. My son reacted badly to Imuran and the GI said it was possible he could tolerate 6mp. We went straight to MTX though, because he was trying to wean off prednisone and we felt it unlikely 6mp would work because he reacted so badly to the imuran. And MTX kicks in quicker.

 

[Maya142]

M has been on MTX three separate times (and on 3 different doses) and each time has had bad side effects (extreme nausea and dizziness to the point where she was in bed for 2 days a week). I don't think there's any point in trying it again. It worked very well for her but it made her so sick that after a few months on it, she would just refuse to take it.

Is it possible that the side effects of Imuran might go away after she get used to the dose increase? She's only been on it a few days so I'm tempted to ask her to stick with it to see if it gets better.

 

[crohnsinct]

Oh Man Maya! I feel so bad for her. Nausea is the worst! It seems she is sensitive. I am the same. If nausea is a side effect you can pretty much guarantee I will get it.

I know with mtx, the side effects for both my girls subsided after a while so maybe you are on to something.

I did acupuncture for my extreme nausea during pregnancy (7 months of it) and it really helped. Maybe you can try that? Or Zofran or the like?

 

[Maya142]

M is VERY sensitive! She also reacted badly to a different drug of the same class that is used for juvenile arthritis (Arava) though it worked very well for her joints. Weirdly, she's never had any side effects with biologics thankfully. Her rheumatologist said if she didn't absolutely have to be on an immunomodulator, she would take her off them immediately!

I'll ask her about acupuncture, but ever since Humira she's been quite wary of needles. She can't take Zofran because it interacts with one of her other meds. I guess we'll just try to hang in there...

 

[Jmrogers4]

Nausea went away for us after a short time, Jack ended up taking right before bed so he would sleep through it and by the time we ended up switching to morning dosage (can't remember why) a few months later no more nausea. Hope it goes away for her quickly.

 

[crohnsinct]

Poor pumpkin!

Tell her to close her eyes at acupuncture and she won't even feel the needles. They are so ridiculously tiny she won't feel them. At first when I did it, it only gave me relief when I was on the table but then the more I did it the longer the relief lasted until I found one day wasn't nauseous and only had to go the day after I took my med. Same with pregnancy. Had to go all the time at first but eventually only once a month.

Have you tried all the natural things like sour lemon drops, ginger, acupressure bands (where them around your wrist). I got a bunch of those solutions from my friend who was undergoing chemo for cancer. Sometimes they work, sometimes they don't. Or they work and then stop. Maybe google it and something will come up.

 

[DustyKat]

Is it possible that the side effects of Imuran might go away after she get used to the dose increase? She's only been on it a few days so I'm tempted to ask her to stick with it to see if it gets better.

I personally believe an escalation in dose has the potential to introduce or re-introduce side effects. Many people that suffer with nausea finds it lasts about 2 weeks. If it is possible to stick it out I would likely go that way but if it continues to keep her up at night I don’t know that is viable to do so. :ghug:

Dusty. xxx

 

[Maya142]

We've tried ginger and lemon drops but no accupressure bands. I bet she would prefer those to accupuncture!

M says she wants to stay with 100mg Imuran for a while to see if this goes away. It did when we went from 50mg to 75mg, so hopefully it will. We see her GI next week, so I'll ask about 6MP and whether that might work.

We're really really hoping a higher dose of Imuran will give Remicade a "boost" because otherwise she will have to try Cimzia or Simponi.

 

[crohnsinct]

Aw! What a trooper! I hope this all goes away soon for her and that it helps the Remicade!

 

[Tesscorm]

Is there no way to gradually increase the dose in smaller increments, rather than jumping from 75 to 100?

 

[Maya142]

That's a good idea, I hadn't even thought of that Tess! We have 50mg pills so I suppose we could try cutting them into quarters. They crumble quite easily but it's definitely worth trying.

 

[Mehita]

Ask about different manufacturers too. When I had to split Azathioprine the first set was very crumbly (and annoying), but then we got the next months from a different pharmacy that used a different manufacturer and those were much easier to work with.

 

[Maya142]

So between M's joints, the switch to Simponi and the new diagnosis of gastroparesis, we never got to raising M's Imuran dose until two weeks ago. She did one week of 87.5mg (Thank you Tesscorm for the idea!) and now this last week has been at 100mg with no side effects.

Today she's been very nauseous all day - not just after meals like she usually is with her gastroparesis. I was wondering if it could be related to the dose increase of Imuran if she's already taken the 100mg dose for a week without any problems?
Any thoughts?

 

[my little penguin]

Can she do 50 in the morning and 50 at night?
That might help ???
I know 6-mp takes a week to drastically drop
So it makes sense if she was already on it
Bumping it up would take a week as well...